Assessing the feasibility and effectiveness of implementing the “Virtual Patient” methodology

Article from the journal “Modern Problems of Science and Education” USE OF “VIRTUAL PATIENT” TECHNOLOGY IN MEDICAL EDUCATION.

Authors: Yudaeva Y.A., Nevolina V.V., Z.F. Zakirzyanova.

Recently, the requirements for the level of training of future specialists have changed in the medical field. Modern society expects a graduate to have a qualitatively new level of professionalism: a combination of a good theoretical base with a well-developed practical component. Especially important is the initial acquisition of practical skills, which form the further formation of the student as a specialist.

In the face of the pandemic, modern education, including medical education, has many problems. First of all, this is due to the introduction of the distance format of work in the educational process, which limits the opportunity for the medical student to contact real patients and practice practical skills. The peculiarity of medical education is that the formation of most professional competencies of a future graduate is closely related to the traditional forms of education, which require working at the “patient’s bedside”. These are communication skills, clinical thinking skills, and practical manipulation skills. In this regard, the professional medical community seriously criticizes the use of distance technology in medical education.

But the situation is such that the new coronavirus infection dictates its own rules, and medical education must also adapt to the new realities. The task of the university in the new conditions is to continue to effectively train medical students, to actively help them to master the necessary skills and abilities, and to introduce objective methods of controlling their formation.

One of the modern trends in pedagogy is the use of various electronic technologies. In higher medical education today this is a very relevant direction [1]. Recently, the Virtual Patient methodology has been actively introduced into the medical education space, but the methodological aspects and experience of its application are insufficiently covered in the domestic literature, and there are no clear mechanisms for integrating this simulation methodology into the educational process. The exchange of experience and the development of an educational and methodological framework for this methodology are required for quality results.

Purpose of the study
Evaluating the feasibility and effectiveness of implementing the Virtual Patient methodology in teaching clinical thinking skills, demonstrating my own experience of using the Virtual Patient program in the teaching process.

Materials and methods of research

To achieve this goal in the course of the discipline “Simulation course, emergencies in general medical practice” during the control of independent work of 6th year students of medical faculty “Virtual patient Academix3D” program was used. To assess the effectiveness of training using the “virtual patient” was analyzed its own teaching experience, conducted a survey of students (280 people) to establish the level of satisfaction.

Results of the study and discussion

At Orenburg State Medical University, the Virtual Patient technology is implemented in two versions: “Bodyinteract” and “Akademiks3D”. Both programs are used in the educational process, but the Bodyinteract program is oriented to the postgraduate level of education (residency, PDO), and the Academic3D Virtual Patient program is used in work with students. The interactive application “Virtual Patient Academics3D” allows the student to work in two modes: theory and practice. Preliminary independent work of the student in theory mode allows you to get theoretical knowledge of the classification, pathogenesis, anamnesis, clinical picture, methods of diagnosis and treatment of various diseases. The study of theoretical material is presented in the form of a quest, which makes the learning process more exciting for the student. Both modes (theory and practice) can be implemented in two forms – study and exam. In the practical sessions, the trainee uses a mode of study that allows the student or instructor to select a particular disease and study it step-by-step. In the final exam session, clinical scenarios are dropped at random without nosology, and the student is asked to demonstrate patient skills at various stages.

To familiarize students with the “Virtual Patient” technique and the features of working with the program during the classroom (or online teacher) demonstration of several clinical situations in accordance with the subject of the class. “Virtual Patient Academics3D” is an interactive computer program for simulating clinical scenarios of the therapeutic profile. This program allows you to simulate the examination of a patient as a district therapist during an initial appointment. The interface of the Academic3D Virtual Patient system is simple and intuitive and allows students to quickly learn the mode of operation.

Before you begin your independent work, the instructor sets a general goal: “You are a district therapist. Your task is to conduct primary and follow-up appointments. It outlines the main obligatory stages for realization of the goal: to interview the patient; to conduct a physical examination; to put forward three diagnostic hypotheses; to prescribe the necessary laboratory-instrumental examination; to evaluate the results of the examination; to make a complete clinical diagnosis; to prescribe treatment.

