title: Web-Based Immersive Virtual Patient Simulators: Positive Effect on Clinical Reasoning in Medical Education.
abstract: BACKGROUND
  Clinical reasoning is based on the declarative and procedural knowledge of workflows in clinical medicine. Educational approaches such as problem-based learning or mannequin simulators support learning of procedural knowledge. Immersive patient simulators (IPSs) go one step further as they allow an illusionary immersion into a synthetic world. Students can freely navigate an avatar through a three-dimensional environment, interact with the virtual surroundings, and treat virtual patients. By playful learning with IPS, medical workflows can be repetitively trained and internalized. As there are only a few university-driven IPS with a profound amount of medical knowledge available, we developed a university-based IPS framework. Our simulator is free to use and combines a high degree of immersion with in-depth medical content. By adding disease-specific content modules, the simulator framework can be expanded depending on the curricular demands. However, these new educational tools compete with the traditional teaching
  
  
  OBJECTIVE
  It was our aim to develop an educational content module that teaches clinical and therapeutic workflows in surgical oncology. Furthermore, we wanted to examine how the use of this module affects student performance.
  
  
  METHODS
  The new module was based on the declarative and procedural learning targets of the official German medical examination regulations. The module was added to our custom-made IPS named ALICE (Artificial Learning Interface for Clinical Education). ALICE was evaluated on 62 third-year students.
  
  
  RESULTS
  Students showed a high degree of motivation when using the simulator as most of them had fun using it. ALICE showed positive impact on clinical reasoning as there was a significant improvement in determining the correct therapy after using the simulator. ALICE positively impacted the rise in declarative knowledge as there was improvement in answering multiple-choice questions before and after simulator use.
  
  
  CONCLUSIONS
  ALICE has a positive effect on knowledge gain and raises students' motivation. It is a suitable tool for supporting clinical education in the blended learning context.
authors.affiliation: Department of General, Visceral, and Cancer Surgery, University of Cologne, Cologne, Germany. robert.kleinert@uk-koeln.de.
authors.forename: Robert
authors.identifier: http://orcid.org/0000-0002-5691-2493
authors.initials: R
authors.lastname: Kleinert
authors.forename: Nadine
authors.identifier: http://orcid.org/0000-0002-4246-8520
authors.initials: N
authors.lastname: Heiermann
authors.forename: Patrick Sven
authors.identifier: http://orcid.org/0000-0002-8165-4553
authors.initials: PS
authors.lastname: Plum
authors.forename: Roger
authors.identifier: http://orcid.org/0000-0003-0037-8620
authors.initials: R
authors.lastname: Wahba
authors.forename: De-Hua
authors.identifier: http://orcid.org/0000-0001-8787-6782
authors.initials: DH
authors.lastname: Chang
authors.forename: Martin
authors.identifier: http://orcid.org/0000-0003-4441-5040
authors.initials: M
authors.lastname: Maus
authors.forename: Seung-Hun
authors.identifier: http://orcid.org/0000-0002-8923-6428
authors.initials: SH
authors.lastname: Chon
authors.forename: Arnulf H
authors.identifier: http://orcid.org/0000-0002-8207-3865
authors.initials: AH
authors.lastname: Hoelscher
authors.forename: Dirk Ludger
authors.identifier: http://orcid.org/0000-0002-1107-0907
authors.initials: DL
authors.lastname: Stippel
mesh_terms: D004501:Education, Medical / Q000379:methods*; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D016544:Patient Simulation; D018794:Problem-Based Learning / Q000379:methods*
keywords: immersive; medical education; simulation; virtual patients