The Use of Virtual Patients to Provide Feedback On Clinical Reasoning : A Systematic Review

Jay, Robert; Sandars, John; Patel, Rakesh; Leonardi-Bee, Jo; Ackbarally, Yasmin; Bandyopadhyaya, Soham; Faraj, Dabean; O'Hanlon, Mary; Brown, Jeremy; Wilson, Emma

Abstract

Purpose: Virtual patients (VPs) are increasingly used across the continuum of medical education to support the development of clinical reasoning (CR). However, the extent to which feedback is given across the components of CR is unknown, and there is a lack of guidance on how VPs can be designed to optimise the development of CR. This systematic review sought to identify how VPs provide feedback on CR.

Method: Seven databases were searched using terms adapted from a previous systematic review. All published studies that described the use of VPs for developing CR in medical professionals and provided feedback on at least one CR component were retrieved. Screening, data extraction and quality assessment were performed independently by two authors. A narrative synthesis was used to summarise and identify patterns.

Results: 6526 results were identified from searches, of which 72 met criteria but only 35 full text papers were analysed as the reporting of interventions in abstracts (n=37) was insufficient. The most common CR component developed by VPs were: information gathering, the leading diagnosis, and management plans. These components were frequently assessed by comparison with lists of correct options, with feedback predominantly provided as an expert answer. Further analysis was limited by the lack of specific reporting in the studies.

Conclusions: Studies describing the use of VPs for giving feedback on CR have mainly focused on CR components that are easy to measure, whereas there were few studies that described VPs designed for assessing CR components such as problem representations, hypothesis generation and diagnostic justification. Despite feedback being essential for supporting learning, few VPs provided information on the learner’s use of self-regulated learning processes. This review highlights potential future research areas and opportunities for further VP development, specifically around effective design that includes all CR components, as well as all dimensions of feedback.

Citation

Jay, R., Sandars, J., Patel, R., Leonardi-Bee, J., Ackbarally, Y., Bandyopadhyaya, S., Faraj, D., O'Hanlon, M., Brown, J., & Wilson, E. (2024). The Use of Virtual Patients to Provide Feedback On Clinical Reasoning : A Systematic Review. Academic Medicine,

• Journal Article Type: Article
• Acceptance Date: Jul 9, 2024
• Online Publication Date: Oct 31, 2024
• Publication Date: Oct 31, 2024
• Deposit Date: Aug 15, 2024
• Publicly Available Date: Nov 1, 2025
• Journal: Academic Medicine
• Print ISSN: 1040-2446
• Electronic ISSN: 1938-808X
• Publisher: Lippincott, Williams & Wilkins
• Peer Reviewed: Peer Reviewed
• Public URL: https://nottingham-repository.worktribe.com/output/38380113
• Publisher URL: https://journals.lww.com/academicmedicine/abstract/9900/the_use_of_virtual_patients_to_provide_feedback_on.992.aspx