The task of the student is to make the right decision at each of the next steps within a given time frame. In distance learning, students have remote access to a computer to work with an instructor online.

Work with the patient begins with questioning. Communication with the patient is realized with the use of text chat, the received information is added to the electronic case history on the monitor screen. Virtual patients are of different genders, ages, and show different positions and movements during appointments. After collecting the complaints and anamnesis, the “doctor” proceeds to the physical examination. The program does not assess the technique of palpation, percussion and auscultation, but it does assess the student’s ability to interpret the results of an objective examination. To do this, the student points the cursor at fixed points on the patient’s body, and the monitor displays the result of the “manipulation performed”. The auscultatory data evaluation is performed according to the same scheme, but there is an opportunity to listen to an audio recording with sound when pointing to a standard point.

Based on the data obtained, the student must make three preliminary diagnoses and demonstrate skills in differential diagnosis using laboratory and instrumental methods of examination. The student is offered a standard set from which he can choose any methods, without limiting himself, and get the result. If there is any doubt about the final diagnosis, it is possible to return to any stage of work with the patient (as long as there is time left).

The assignment is successfully completed after a final diagnosis (primary and comorbid) is formulated and appropriate treatment is prescribed.

The result of each student’s work is saved on the desktop in the form of a detailed report that gives a detailed evaluation of each step and a cumulative grade. The report is available for review by the student and the instructor.

Based on the results of work with the Virtual Patient program, a questionnaire was administered to students to assess their satisfaction with the simulator (table).

Evaluating the effectiveness of Virtual Patient technology among students

Question Yes I can’t answer that. No
Use of “virtual patient” technology effectively trains clinical thinking skills 73% 18% 9%
The “virtual patient” technology gives a more complete immersion in the learning process compared to a traditional hands-on session 83% 7% 10%
The result of training on the simulator depends on the level of training of students 71% 1% 28%
The result of training on the simulator depends on the level of complexity of the scenario 29% 8% 63%
The feedback system in the Virtual Patient program can completely replace debriefing with a teacher 59% 2% 39%
I am fully satisfied with the implementation of the Virtual Patient technology in the educational process 88% 10% 2%
My motivation to continue learning has increased with the introduction of Virtual Patient technology into the process 98% 0% 2%
The “virtual patient” technology should be used in the learning process along with traditional forms of 100%

When asked, “How satisfied are you with the implementation of the Virtual Patient technology? 88% of students responded, “Completely satisfied. 98% of the students indicated that they were fully engaged and immersed in the educational process, which is an important positive point. 73% confirm that using this technique trains clinical thinking skills. 59% of the students appreciated the feedback system (report), the rest felt that debriefing with the instructor produced a higher result. 71% of respondents believe that the result depends on the level of training of students, 29% say – on the level of complexity of the scenario. 100% of students believe that this technology should be used in the learning process along with traditional forms.

The disadvantage of the Virtual Patient technique was cited by 61% of the students as a lack of emotional contact and real interaction.

The Virtual Patient device includes several simulation technologies: robotic patient simulators, a standardized patient simulating a clinical case, and interactive computer simulation of the situation [2, 3]. The first two technologies have long been successfully implemented in medical education and are actively used to practice chiropractic skills in a simulation center, which is impossible in a distance learning format. Multimedia clinical case simulation is a relatively young technology, which was first tested in the training of medical staff in the 1970s. [In Russian medical education, these technologies appeared relatively recently, but have been actively introduced in medical education only in recent years [6, 7].

