Kononowicz Andrzej A, Woodham Luke A, Edelbring Samuel, Stathakarou Natalia, Davies David, Saxena Nakul, Tudor Car Lorainne, Carlstedt-Duke Jan, Car Josip, Zary Nabil
Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Kraków, Poland.
Institute of Medical and Biomedical Education, St George's, University of London, London, United Kingdom.
J Med Internet Res. 2019 Jul 2;21(7):e14676. doi: 10.2196/14676.
Virtual patients are interactive digital simulations of clinical scenarios for the purpose of health professions education. There is no current collated evidence on the effectiveness of this form of education.
The goal of this study was to evaluate the effectiveness of virtual patients compared with traditional education, blended with traditional education, compared with other types of digital education, and design variants of virtual patients in health professions education. The outcomes of interest were knowledge, skills, attitudes, and satisfaction.
We performed a systematic review on the effectiveness of virtual patient simulations in pre- and postregistration health professions education following Cochrane methodology. We searched 7 databases from the year 1990 up to September 2018. No language restrictions were applied. We included randomized controlled trials and cluster randomized trials. We independently selected studies, extracted data, and assessed risk of bias and then compared the information in pairs. We contacted study authors for additional information if necessary. All pooled analyses were based on random-effects models.
A total of 51 trials involving 4696 participants met our inclusion criteria. Furthermore, 25 studies compared virtual patients with traditional education, 11 studies investigated virtual patients as blended learning, 5 studies compared virtual patients with different forms of digital education, and 10 studies compared different design variants. The pooled analysis of studies comparing the effect of virtual patients to traditional education showed similar results for knowledge (standardized mean difference [SMD]=0.11, 95% CI -0.17 to 0.39, I=74%, n=927) and favored virtual patients for skills (SMD=0.90, 95% CI 0.49 to 1.32, I=88%, n=897). Studies measuring attitudes and satisfaction predominantly used surveys with item-by-item comparison. Trials comparing virtual patients with different forms of digital education and design variants were not numerous enough to give clear recommendations. Several methodological limitations in the included studies and heterogeneity contributed to a generally low quality of evidence.
Low to modest and mixed evidence suggests that when compared with traditional education, virtual patients can more effectively improve skills, and at least as effectively improve knowledge. The skills that improved were clinical reasoning, procedural skills, and a mix of procedural and team skills. We found evidence of effectiveness in both high-income and low- and middle-income countries, demonstrating the global applicability of virtual patients. Further research should explore the utility of different design variants of virtual patients.
虚拟患者是用于健康职业教育的临床场景交互式数字模拟。目前尚无关于这种教育形式有效性的综合证据。
本研究的目的是评估虚拟患者与传统教育相比、与传统教育相结合、与其他类型数字教育相比以及虚拟患者在健康职业教育中的设计变体的有效性。感兴趣的结果是知识、技能、态度和满意度。
我们按照Cochrane方法对虚拟患者模拟在注册前和注册后健康职业教育中的有效性进行了系统评价。我们检索了从1990年到2018年9月的7个数据库。未设语言限制。我们纳入了随机对照试验和整群随机试验。我们独立选择研究、提取数据并评估偏倚风险，然后成对比较信息。如有必要，我们会联系研究作者获取更多信息。所有汇总分析均基于随机效应模型。
共有51项涉及4696名参与者的试验符合我们的纳入标准。此外，25项研究将虚拟患者与传统教育进行了比较，11项研究将虚拟患者作为混合学习进行了调查，5项研究将虚拟患者与不同形式的数字教育进行了比较，10项研究比较了不同的设计变体。对比较虚拟患者与传统教育效果的研究进行的汇总分析显示，在知识方面结果相似（标准化均数差[SMD]=0.11，95%CI -0.17至0.39，I²=74%，n=927），在技能方面虚拟患者更具优势（SMD=0.90，95%CI 0.49至1.32，I²=88%，n=897）。测量态度和满意度主要使用逐项比较的调查。比较虚拟患者与不同形式数字教育和设计变体的试验数量不足，无法给出明确建议。纳入研究中的一些方法学局限性和异质性导致证据质量普遍较低。
低到中等程度且参差不齐的证据表明，与传统教育相比，虚拟患者可以更有效地提高技能，并且至少能同样有效地提高知识。提高的技能包括临床推理、操作技能以及操作和团队技能的组合。我们在高收入国家和低收入及中等收入国家都发现了有效性证据，证明了虚拟患者的全球适用性。进一步的研究应探索虚拟患者不同设计变体的效用。
Zotero 插件
