Cook David A, Triola Marc M
Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Med Educ. 2009 Apr;43(4):303-11. doi: 10.1111/j.1365-2923.2008.03286.x.
The opposing forces of increased training expectations and reduced training resources have greatly impacted health professions education. Virtual patients (VPs), which take the form of interactive computer-based clinical scenarios, may help to reconcile this paradox.
We summarise research on VPs, highlight the spectrum of potential variation and identify an agenda for future research. We also critically consider the role of VPs in the educational armamentarium.
We propose that VPs' most unique and cost-effective function is to facilitate and assess the development of clinical reasoning. Clinical reasoning in experts involves a non-analytical process that matures through deliberate practice with multiple and varied clinical cases. Virtual patients are ideally suited to this task. Virtual patients can also be used in learner assessment, but scoring rubrics should emphasise non-analytical clinical reasoning rather than completeness of information or algorithmic approaches. Potential variations in VP design are practically limitless, yet few studies have rigorously explored design issues. More research is needed to inform instructional design and curricular integration.
Virtual patients should be designed and used to promote clinical reasoning skills. More research is needed to inform how to effectively use VPs.
培训期望增加与培训资源减少这两种相反的力量对卫生专业教育产生了巨大影响。虚拟患者（VPs）采用基于计算机的交互式临床场景形式，可能有助于调和这一矛盾。
我们总结了关于虚拟患者的研究，突出了潜在变化的范围，并确定了未来研究的议程。我们还批判性地思考了虚拟患者在教育工具中的作用。
我们认为虚拟患者最独特且最具成本效益的功能是促进和评估临床推理的发展。专家的临床推理涉及一个非分析性过程，该过程通过对多个不同临床病例的刻意练习而成熟。虚拟患者非常适合这项任务。虚拟患者也可用于学习者评估，但评分标准应强调非分析性临床推理，而不是信息的完整性或算法方法。虚拟患者设计的潜在变化实际上是无限的，但很少有研究严格探讨设计问题。需要更多研究为教学设计和课程整合提供信息。
应设计并使用虚拟患者来促进临床推理技能。需要更多研究来指导如何有效使用虚拟患者。