“Virtual patient” gives the future physician the opportunity to form non-technical skills – clinical thinking [8, 9]. The “Virtual Patient Academics3D” system simulates a realistic environment of a district therapist’s office and gives the student the opportunity to form professional competencies while working with “patients”. Highly realistic patients present complaints, demonstrate clinical signs of disease, and allow for physical examination. The program offers a large number of scenarios with different profiles (pathology of the respiratory system, blood circulation, urinary tract, etc.). Scenarios is a multilevel structure with blocks of information about the patient’s condition, and one nosology is presented in several variants, which reduces the probability of accidental correct decisions. Each scenario offers a standard set of laboratory-instrumental examinations from which to choose. A detailed on-screen report shows the student and the instructor the results of the work at all stages (benchmark and actual versions). The program allows you to build a system of achievements of the student in his personal account, which is a motivating factor for him. The advantages of this system are the dynamic process of creating “virtual patients,” the possibility of feedback to developers through messages.

Virtual patients give medical students the opportunity to practice clinical thinking and medical decision-making skills in an environment very close to the real world, which is especially important in environments where access to clinics is limited.

Working with a virtual patient has a number of positive aspects that should be used for a very wide range of tasks. The program allows the student to access the “patient” on demand, at a convenient time for him (which is especially important in the case of controlling the independent work), increases the autonomy of the student and reduces the burden on the teacher. The simulated scenario can be replayed several times, implementing various options for action, achieving the solution to the problem. Another advantage of working with an artificial patient is the possibility of imitating patients suffering from rare, orphan diseases, which is difficult in a medical organization. Despite the large number of clinical scenarios, working in the program provides standardization of training and monitoring methods.

A number of foreign authors in their works describe the Virtual Patient method as a game format of training in medical education [9]. When implementing simulation technologies in the educational process, game technologies (gamification) are of greatest interest as a specific form of interaction between the student and the teacher in the implementation of a given scenario. Since ancient times, game technology has been used as a method of teaching and a way to transfer experience, and today it is relevant to higher education, especially medical school.

The importance of game technology varies at different stages of learning. In the younger courses, more traditional forms of learning, such as business and/or role-playing games with simple linear scenarios, should be used in the first place when forming students’ general medical knowledge, skills and abilities. Game technology should be used when practicing manual technique, practical skills and abilities; elements of a business game can be a structural element and/or evaluation tool in a practical lesson.

The Virtual Patient technology with a branched out system of clinical scenarios is more suitable for advanced students, as it contributes to the development of cognitive skills of a future doctor and is aimed at constructing a model of professional behavior. Graduate students already have some clinical experience and more easily draw parallels with real patients. Trainees regard this technique as an integration of biomedical knowledge and clinical experience. This integration provides the basis for physician decision-making, forms a system for recognizing persistent clinical and laboratory syndromes, and structures the methodology for making a diagnosis without real stress to the trainee.

The virtual environment creates a special highly realistic simulation of the professional situation, helping to learn abstract, iconic forms of professional formation in the course of performing professional actions. The virtual professional world allows a student to make a medical mistake by making the wrong decision, but the safe environment provides an opportunity to understand why it happened and to correct it without stress to the patient and the student. The Virtual Patient technology is based on scientific clinical advances and modern pedagogical game techniques. Modern students have grown up in a period of rapid development of computer technology, used to spend a lot of time in the virtual world, so they are ready to learn their profession through computer games. Digitalization and informatization of the modern educational environment are new ways of interacting with the modern generation of students. The game is a great way to learn, helping students learn effectively rather than just acquiring unnecessary knowledge. Gamification is a tool to maximize the involvement of the modern student in the learning process and positively influence the main group of learning motives.

However, the student needs competent pedagogical support throughout the process of mastering professional competencies, especially if the teacher uses game technology. The application of the “Virtual Patient” technology in the educational process requires high-quality methodological support and the development of practical recommendations for the implementation of this game method. If the required level of teacher training is insufficient, there is a risk of using pseudo-game forms in the educational process, which in fact have no practical relevance and educational value. Despite the mass of positive aspects, it should be understood that gamification involves not replacing, but modernizing traditional pedagogical forms with the introduction of new motivational schemes.

