Phase of the curriculum
- Into which level of medical curriculum should I implement virtual patients (VPs)?
- What is my target group?
- Should VPs be created for students in pre-clinical, clinical years or maybe for all students?
Medical education across the world may be based on very different types of curricula. Virtual patients could be part of a traditional pre-clinical and clinical course, an integrated/system-based course, problem-based learning (PBL), case-based learning (CBL), enquiry-based learning (EBL), multi or inter-professional learning course. As a teacher you need to be flexible and choose the solution that will fit best to your own curriculum and your needs.
The literature is not clear on the exact best time to introduce the VPs into curricula. The general recommendation that emerges from the literature is not to start too early with introducing VP’s into the curriculum as the baseline knowledge or interest of undergraduate medical students might be limited [Radon 2011]. The prerequisite is that students should be learning semiology subjects (when they learn about signs and symptoms).
There is a variation in recommendations for VP integration time. Some authors suggest that the integration of the VPs should start in the early stage of medical education [McCarthy 2015]. Medical students prefer to use VPs in their early years (e.g. 2nd year [Gesundheit 2009] , when they do not yet have access to patients in a clinical setting, in contrast to higher years’ students, where the interest declines. This is reversed in the last (6th) year, when they want to acquire more clinical experience before becoming an independent doctor [Dafli 2019]. On the other hand, Postma et al. showed that the accuracy and precision of the third-year students who participated in the intervention were in fact similar to the scores of the fourth- and fifth-year students. Generally, most of the VPs in medical curricula were introduced in years 3 and 4 [Kononowicz 2019]. Depending also on your teaching setting and how specific the topic you want to cover is – it might be valuable to divide your VPs collection into undergraduate and postgraduate. [Kolb 2009]
The question that may also arise is about the level of difficulty of VP’s that should be introduced to the students. Here both Huwendiek et al. and Kulasegaram et al. agree on progressive introduction of complexity in different clinical skills, clinical reasoning, or the design in relation to VPs [Huwendiek 2013, Kulasegaram 2018], such as e.g. uncommon clinical pictures to be recognized and multitude of influencing (contextual) factors to be considered by the students while solving a VP. When students have less experience and knowledge, VPs should be less complex, and the complexity should be increased along with the growth of knowledge and experience during the transition through the curriculum. Dahri et al. observed problems with finding the VPs difficulty level appropriate by 1st year students in comparison with 2nd and 3rd year students, they also did not find VPs very helpful in learning about the main signs or symptoms [Dahri 2019].
– To work on VPs students should have some baseline knowledge e.g., in semiology.
– There is variability in recommended VPs’ integration time: early years – for patients’ exposure before clinical years, lateer years – to acquire more clinical practice before becoming independent health professionals.
– Complexity of VPs (in clinical skills, clinical reasoning, design) should be increased along with the growth of students’ knowledge and experience.