Learning at your own pace: virtual patients in medical education

As an important part of their education, medical students learn clinical skills by practicing on patients. Unfortunately, this was sometimes not an option amid the COVID-19 pandemic. The solution? Training with virtual patients. Even post-pandemic, they are a great learning tool for future medical professionals.

MEDICA-tradefair.com talked with Inga Hege, who introduced virtual patients in medical education at the University of Augsburg.

Dr. Hege, how does one create and treat a virtual patient and how does the treatment work?

Dr. Inga Hege: Creating virtual patients requires a multifaceted approach. As part of our iCoViP (International Collection of Virtual Patients) project, we first decide on what this collection of virtual patients should look like. We initially create a blueprint. This is essentially a large Excel table in which we enter the metadata of the virtual patients – information about the name, age, key symptoms, diagnoses, disabilities, or sexual orientation. The goal here is to ensure a realistic representation of patients with real-world medical conditions. The next step is to create the virtual patient. To do this, we collect media material, write descriptions, and enter our diagnostic findings into the system.

The students then log into the system to access the virtual patients. At this point, they can decide how they want to proceed and review the data and findings they have already collected. The entire process is interactive, which means the students are challenged to deliberate and document their findings to make a diagnosis. Needless to say, they can also make a wrong diagnosis.

You use the CASUS software for the projects. Why did you choose this system?

Hege: CASUS was the right choice for our project because the system is very user-friendly. It allows the students to review many virtual patients in a short amount of time. On average, processing takes twenty minutes. Treating multiple – virtual or real – patients is especially helpful when students aim to train clinical reasoning and decision-making. CASUS also has a special interactive tool: a kind of concept map that enables students to create visual diagrams of their clinical decision-making process and actively illustrate and document their findings.

Another advantage of the platform: CASUS is a web-based software package. This was especially helpful during the lockdowns. All the students had to do was sign in online from home to access the virtual patients.

There is more complex software available on the market, of course. The options run the gamut from simple to complex, from virtual reality to avatars. The choice always depends on what you want to accomplish by using the system.

How do medical students benefit from practicing on virtual patients?

Hege: The key advantage in my eyes is that it allows students to practice in a safe environment, especially at the beginning when they can and will make mistakes. It gives them the chance to learn from these errors. Students can take their time and even look things up if needed. The learning environment can be adapted to the student’s level of knowledge and competence – to prepare for real patient interactions since we can adjust the level of realism thanks to the virtual patients. Over time, you can increase the level of complexity and even train emergencies in the virtual setting.

How common are virtual patient simulations in Germany?

Hege: We have seen a significant increase in demand for virtual patient simulations amid the coronavirus pandemic. In some instances, the medical students no longer had any direct patient contact. This prompted many faculties to use virtual patients at an increasing rate. Having said that, this only pertained to selected subject areas – unfortunately, there is often a lack of a global concept to guide students through the entire curriculum using virtual patients and foster longitudinal experience.

Can virtual patients replace “real” patients?

Hege: No. This model serves to prepare students for contact with real patients. It works best if you combine three components: learning on virtual patients, bedside education, and patient simulation training. This gradual introduction to reality allows you to train the cognitive and critical thinking skills of the students. This prepares them to be able to fully focus on the real patient down the road because it is impossible to reflect this human aspect with virtual patients.

Do you find that students struggle less with the pressure to perform if they can practice on virtual patients?

Hege: Even in a calm learning environment with virtual patients, we notice that minor changes can increase work-related stress, or the complexity students face. For example, if you make the virtual patient slightly more hostile or aggressive, it instantly makes his/her treatment more challenging and difficult for the learner. As you can see, there are many ways to adjust the complexity.

We are working on a real-time control option at the moment. Up to now, we have defined the patient collection ahead of time, but we are exploring learning analytics in this context. Initial studies are already underway to determine whether we can use the data about the students’ management of virtual patients to optimize learning and increase the exercise complexity.

Do you think learning with virtual patients effectively prepares students for a career in medicine?

Hege: I think practicing with virtual patients is a great complement. After all, the idea is not that students should exclusively learn via virtual patients and not be exposed to real patients in their first years. In my view, it’s definitely possible to train the cognitive aspects using virtual patients and combine it with in-person real patient contact activities starting with the first semester. In case of the latter, students can focus on communication and practice respectful interactions with patients at eye level.

Do you think medical degrees will reflect these aspects in the future?

Hege: I am certain that the applications of virtual patients will continue to increase, prompting medical studies to take a more student-centered learning approach. I think students are capable of deciding on their own how many virtual patients they want to engage with to feel prepared to move on and interact with real patients.