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The Evolving Role of Online Virtual Patients in Internal Medicine Clerkship Education Nationally

Lang, Valerie J. MD; Kogan, Jennifer MD; Berman, Norm MD; Torre, Dario MD, PhD

doi: 10.1097/ACM.0b013e3182a7f28f
Research Reports

Purpose Despite the significant resources required to develop and maintain virtual patient (VP) programs, little is known about why this innovation has been adopted and how it is implemented. Understanding needs and implementation strategies is important for effective curriculum planning.

Method In 2009 and 2011, surveys were offered to 110 U.S. internal medicine clerkship directors regarding their goals for adoption of Simulated Internal Medicine Patient Learning Experience VPs. In 2011, respondents were asked how they implemented VPs in their curricula. Results were analyzed using chi-square and Fisher exact test.

Results Responses were obtained from 33 clerkship directors in 2009 and 45 in 2011. Comparing 2009 with 2011, improving students’ knowledge (29/33 [88%] versus 40/45 [91%]), differential diagnoses (27/33 [82%] versus 38/45 [86%]), and ability to identify key findings (26/33 [79%] versus 38/45 [86%]) remained somewhat or very important reasons for adopting VPs. Meeting Liaison Committee on Medical Education ED-2 (31/33 [94%] versus 33/45 [73%], P = .011) and ED-8 requirements (25/33 [76%] versus 25/45 [56%], P = .004) declined in importance. Eight of 38 (21%) replaced a learning activity with VPs, 9/38 (24%) integrated VPs into other learning activities, and 21/38 (55%) simply added VPs onto their curricula.

Conclusions This large, multi-institutional study reports national trends in VP adoption and inte gration. Meeting cognitive learning objectives remained an important reason for adopting VPs, whereas meeting regulatory requirements decreased significantly in importance. Opportunities remain for m ore systematically integrating VPs into clerkship curricula. Clarifying the changing goals may help with this process.

Dr. Lang is associate professor, Hospital Medicine Division, University of Rochester School of Medicine and Dentistry, Rochester, New York.

Dr. Kogan is associate professor, General Medicine Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Dr. Berman is professor of pediatrics, Geisel School of Medicine, Dartmouth University, Hanover, New Hampshire.

Dr. Torre is associate professor, Department of Internal Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.

Funding/Support: Not applicable.

Other disclosures: None.

Ethical approval: The Case Western Reserve University institutional review board reviewed and approved the protocol.

Previous presentations: An abstract was presented at the Alliance for Academic Internal Medicine Annual Meeting, 2012, in Phoenix, Arizona.

Correspondence should be addressed to Dr. Lang, 601 Elmwood Ave., Box MED-HMD, Rochester, NY 14642; telephone: (585) 275-4912; fax: (585) 276-2212; e-mail:

© 2013 by the Association of American Medical Colleges