title: Evaluating medical student engagement during virtual patient simulations: a sequential, mixed methods study.
abstract: BACKGROUND
  Student engagement is an important domain for medical education, however, it is difficult to quantify. The goal of this study was to investigate the utility of virtual patient simulations (VPS) for increasing medical student engagement. Our aims were specifically to investigate how and to what extent the VPS foster student engagement. This study took place at A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA), in the USA.
  
  
  METHODS
  First year medical students (n = 108) worked in teams to complete a series of four in-class virtual patient case studies. Student engagement was measured, defined as flow, interest, and relevance. These dimensions were measured using four data collection instruments: researcher observations, classroom photographs, tutor feedback, and an electronic exit survey. Qualitative data were analyzed using a grounded theory approach.
  
  
  RESULTS
  Triangulation of findings between the four data sources indicate that VPS foster engagement in three facets: 1) Flow. In general, students enjoyed the activities, and were absorbed in the task at hand. 2) Interest. Students demonstrated interest in the activities, as evidenced by enjoyment, active discussion, and humor. Students remarked upon elements that caused cognitive dissonance: excessive text and classroom noise generated by multi-media and peer conversations. 3) Relevance. VPS were relevant, in terms of situational clinical practice, exam preparation, and obtaining concrete feedback on clinical decisions.
  
  
  CONCLUSIONS
  Researchers successfully introduced a new learning platform into the medical school curriculum. The data collected during this study were also used to improve new learning modules and techniques associated with implementing them in the classroom. Results of this study assert that virtual patient simulations foster engagement in terms of flow, relevance, and interest.
authors.affiliation: A.T. Still University, School of Osteopathic Medicine in Arizona, 5850 E. Still Circle, Mesa, AZ, 85206, USA. lmccoy@atsu.edu.
authors.forename: Lise
authors.initials: L
authors.lastname: McCoy
authors.affiliation: A.T. Still University, School of Osteopathic Medicine in Arizona, 5850 E. Still Circle, Mesa, AZ, 85206, USA.
authors.forename: Robin K
authors.initials: RK
authors.lastname: Pettit
authors.affiliation: A.T. Still University, School of Osteopathic Medicine in Arizona, 5850 E. Still Circle, Mesa, AZ, 85206, USA.
authors.forename: Joy H
authors.initials: JH
authors.lastname: Lewis
authors.affiliation: A.T. Still University, School of Osteopathic Medicine in Arizona, 5850 E. Still Circle, Mesa, AZ, 85206, USA.
authors.forename: J Aaron
authors.initials: JA
authors.lastname: Allgood
authors.affiliation: A.T. Still University, Arizona School of Health Sciences, 5850 East Still Circle, Mesa, 85206, Arizona, USA.
authors.forename: Curt
authors.initials: C
authors.lastname: Bay
authors.affiliation: A.T. Still University, School of Osteopathic Medicine in Arizona, 5850 E. Still Circle, Mesa, AZ, 85206, USA.
authors.forename: Frederic N
authors.initials: FN
authors.lastname: Schwartz
mesh_terms: D001130:Arizona; D002983:Clinical Competence; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008297:Male; D010021:Osteopathic Medicine / Q000193:education*; D016544:Patient Simulation; D014584:User-Computer Interface; D055815:Young Adult