One of the requirements for pedagogical technology is its effectiveness, indicating the high efficiency of training, as well as the degree of energy consumption. The effectiveness of the Virtual Patient technology was evaluated by an expert method based on the comprehensive opinion of competent experts [10]. The experts were instructors who had many years of experience in building students’ clinical thinking skills in the implementation of clinical disciplines and, as a result, had practical decision-making capacity. The work of the experts consisted of two stages: in the first stage, the experts identified the need for the implementation of digital technology, and in the second stage, they analyzed the effectiveness of the implemented technology. The objective need for this technology is due to several things. The Virtual Patient program is the modern equivalent of the usual problem-situation tasks, based on the use of active and interactive learning tools. Restricting students’ access to the clinic to develop skills for supervising patients makes its use all the more urgent. The high efficiency of the Virtual Patient technology, according to teachers, is due to the ability to qualitatively solve such didactic tasks as:

1) building an individual educational trajectory, taking into account the different initial level of competence of the student;

2) visual presentation of educational information;

3) realistic modeling of a professional task;

4) objective control of learning outcomes, quick feedback;

5) diagnosis of errors, self-monitoring and self-correction;

6) strengthening the motivational aspect of learning.


The Virtual Patient software product is an effective pedagogical methodology that can be successfully used to practice clinical thinking skills and medical decision-making.

The Virtual Patient method is a problem-oriented form of learning that can be effectively used during the distance learning format.

Given the positive results, medical schools can make wider use of “virtual patient” technology in educational activities, but in order to get a quality result, it is necessary to develop ways to integrate this simulation technology into existing curricula.

Both teachers and trainees recognize the high effectiveness of this method, but we should not forget the need for face-to-face clinical sessions at the bedside of a real patient.

Bibliographical reference

Yudaeva Yu.A., Nevolina V.V., Zakirzyanova Z.F. USE OF TECHNOLOGY “VIRTUAL PATIENT” IN MEDICAL EDUCATION // Modern problems of science and education. – 2022. – № 2. ;

1. Khan K., Tolhurst-Cleaver S., White S., Simpson W. AMEE Guide 50: Simulation in Healthcare Education. Building a Simulation Program: Practical Guide, 2011. 31р.
2. Gorshkov M.D. Simulation training in anesthesiology and resuscitation / co. M.D. Gorshkov; ed. Evdokimov. Moscow: GEOTAR-Media: ROSOMED, 2014. 312 с.
3. Zaitsev V.S. Modern Pedagogical Technologies: Textbook. In 2 books. Kn. 1. Chelyabinsk, Chelyabinsk State Pedagogical University, 2012. 411 с.
4. S.I. Karas. Virtual Patients as a Format for Simulation Training in Continuing Medical Education (Literature Review) // Bulletin of Siberian Medicine. 2020. № 19(1). С. 140-149.
5. Kamyshnikova L.A., Efremova O.A., Ivakhno E.N., Dubrova V.A. Possibilities of using simulators in medical education // Medical Technology. Evaluation and choice. 2019. № 3 (37). С. 46-52.
6. Svistunov A.A. Methods and principles of simulation training. Simulation training in medicine. Ros. Society for Simulation Education in Medicine / ed. A.A. Svistunova; co. М. D. Gorshkov. Moscow: Publishing house of the First Moscow State Medical University. И. M. Sechenov, 2013. 287 с.
7. Shmakov S.A., Nikitina B.P., Elkonin D.B., Vygotsky L.S. Game technologies // Methodological development. [Electronic resource]. URL: (date of access: 19.03.2022).
8. Kolpakov F.A., Kiselev I.N. Virtual Patient // Kommersant Nauka. 2019. №. 4 (1). С. 28-29.
9. Meshcheryakova M., Podchernyaeva N., Shubina L. Training of professional manual skills and assessment of the level of their formation among medical students // Doctor. 2007. № 7. С. 81-83.
10. Khlebovich D.I. Expert survey as a tool for researching problems of higher professional education: prerequisites and practice of use // Izvestia IHEA. 2013. № 6 (92). С. 12-20.