The Design and Evaluation of a Virtual Patient for Early Training in Disclosure of Medical Error

Competence in the management and disclosure of medical error (DME) is vital for medical graduates. Despite its importance, doctors frequently report challenges with DME in practice; key reasons for which include late and/or inadequate training. The aim of this study was to design and evaluate a virtual patient (VP) that supports early training in DME and empathic communication, using recently published recommendations by Lee et al. (2020) as a conceptual framework, and Cognitive Load Theory (CLT) to provide a theoretical lens. VP design comprised a multi-disciplinary approach and included script/scenario and technical development, resulting in a branching design consultation with integrated instructional interventions. VP evaluation in terms of system usability and learning effectiveness was performed using a mixed methods approach with two key study phases involving 27 third-year medical students, and procedures included: the Think Aloud method and post-activity interviews (with subsequent thematic analysis), as well as a quantitative post-activity Cognitive Load Questionnaire (CLQ). Qualitative findings indicated that the VP was technically sound, realistic, and useful from a learning perspective, and this was supported by CLQ results. Key design features that supported learning included: realism (which appeared to promote patient-centred communication), and the three-response option branching design (which supported novice learners). This study highlights that carefully designed VPs can be used to support early training in DME and empathic communication skills, and the CLT allows for in-depth understanding in how this can be achieved. While such a learning tool will never negate the need for in-person training, it allows for remote learning and offers novices time to practice and build cognitive schemas, so that they can make the most of limited higher fidelity training at a later stage. Further research is needed to rigorously evaluate such a VP in terms of skills acquisition and its effects on long-term learning outcomes.