Letters to the Editor
To the Editor:
First, Berman and colleagues1 provide an excellent synthesis of work with virtual patients (VPs) and powerfully make the case for their broad-based use. The authors’ proposed uses of VPs in promoting deep learning, enhancing intrinsic motivation, developing clinical reasoning, and assessing competence are compelling. We are thrilled with the possibilities, but we think the potential for VPs extends even further.
Health outcomes are heavily influenced by personal and family circumstances; therefore, at Eastern Virginia Medical School we routinely place the person-in-context2 at the center of our simulated cases so that the model represents the patient as well as the immediate context of the patient’s life. With the increased focus on multiple chronic conditions, this model helps our learners think of solutions to complex human challenges. It is not a focus on technology so much as a perspective on the person-in-context in case-based learning.
This focus on the virtual family is not incompatible with leading VP typologies3 but, rather, an intentional extension of them. This focus has the potential for several unique gains: (1) case-based learning that includes more naturalistic performance cues (enhancing transfer); (2) a low-tech (i.e., low-cost) approach, allowing cases to be spread ubiquitously through the curriculum; (3) the capacity to authentically address social determinants of health; (4) the opportunity to present VPs experiencing health and illness trajectories in a longitudinal care context; (5) the ability to enhance the sense of “human presence” in our routine presentation of cases; and (6) a broader situated learning matrix.
This approach is feasible because it deemphasizes reliance on expensive technologies and instead relies on narrative, character image sets, and intentional instructional design methodologies. Social presence is created by story, including rich social context,4 case branching, progressive discovery, and creative image use. Prototypes using Articulate Storyline software provide stimulating glimpses of the future.
We thank the authors for their excellent article and are excited for the continued development of VPs in medical education.
Don G. Robison, PhD
Assistant professor, Department of Family and Community Medicine, Eastern Virginia Medical School, Norfolk, Virginia; RobisoDG@evms.edu.
Julie Bridges-Catalano, MS
Instructional designer, Medical Education, Eastern Virginia Medical School, Norfolk, Virginia.
Christine C. Matson, MD
Professor and chair, Department of Family and Community Medicine, Eastern Virginia Medical School, Norfolk, Virginia.
1. Berman NB, Durning SJ, Fischer MR, Huwendiek S, Triola MM. The role for virtual patients in the future of medical education. Acad Med. 2016;91:1217–1222.
2. Ford ME. Motivating Humans: Goals, Emotions, and Personal Agency Beliefs. 1992.Newbury Park, CA: Sage Publications.
3. Huwendiek S, De leng BA, Zary N, Fischer MR, Ruiz JG, Ellaway R. Towards a typology of virtual patients. Med Teach. 2009;31:743–748.
4. Behforouz HL, Drain PK, Rhatigan JJ. Rethinking the social history. N Engl J Med. 2014;371:1277–1279.