Jay Robert, Sandars John, Patel Rakesh, Leonardi-Bee Jo, Ackbarally Yasmin, Bandyopadhyay Soham, Faraj Dabean, O'Hanlon Mary, Brown Jeremy, Wilson Emma
Acad Med. 2025 Feb 1;100(2):229-238. doi: 10.1097/ACM.0000000000005908. Epub 2024 Oct 31.
Virtual patients (VPs) are increasingly used in health care professions education to support clinical reasoning (CR) development. However, the extent to which feedback is given across CR components is unknown, and guidance is lacking on how VPs can optimize CR development. This systematic review sought to identify how VPs provide feedback on CR.
Seven databases (MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, Scopus, and ProQuest Dissertations) were searched in March 2023 using terms (e.g., medical education , virtual patient , case-based learning , computer simulation ) adapted from a previous systematic review. All studies describing VP use for developing CR in medical professionals and provided feedback on at least 1 CR component were retrieved. Screening, data extraction, and quality assessment were performed. Narrative synthesis was performed to describe the approaches used to measure and provide feedback on CR.
A total of 6,526 results were identified from searches, of which 72 met the criteria, but only 35 full-text articles were analyzed because the reporting of interventions in abstracts (n = 37) was insufficient. The most common CR components developed by VPs were leading diagnosis (23 [65.7%]), management or treatment plan (23 [65.7%]), and information gathering (21 [60%]). The CR components were explored by various approaches, from predefined questions to free text and concept maps.
Studies describing VP use for giving CR feedback have mainly focused on easy-to-assess CR components, whereas few studies have described VPs designed for assessing CR components, such as problem representation, hypothesis generation, and diagnostic justification. Despite feedback being essential for learning, few VPs provided information on the learner's use of self-regulated learning processes. Educators designing or selecting VPs for CR use must consider the needs of learner groups and how different CR components can be explored and should make the instructional design of VPs explicit in published work.
虚拟患者（VPs）在医疗保健专业教育中越来越多地被用于支持临床推理（CR）的发展。然而，在CR各个组成部分提供反馈的程度尚不清楚，并且缺乏关于VPs如何优化CR发展的指导。本系统评价旨在确定VPs如何提供关于CR的反馈。
2023年3月，使用从之前的系统评价中改编的术语（如医学教育、虚拟患者、基于案例的学习、计算机模拟）对七个数据库（MEDLINE、EMBASE、CINAHL、ERIC、PsycINFO、Scopus和ProQuest Dissertations）进行了检索。检索了所有描述在医学专业人员中使用VPs来发展CR并至少对1个CR组成部分提供反馈的研究。进行了筛选、数据提取和质量评估。进行了叙述性综合分析，以描述用于测量和提供关于CR反馈的方法。
通过检索共识别出6526条结果，其中72条符合标准，但仅分析了35篇全文文章，因为摘要中对干预措施的报告（n = 37）不足。VPs开发的最常见的CR组成部分是主导诊断（23个[65.7%]）、管理或治疗计划（23个[65.7%]）以及信息收集（21个[60%]）。通过各种方法探索CR组成部分，从预定义问题到自由文本和概念图。
描述使用VPs提供CR反馈的研究主要集中在易于评估的CR组成部分，而很少有研究描述为评估CR组成部分（如问题表征、假设生成和诊断依据）而设计的VPs。尽管反馈对学习至关重要，但很少有VPs提供关于学习者自我调节学习过程使用情况的信息。为CR使用设计或选择VPs的教育工作者必须考虑学习者群体的需求以及如何探索不同的CR组成部分，并应在已发表的作品中明确VPs的教学设计。
