From Wikipedia, the free encyclopedia

Contents 1 Virtual Patients 2 What Educational Issues do Virtual Patients Help to Address? 3 How are Virtual Patients used in Education? 4 What are the problems with using Virtual Patients in Education? 5 Virtual Patient Data Standards 6 Examples

Virtual patients are simulations or representations of individuals involved in one or more healthcare processes, typically but not necessarily, patients. The main uses for virtual patients are education, training and research. Virtual patients may take a number of different forms:

• Artificial patients: computer simulations of biochemical processes such as the effect of drugs in organisms. These are typically used in pharmacological research as an alternative to testing on animals and humans for some of the drug development process.
• Real patients: reflected in data e.g. electronic health records (EHRs). In this case the virtual patient is the reflection of the real patient in terms of data held about them. These are sometimes called e-patients.
• Physical simulators: mannequins (sometimes spelled 'manikins'), models or related artefacts.
• Simulated patients: where the patient is recreated by humans or computer-generated characters acting as such or engaging in other kinds of role-play.
• Electronic case-studies and scenarios where users work through problems, situations or similar narrative-based activities.

Clinical care is becoming faster and less invasive meaning that patients are spending less time in care. Widespread changes in employment legislation are leading to reduced working hours for doctors which in turn also reduce the capacity for bedside teaching. At the same time we need more and more doctors, nurses and allied health professionals, indeed not just more doctors but better and safer doctors too. Not only do virtual patients offer the promise of addressing the defecit in healthcare training opportunities but they help to move away from opportunistic training to more normalized patterns of student experience and study. From a more positive perspective virtual patients allow healthcare education to be conducted in valid and authentic settings, they help to contextualise medical science, skills, sociology and knowledge and they can support students' synthesis of these different aspects of their training. Unlike real patients virtual patients can be accessed on demand and they can be endlessly replayable (allowing the user to explore different options and strategies). Furthermore they can be significantly more immersive than other forms of study and they can be structured with narratives that represent real situations while challenging and engaging the user with a wide range of problems and tasks.

• The role of the learner may take many forms, such as the physician, the patient, an external observer, the tutor for other students, or some other participant in the healthcare process or the patient's journey.
• The learner may be acting independently, under the guidance of a tutor or instructor, or in a collaborative setting with other learners.
• The virtual patient may be naturalistic (capturing the perhaps less than ideal nature of real patient care) or formalized (presenting an idealised or particularly structured learning experience).

A number of different modes of virtual patient delivery have been defined:

• Predetermined scenario [directed mode]
• The learner may build up the patient or case data from observations and interactions [blank mode]
• The learner may view and appraise or review an existing patient or scenario [critique mode or rehearsal mode]
• The VP may be used as a mechanism to address particular topics [context mode]
• The learner may use a scenario or patient to explore personal/professional dimensions [reflective mode]
• Banks of patients or scenarios may collectively address broad issues of healthcare [pattern mode]

• Despite their efficacy virtual patients are still a tangent and a prosthesis to reality. They should be viewed as augmenting existing modes and methods of clinical teaching.
• The use of virtual patients can lead to over-standardised encounters if variation and user agency is low within them.
• Creating virtual patients is time consuming and difficult. For instance, authors need to develop skills in creating convincing and meaningful narratives.
• The sharing and exchange of virtual patients can be problematic for many technical, educational socio-cultural and individual reasons.

The MedBiquitous consortium established a working group in 2005 to create a free and open data standard for expressing and exchanging virtual patients between different authoring and delivery systems. This was in part to address the problem of exchanging and resuing virtual patients and in part to encourage and support easier and wider use of virtual patients in general.

MedBiquitous Virtual Patient Working Group

Electronic Cases

WebSP from Karolinska Institutet

Virtual Patients from Harvard Medical School

Virtual Patient Project from New York University

Labyrinth from the University of Edinburgh

Simulators

Limbs and Things simulators

Entelos predictive biosimulators

SimMan simulator

Harvey simulator,