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Virtual patient simulations in health professions education : systematic review and meta-analysis by the Digital Health Education Collaboration
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Kononowicz, Andrzej A., Woodham, Luke A., Edelbring, Samuel, Stathakarou, Natalia, Davies, David, Saxena, Nakul, Tudor Car, Lorainne, Carlstedt-Duke, Jan, Car, Josip and Zary, Nabil (2019) Virtual patient simulations in health professions education : systematic review and meta-analysis by the Digital Health Education Collaboration. Journal of Medical Internet Research, 21 (7). e14676. doi:10.2196/14676 ISSN 1438-8871.
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Official URL: https://doi.org/10.2196/14676
Abstract
Background: 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.
Objective: 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.
Methods: 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.
Results: 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, I2=74%, n=927) and favored virtual patients for skills (SMD=0.90, 95% CI 0.49 to 1.32, I2=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.
Conclusions: 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.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RA Public aspects of medicine | ||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| SWORD Depositor: | Library Publications Router | ||||||
| Library of Congress Subject Headings (LCSH): | Clinical medicine -- Computer-assisted instruction, Medical Informatics, Clinical medicine -- Decision making -- Data processing, Virtual reality in medicine | ||||||
| Journal or Publication Title: | Journal of Medical Internet Research | ||||||
| Publisher: | JMIR Publications Inc. | ||||||
| ISSN: | 1438-8871 | ||||||
| Official Date: | 2 July 2019 | ||||||
| Dates: |
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| Volume: | 21 | ||||||
| Number: | 7 | ||||||
| Article Number: | e14676 | ||||||
| DOI: | 10.2196/14676 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||
| Date of first compliant deposit: | 22 July 2019 | ||||||
| Date of first compliant Open Access: | 22 July 2019 |
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