Theme
Virtual Patients and eCase Studies
Category
Virtual Patients
INSTITUTION
University of Rochester, University of Pennsylvania, Dartmouth Medical School, Drexel University
The apprenticeship model has remained the dominant learning activity in clinical clerkships for the past 100 years, supplemented by classroom activities and self-directed reading. On-line virtual patients (VPs) are an innovation which has rapidly diffused to teach medical students. Despite the significant resources required to develop and maintain VP programs, little is known about why and how this innovation has been adopted.
Rogers' diffusion of innovation theory (4) and Kern and colleagues' systems approach to curriculum development in medical education (5) provide conceptual frameworks for interpreting the results of our study. Diffusion of innovations theory describes 5 steps in the diffusion-decision process: knowledge, persuasion, decision, implementation, and confirmation.(4,p169) Knowledge and persuasion were supported by the collaborative process of developing the VP program.(6) Early adopters may have implemented the VPs and found that their assumptions were confirmed, resulting in the sustained importance of VPs in meeting cognitive learning objectives. Late adopters or "laggards" may have had different goals, placing less emphasis on LCME requirements.(4,p283-4) Kern and colleagues describe a 6-step systems-based model of curriculum development in medical education.(5) Our study provides insight into the first three steps of Kern’s model; by understanding the needs, goals, and objectives for which VPs are adopted, clerkship directors can make more informed choices about how they implement virtual patients within the broader clerkship curriculum. Prior studies have shown improved student satisfaction and perceived learning value when VPs are systematically integrated into clerkship curricula.(7,8)
Meeting cognitive learning objectives and regulatory requirements are important reasons for adopting VPs, though goals may change as the innovation is more widely diffused. Clarifying goals is an important first step in more systematically integrating VPs in clerkship curricula.
In 2009 and 2011, 110 U.S. internal medicine clerkship directors were surveyed regarding their adoption of Simulated Internal Medicine Patient Learning Experience (SIMPLE) VPs, including meeting national Core Medicine Clerkship Curriculum learning objectives (3), Accreditation Council on Graduate Medical Education competencies, and Liaison Committee on Medical Education (LCME) requirements (2), and accommodating changes in the learning environment. In 2011 respondents were also asked how they implemented VPs in their curricula.
Responses were obtained from 69 (63%) of the 110 clerkship directors in 2009, and 86 (78%) in 2011. In 2011, 8 (21%) replaced a learning activity with VPs, 9 (24%) integrated VPs into other learning activities, and 21 (55%) simply added VPs onto their curricula.
The authors wish to thank the Clerkship Directors in Internal Medicine for assistance in administering and completing the surveys.