Department of Medicine, RCSI University of Medicine and Health Science, Smurfit Building, ERC, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
Health Professions Education Centre, RCSI University of Medicine and Health Science, Dublin, Ireland.
BMC Med Educ. 2022 Jun 3;22(1):429. doi: 10.1186/s12909-022-03474-9.
Communication is an essential competence for medical students. Virtual patients (VP), computerized educational tools where users take the role of doctor, are increasingly used. Despite the wide range of VP utilization, evidence-based practical guidance on supporting development of communication skills for medical students remains unclear. We focused this scoping review on VP affordance for student learning especially important in the current environment of constrained patient access.
This scoping review followed Arksey & O'Malley's methodology. We tested and used a search strategy involving six databases, resulting in 5,262 citations. Two reviewers independently screened titles, full texts (n= 158) and finally performed data extraction on fifty-five included articles. To support consideration of educational affordance the authors employed a pragmatic framework (derived from activity theory) to map included studies on VP structure, curricular alignment, mediation of VP activity, and socio-cultural context.
Findings suggest that not only the VP itself, but also its contextualization and associated curricular activities influence outcomes. The VP was trialled in the highest proportion of papers as a one-off intervention (19 studies), for an average duration of 44.9 minutes (range 10-120min), mainly in senior medical students (n=23), notably the largest group of studies did not have VP activities with explicit curricular integration (47%). There was relatively little repeated practice, low levels of feedback, self-reflection, and assessment. Students viewed VPs overall, citing authenticity and ease of use as important features. Resource implications are often omitted, and costings would facilitate a more complete understanding of implications of VP use.
Students should be provided with maximal opportunity to draw out the VPs' full potential through repeated practice, without time-constraint and with curricular alignment. Feedback delivery enabling reflection and mastery is also key. The authors recommend educators to explicitly balance computerized authenticity with instructional design integrated within the curriculum.
沟通是医学生的一项重要能力。虚拟患者（VP）是一种用户扮演医生角色的计算机教育工具，越来越多地被使用。尽管 VP 的应用范围广泛，但支持医学生发展沟通技能的循证实践指导仍不清楚。我们将本范围界定综述的重点放在 VP 为学生学习提供的机会上，特别是在当前患者就诊受限的环境下，这些机会尤为重要。
本范围界定综述遵循 Arksey 和 O'Malley 的方法。我们测试并使用了包含六个数据库的搜索策略，共产生 5262 条引文。两名审查员独立筛选标题、全文（n=158），最终对 55 篇纳入文章进行了数据提取。为了支持教育机会的考虑，作者采用了一个实用框架（源自活动理论）来映射 VP 结构、课程调整、VP 活动的调解以及社会文化背景下的纳入研究。
研究结果表明，不仅 VP 本身，而且其情境化和相关课程活动都会影响结果。VP 作为一次性干预措施在最多的论文中进行了测试（19 项研究），平均持续时间为 44.9 分钟（范围为 10-120 分钟），主要在高年级医学生中（n=23），特别是最大的研究群体并没有明确课程整合的 VP 活动（47%）。重复练习的次数相对较少，反馈、自我反思和评估的水平较低。学生总体上对 VP 表示赞赏，认为真实性和易用性是重要特征。资源影响通常被忽略，而成本核算将有助于更全面地了解 VP 使用的影响。
应该为学生提供通过重复练习充分发挥 VP 潜力的最大机会，不限制时间，并与课程调整保持一致。反馈的提供应能促进反思和掌握。作者建议教育工作者明确平衡计算机化的真实性与课程内集成的教学设计。
