The use of virtual patients to teach medical students history taking and communication skills.
BACKGROUND
At most institutions, medical students learn communication skills through the use of standardized patients (SPs), but SPs are time and resource expensive. Virtual patients (VPs) may offer several advantages over SPs, but little data exist regarding the use of VPs in teaching communication skills. Therefore, we report our initial efforts to create an interactive virtual clinical scenario of a patient with acute abdominal pain to teach medical students history-taking and communication skills.


METHODS
In the virtual scenario, a life-sized VP is projected on the wall of an examination room. Before the virtual encounter, the student reviews patient information on a handheld tablet personal computer, and they are directed to take a history and develop a differential diagnosis. The virtual system includes 2 networked personal computers (PCs), 1 data projector, 2 USB2 Web cameras to track the user's head and hand movement, a tablet PC, and a microphone. The VP is programmed with specific answers and gestures in response to questions asked by students. The VP responses to student questions were developed by reviewing videotapes of students' performances with real SPs. After obtaining informed consent, 20 students underwent voice recognition training followed by a videotaped VP encounter. Immediately after the virtual scenario, students completed a technology and SP questionnaire (Maastricht Simulated Patient Assessment).


RESULTS
All participants had prior experience with real SPs. Initially, the VP correctly recognized approximately 60% of the student's questions, and improving the script depth and variability of the VP responses enhanced most incorrect voice recognition. Student comments were favorable particularly related to feedback provided by the virtual instructor. The overall student rating of the virtual experience was 6.47 +/- 1.63 (1 = lowest, 10 = highest) for version 1.0 and 7.22 +/- 1.76 for version 2.0 (4 months later) reflecting enhanced voice recognition and other technological improvements. These overall ratings compare favorably to a 7.47 +/- 1.16 student rating for real SPs.


CONCLUSIONS
Despite current technological limitations, virtual clinical scenarios could provide students a controllable, secure, and safe learning environment with the opportunity for extensive repetitive practice with feedback without consequence to a real or SP.
Stevens
Amy
A
College of Medicine, University of Florida, Gainesville, FL, USA.
Hernandez
Jonathan
J
Johnsen
Kyle
K
Dickerson
Robert
R
Raij
Andrew
A
Harrison
Cyrus
C
DiPietro
Meredith
M
Allen
Bryan
B
Ferdig
Richard
R
Foti
Sebastian
S
Jackson
Jonathan
J
Shin
Min
M
Cendan
Juan
J
Watson
Robert
R
Duerson
Margaret
M
Lok
Benjamin
B
Cohen
Marc
M
Wagner
Peggy
P
Lind
D Scott
DS
D002983:Clinical Competence; D003142:Communication; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods*; D016544:Patient Simulation; D010817:Physician-Patient Relations; D013337:Students, Medical; D013663:Teaching / Q000379:methods; D014584:User-Computer Interface