Accelerating Change in Medical Education

Virtual patients help create the med ed environment of the future

Medical students can expect virtual patients, those almost-real cases based in cyberspace, to play a larger role in learning and problem-solving as medical education evolves. Educators are looking at ways this technology can help address current issues in medical school education.

A low-risk education tool

“Virtual patients allow students to learn without putting real patients at risk,” said Norm Berman, MD, professor of pediatrics at the Geisel School of Medicine at Dartmouth and the lead author of a perspective piece recently published by the journal Academic Medicine. “No actual patients are harmed in the process of learning from virtual patients.”

The authors outlined the role of virtual patients in light of challenges and opportunities facing medical education, including the rapidly expanding body of medical knowledge, the ongoing issue of diagnostic and other cognitive errors, the ability to enhance education through learning preferences, and the need for better assessment.

The authors argued that virtual patients have the potential to:

  • Deepen learning. Virtual patients can be used for interactive learning activities that help students grasp expanding medical knowledge. One strategy is to assign virtual patients to students ahead of a seminar so they can practice a particular concept on their own and then attend a seminar or a problem-based learning or team-based learning session—the “flipped classroom” model. Virtual patients with embedded learning analytics can give the instructor insights into students’ preparation that would not otherwise be available.     
  • Promote clinical reasoning expertise. Virtual patients offer an opportunity to help students overcome the common difficulty of applying knowledge of foundational scientific and clinical concepts when they are solving or explaining clinical problems. Virtual patients can be integrated into earlier education and provide hands-on experience in clinical reasoning techniques, such as asking open-ended questions, supplying single-sentence summaries of patient problems, probing early for differential diagnoses and comparing diagnostic hypotheses based on real clinical data.
  • Foster mastery and lifelong learning. Virtual patients can incorporate adaptive technologies, matching the cognitive demands of virtual patients with student capabilities. In this way, virtual patients can foster student mastery of the content, rather than simply meeting short-term goals, such as getting a good grade on a test.   
  • Reduce medical errors. As training in medical school and residency becomes increasingly focused on achieving competencies, virtual patients can be used to assess students’ competency and facilitate mastery of clinical skills needed for working with real patients.   
  • Improve learning outcomes. In addition to assessing individual students, virtual patients can help educators better understand educational outcomes more broadly. Learning data could be collected from virtual patients across a broad group of students and institutions, and analysis of this data can better inform education strategies and curriculum.

Growing sophistication

The authors predicted that ever-more sophisticated virtual patients will play an increasing role in education and supplement case-based and patient-based learning.

“Current virtual patients are largely one-size-fits-all,” said Marc Triola, MD, director of the Institute for Innovations in Medical Education, an associate professor at the NYU School of Medicine and one of the authors of the perspective piece. NYU School of Medicine is one of the founding members of the AMA’s Accelerating Change in Medical Education Consortium.

“Future virtual patients will be able to incorporate data from other systems, such as the electronic health record, to tailor the content and level of complexity of the cases to the needs of each specific learner,” Dr. Triola said.

Dr. Berman agreed that virtual patients of the future will be vastly smarter. “Virtual patients with embedded learning analytics should be able to discern how much the student knows and how well the learner is able to think through a problem,” he said.

For more information on the changing nature of medical education