title: 3D immersive patient simulators and their impact on learning success: a thematic review.
abstract: BACKGROUND
  Immersive patient simulators (IPSs) combine the simulation of virtual patients with a three-dimensional (3D) environment and, thus, allow an illusionary immersion into a synthetic world, similar to computer games. Playful learning in a 3D environment is motivating and allows repetitive training and internalization of medical workflows (ie, procedural knowledge) without compromising real patients. The impact of this innovative educational concept on learning success requires review of feasibility and validity.
  
  
  OBJECTIVE
  It was the aim of this paper to conduct a survey of all immersive patient simulators currently available. In addition, we address the question of whether the use of these simulators has an impact on knowledge gain by summarizing the existing validation studies.
  
  
  METHODS
  A systematic literature search via PubMed was performed using predefined inclusion criteria (ie, virtual worlds, focus on education of medical students, validation testing) to identify all available simulators. Validation testing was defined as the primary end point.
  
  
  RESULTS
  There are currently 13 immersive patient simulators available. Of these, 9 are Web-based simulators and represent feasibility studies. None of these simulators are used routinely for student education. The workstation-based simulators are commercially driven and show a higher quality in terms of graphical quality and/or data content. Out of the studies, 1 showed a positive correlation between simulated content and real content (ie, content validity). There was a positive correlation between the outcome of simulator training and alternative training methods (ie, concordance validity), and a positive coherence between measured outcome and future professional attitude and performance (ie, predictive validity).
  
  
  CONCLUSIONS
  IPSs can promote learning and consolidation of procedural knowledge. The use of immersive patient simulators is still marginal, and technical and educational approaches are heterogeneous. Academic-driven IPSs could possibly enhance the content quality, improve the validity level, and make this educational concept accessible to all medical students.
authors: Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany. robert.kleinert@uk-koeln.de.
authors: Robert
authors: http://orcid.org/0000-0002-5691-2493
authors: R
authors: Kleinert
authors: Roger
authors: http://orcid.org/0000-0003-0037-8620
authors: R
authors: Wahba
authors: De-Hua
authors: http://orcid.org/0000-0001-8787-6782
authors: DH
authors: Chang
authors: Patrick
authors: http://orcid.org/0000-0002-8165-4553
authors: P
authors: Plum
authors: Arnulf H
authors: http://orcid.org/0000-0002-8207-3865
authors: AH
authors: Hölscher
authors: Dirk L
authors: http://orcid.org/0000-0002-1107-0907
authors: DL
authors: Stippel
mesh_terms: D000328:Adult; D003198:Computer Simulation; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D007858:Learning; D016544:Patient Simulation; D013337:Students, Medical; D014584:User-Computer Interface
keywords: Web-based learning; immersion; immersive patient simulators; procedural knowledge; validity