title: Virtual Patients in a Behavioral Medicine Massive Open Online Course (MOOC): A Qualitative and Quantitative Analysis of Participants' Perceptions.
abstract: OBJECTIVE
  The purpose of this article is to explore learners' perceptions of using virtual patients in a behavioral medicine Massive Open Online Course (MOOCs) and thereby describe innovative ways of disseminating knowledge in health-related areas.
  
  
  METHODS
  A 5-week MOOC on behavioral medicine was hosted on the edX platform. The authors developed two branched virtual patients consisting of video recordings of a live standardized patient, with multiple clinical decision points and narration unfolding depending on learners' choices. Students interacted with the virtual patients to treat stress and sleep problems. Answers to the exit survey and participant comments from the discussion forum were analyzed qualitatively and quantitatively.
  
  
  RESULTS
  In total, 19,236 participants enrolled in the MOOC, out of which 740 received the final certificate. The virtual patients were completed by 2317 and 1640 participants respectively. Among survey respondents (n = 442), 83.1% agreed that the virtual patient exercise was helpful. The qualitative analysis resulted in themes covering what it was like to work with the virtual patient, with subthemes on learner-centered education, emotions/eustress, game comparisons, what the participants learned, what surprised them, how confident participants felt about applying interventions in practice, suggestions for improvement, and previous experiences of virtual patients.
  
  
  CONCLUSIONS
  Students were enthusiastic about interacting with the virtual patients as a means to apply new knowledge about behavioral medicine interventions. The most common suggestion was to incorporate more interactive cases with various levels of complexity. Further research should include patient outcomes and focus on interprofessional aspects of learning with virtual patients in a MOOC.
authors.affiliation: Karolinska Institutet, Center for Psychiatry Research, Stockholm, Sweden. anne.h.berman@ki.se.
authors.forename: Anne H
authors.identifier: http://orcid.org/0000-0002-7709-0230
authors.initials: AH
authors.lastname: Berman
authors.affiliation: Karolinska Institutet, Center for Psychiatry Research, Stockholm, Sweden.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Biguet
authors.affiliation: Karolinska Institutet, Center for Psychiatry Research, Stockholm, Sweden.
authors.forename: Natalia
authors.initials: N
authors.lastname: Stathakarou
authors.affiliation: Stockholm University, Stockholm, Sweden.
authors.forename: Beata
authors.initials: B
authors.lastname: Westin-Hägglöf
authors.affiliation: The Stress Research Clinic, Stockholm, Sweden.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Jeding
authors.affiliation: Karolinska Institutet, Center for Psychiatry Research, Stockholm, Sweden.
authors.forename: Cormac
authors.initials: C
authors.lastname: McGrath
authors.affiliation: Karolinska Institutet, Center for Psychiatry Research, Stockholm, Sweden.
authors.forename: Nabil
authors.initials: N
authors.lastname: Zary
authors.affiliation: Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Andrzej A
authors.initials: AA
authors.lastname: Kononowicz
mesh_terms: D000328:Adult; D001524:Behavioral Medicine / Q000193:education*; D020375:Education, Distance / Q000379:methods*; D004501:Education, Medical / Q000379:methods*; D006801:Humans; D036301:Qualitative Research; D000066908:Simulation Training / Q000379:methods*; D013337:Students, Medical; D000076142:Virtual Reality
keywords: Behavioral medicine; Case-based learning; Evaluation; MOOC; Qualitative content analysis; Virtual patient