Department of Dental Education, School of Dentistry, Seoul National University, Seoul, South Korea.
Smart Experience Design, Graduate School of Techno Design, Kookmin University, Seoul, South Korea.
Med Educ. 2020 Sep;54(9):786-795. doi: 10.1111/medu.14152. Epub 2020 May 22.
Despite the growing use of virtual patients (VPs) in medical education, few studies have explored the features and effectiveness of VP-based medical communication skills training. We undertook a systematic review to summarise the design and evaluation of VP-based medical communication skills training systems in order to identify features of successful cases.
Following PRISMA guidelines, we searched four databases for studies published between 2006 and 2018. Using a refined classification scheme, we extracted data on instructional design (scenario and instructional intervention), technological design (modality and interaction), and evaluation (user experience, learning effectiveness and evaluator). We assessed the quality of studies using the Medical Education Research Study Quality Instrument (MERSQI) and the QualSyst standard assessment criteria.
A total of 14 studies were included for review. Of these, 85.7% (n = 12) were quantitative and 71.4% (n = 10) involved undergraduate students. The most common VP training scenario was history taking followed by the delivery of bad news. Diverse instructional interventions, including tutorials, learning activities, and feedback, were embedded in the VPs. The first-person perspective animated within-screen size VP was a popular technological feature. Most evaluations concerned the reality of simulation (for user experience) and skill in expressing empathy (as a learning outcome). Of the eight comparative studies, half reported significant attitude or skill improvements in the VP group. The distinct features of VPs shown to be effective were well-designed instructional interventions (eg, a pre-activity with a protocol-informed tutorial), and post-activity (eg, debrief or reflection), scaffolding and human feedback, but not system feedback.
Evidence-based VP training can enable students to gain communication skills in a safe and affordable learning environment. Elaborate technology alone cannot guarantee effective learning, but evidence-based instructional interventions can facilitate its optimal use and bring about better learning outcomes.
尽管虚拟患者（VP）在医学教育中的应用日益广泛，但很少有研究探讨基于 VP 的医学沟通技巧培训的特点和效果。我们进行了系统评价，以总结基于 VP 的医学沟通技巧培训系统的设计和评估，从而确定成功案例的特点。
根据 PRISMA 指南，我们在四个数据库中搜索了 2006 年至 2018 年期间发表的研究。使用精炼的分类方案，我们提取了教学设计（情景和教学干预）、技术设计（模式和交互）和评估（用户体验、学习效果和评估者）的数据。我们使用医学教育研究研究质量工具（MERSQI）和 QualSyst 标准评估标准评估研究质量。
共纳入 14 项研究进行综述。其中，85.7%（n=12）为定量研究，71.4%（n=10）涉及本科生。最常见的 VP 培训情景是病史采集，其次是传达坏消息。各种教学干预措施，包括辅导、学习活动和反馈，都嵌入在 VP 中。第一人称视角的动画 VP 是一种流行的技术特征。大多数评估都涉及模拟的真实性（用户体验）和表达同理心的技能（学习成果）。在八项比较研究中，有一半报告了 VP 组在态度或技能方面的显著改善。证明有效的 VP 独特特点是精心设计的教学干预措施（例如，有协议指导的预习活动）和课后活动（例如，讨论或反思）、支架和人工反馈，但不是系统反馈。
基于证据的 VP 培训可以使学生在安全且负担得起的学习环境中获得沟通技巧。仅仅精心设计的技术并不能保证有效的学习，但基于证据的教学干预措施可以促进其最佳使用，并带来更好的学习成果。
