Office of Education Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Acad Med. 2010 Oct;85(10):1589-602. doi: 10.1097/ACM.0b013e3181edfe13.
Educators increasingly use virtual patients (computerized clinical case simulations) in health professions training. The authors summarize the effect of virtual patients compared with no intervention and alternate instructional methods, and elucidate features of effective virtual patient design.
The authors searched MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, and Scopus through February 2009 for studies describing virtual patients for practicing and student physicians, nurses, and other health professionals. Reviewers, working in duplicate, abstracted information on instructional design and outcomes. Effect sizes were pooled using a random-effects model.
Four qualitative, 18 no-intervention controlled, 21 noncomputer instruction-comparative, and 11 computer-assisted instruction-comparative studies were found. Heterogeneity was large (I²>50%) in most analyses. Compared with no intervention, the pooled effect size (95% confidence interval; number of studies) was 0.94 (0.69 to 1.19; N=11) for knowledge outcomes, 0.80 (0.52 to 1.08; N=5) for clinical reasoning, and 0.90 (0.61 to 1.19; N=9) for other skills. Compared with noncomputer instruction, pooled effect size (positive numbers favoring virtual patients) was -0.17 (-0.57 to 0.24; N=8) for satisfaction, 0.06 (-0.14 to 0.25; N=5) for knowledge, -0.004 (-0.30 to 0.29; N=10) for reasoning, and 0.10 (-0.21 to 0.42; N=11) for other skills. Comparisons of different virtual patient designs suggest that repetition until demonstration of mastery, advance organizers, enhanced feedback, and explicitly contrasting cases can improve learning outcomes.
Virtual patients are associated with large positive effects compared with no intervention. Effects in comparison with noncomputer instruction are on average small. Further research clarifying how to effectively implement virtual patients is needed.
教育工作者越来越多地在医学专业培训中使用虚拟患者（计算机临床病例模拟）。作者总结了虚拟患者与无干预和替代教学方法相比的效果，并阐明了有效虚拟患者设计的特点。
作者通过检索 MEDLINE、EMBASE、CINAHL、ERIC、PsychINFO 和 Scopus，查找描述用于实习医生、护士和其他卫生专业人员的虚拟患者的研究，检索时间截至 2009 年 2 月。审查员以重复方式提取关于教学设计和结果的信息。使用随机效应模型汇总效应量。
共发现 4 项定性研究、18 项无干预对照研究、21 项非计算机教学对照研究和 11 项计算机辅助教学对照研究。大多数分析的异质性很大（I²>50%）。与无干预相比，知识结果的合并效应大小（95%置信区间；研究数量）为 0.94（0.69 至 1.19；N=11），临床推理为 0.80（0.52 至 1.08；N=5），其他技能为 0.90（0.61 至 1.19；N=9）。与非计算机教学相比，满意度的合并效应大小（有利于虚拟患者的正值）为-0.17（-0.57 至 0.24；N=8），知识为 0.06（-0.14 至 0.25；N=5），推理为-0.004（-0.30 至 0.29；N=10），其他技能为 0.10（-0.21 至 0.42；N=11）。不同虚拟患者设计的比较表明，重复直至达到掌握水平、先行组织者、增强反馈和明确对比案例可以提高学习效果。
与无干预相比，虚拟患者与较大的积极效果相关。与非计算机教学相比，效果平均较小。需要进一步研究以明确如何有效地实施虚拟患者。
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