Teachers’ expectations and concerns about

introducing Virtual Patients in a clinical course

Samuel Edelbring, Nabil Zary

VP-lab, CME KI Sweden
Organisation culture plays a role in
diffusion of new technology (Rogers 2003)
• A part of our culture is course directors and teachers.

• Their expectations are important to bring out in an

implementation process.
research question for this
investigation
 What possibilities do teachers see with virtual
patients and what concerns do they have about
introducing VPs in their course?
Setting of the investigation

 Course planning group with Web-SP implementation

at 4 hospitals sharing the same cases in similar
course.
 Expectations and concerns were investigated before
the actual use of VPs.
 Open ended questions in written form.
Questions in the form

 In what way do you believe that the VP-activity will

contribute to student learning in your course?
 What general expectations do you have on the VP
activity?
 Do you have any concerns regarding the use of VPs?
Result

 12 forms handed out, 8 returned (67% response rate)

containing free text expectations and concerns.
Expectations regarding contributions to
student learning
Content of the VPs as such and functionality, “opening
up” the diagnostic reasoning process and the relation
to real patient contact.
 It will provide an overview of different reasoning paths.
 Support and activate students’ own clinical reasoning.
 Give an understanding of how patient interview and
investigations work together like tools on the way to finding a
diagnosis.
 Expose students to the variety of lab tests and different
investigation methods that are available.
 This will be more process oriented than previous paper cases in
seminars.
 It will prepare students well before meeting actual patients.
General expectations
on VP course activity

How students will use the software and its role

in the course.
 I hope that students will sit at home in piece and quiet
to reflect over potential differential diagnoses.
 This will complement the actual clinical experience.
 It is better to instead use the valuable course time for
actual patient encounters.
 This is a fun variation to the traditional seminar.
 The reusability and scalability aspect is valuable.
Concerns

Worries about upcoming technical problems, creation of

cases, levels of cases and that VPs would replace
real patient contact.
 It must not replace patient-doctor encounter.
 That there will be technical problems of accessability or slow
functionality.
 That the level of difficulty will be to low/high.
 That students don’t work through the cases properly at home.
 That teachers will find case creation too time consuming and
difficult.
 That students will use the VPs at the expense of reading course
literature.
Two views of learning
reflected in the material
 Learning as acquiring new factual knowledge and
remembering: ”active students learn more/remembers easier the
important stuff”, ”there is a risk that students read to little in the
textbook and thus not really gain new knowledge”

 Learning as processing and integrating existing knowledge,

applying/trying out/training of investigation techniques: ”To
learn to gather data in order to reach a diagnosis” ”This can give an
increased understanding of how the patient interview and physical
examinations should be structured”, ”a tool for integrating students’
knowledge of the different parts of the course”
 In what learning aspect can VPs
contribute their full potential?
Results overlayed on
Miller’s Model for assessment of
clinical competence (Miller 1990)
processing and
performing

acquiring new
knowledge and
remembering
Summary

 We believe that teachers and course directors have a

key position in defining the role of VPs in health
science education.
 Expectations and concerns with teachers can brought
forward by using open ended questions in a written
form.
 Expectations on student learning with VPs vary
between acquisition of factual knowledge and higher
order clinical reasoning.
 Interesting to follow up teachers conceptions after
more experience with VPs.