Virtual Patient Simulation and the Promotion of Clinical Reasoning Abilities

Sarah Neeler, PharmD, PGY-1 Pharmacy Practice Resident at Kaiser Permanente of the Mid-Atlantic States

          In 2011, it was estimated that nearly all US accredited colleges and schools of pharmacy were utilizing technology to present material and information to students, whether that was through presentation software, videoconferencing, audio response systems, or hardware.⁶  As students of the Educational Theory and Practice course, we are using education technology though blogging, document collaboration, and web-based learning activities.  While we all may be familiar with using technology for education in these ways, new and more sophisticated technology is constantly being developed to increase education and knowledge.  Specifically in the medical field, we have seen great developments in technology to teach upcoming healthcare professionals important patient care and clinical skills.

The Association of American Medical Colleges (AAMC) divides educational technology into three categories: 1) Computer-aided instruction, 2) Human-patient simulation, and 3) Virtual patients.⁴  Computer-aided instruction incorporates interactive instruction that is delivered and directed to learners using computer technology.  This technology utilizes web-based learning and allows individuals to independently explore complex processes and learning.  Human-patient simulation utilizes mannequin and models to simulate a patient care environment.  This helps teach students specific tasks, such as a virtual labor and delivery or endoscopy.  Virtual patient simulation is a specific type of computer-based instruction that simulates actual clinical scenarios and changes in response to learner input.⁴  In today’s blog, I am going to expand upon virtual patient simulation and the impact on clinical reasoning skills and healthcare professionals’ education.

          Virtual patient simulation involves an interactive, simulated patient generated by a computer software program that is used to emulate a realistic clinical scenario.^4-7  You can think of it as a computer-based virtual reality program. Students adopt the role of the healthcare provider and are able to provide therapeutic treatment plans in a safe, controlled environment.^1,7  The computer software allows students to gather information for clinical diagnosis or treatment.  This may involve permitting students to access to the virtual patient’s medical records for them to review laboratory values, past medical history, and medications.  The software does not provide any direction or instruction to the student in regards of what to view or evaluate prior to making a clinical decision.  What is truly unique about virtual patient simulation is that the computer software will adapt and provide non-sequential, individualized responses to the therapy recommended by the students.^1,4-7  It is a safe environment that allows students to practice implementing decisions without posing risk to patients.  It is an environment where students are allowed to make mistakes and evaluate the results of their decisions.  Another benefit of virtual patient simulations is that students can practice working with unique disease states that may not be typically seen in their own practice sites.²  For example, while we have all learned about statin myopathy, we may not see very rare cases of autoimmune myopathy in patients treated with statins in our clinical practices.  Virtual patient simulations help bring both commonly seen and rare disease states together into one program for the benefit of all learners.

          Why should we utilize this technology in pharmacy education?  Virtual patient simulation enables students to adopt the role of healthcare providers and implement their own medical decisions without risk to a patient.^6,7  Students will be able to interview, assess, and propose interventions.  Additionally, students will be able to enhance their counseling skills.  Virtual patients emulate the psychological state of different types of patients and may show a wide spectrum of emotions such as becoming angry, anxious, persuasive, or tearful.⁷  Students will be able to practice real-world skills in a controlled, protected environment to allow them to learn on their own without only watching their preceptors counsel patients and make clinical decisions.  Additionally, educators will be able to assess their clinical and critical thinking skills by reviewing the decisions the students made.^6,7  Teachers will be able to target exact points of care that should have been done differently that would have resulted in a successful outcome for their patients, if needed.

According to the Accreditation Council for Pharmacy Education (ACPE), “graduating pharmacy students must have a competence in providing independent, patient-centered, evidence-based pharmaceutical care”.³  The ACPE has acknowledged virtual patient simulation as an acceptable learning experience in early pharmacy curriculum that is comparable to direct patient care and in June 2010, ACPE’s board approved a policy to allow 20%, or approximately 60 hours, of introductory pharmacy practice experience (IPPE) time to be simulations.³

          So what’s the catch?  Virtual patient simulation has a lot of positive effects on learning and has been accepted by the ACPE as an appropriate form of teaching students, however it comes with a price.  There are high financial costs associated with virtual patient simulation and there is a large time commitment to develop and maintain the technology.  As guidelines change annually and new recommendations and drugs are developed, this technology must be updated to include appropriate medication options and responses.^4,6  Additionally, if patients are interacting with a computer system, they are losing time in an environment that allows physical interaction between students and professors.

          Overall, virtual patient simulation is an up and coming educational technique that provides a fun and interesting opportunity for students to learn in a safe environment.  If facilities are willing to take on the financial and time commitments to optimize virtual patient simulations, students have a great learning opportunity to enhance their clinical reasoning skills.

References:

1.    Aghili R, et al. Virtual patient simulation: Promotion of clinical reasoning abilities of medical students. Knowledge Management & E-Learning: An International Journal. 2012;4(4):518-527

2.    Zary N, et al. Development, implementation, and pilot evaluation of a web-based virtual patient case simulation environment. BMC Medical Education. 2006;6(10):1-17 DOI: 10.1186/1472-6920-6-10

3.    Accreditation Council for Pharmacy Education. Guidance for the accreditation standards and key elements for the professional program in pharmacy leading to the doctor of pharmacy degree. ACPE 2015

4.    Effective Use of Educational Technology in Medical Education. AAMC Institute for Improving Medical Education. Website: https://members.aamc.org/eweb/upload/effective%20use%20of%20educational.pdf Published March 2007.  Accessed March 16, 2017.

5.    Koller V, et al. Technology-based learning strategies. Social Policy Research Associates. Website: http://www.doleta.gov/reports/papers/TBL_Paper_FINAL.pdf Published 2006. Accessed March 16, 2017

6.    Smith M and Benedick N. Effectiveness of educational technology to improve patient care in pharmacy curricula. American Journal of Pharmacy Education. 2015 Feb 17;79(1):15 doi: 10.5688/aipe79115

7.    Jabbur-Lopes M, et al. Virtual patients in pharmacy education. American Journal of Pharmacy Education. 2012 Jun 18;76(5):92.