Integration strategies for using virtual patients in clinical clerkships

Acad Med. 2009 Jul;84(7):942-9. doi: 10.1097/ACM.0b013e3181a8c668.


Purpose: To explore students' perceptions of virtual patient use in the clinical clerkship and develop a framework to evaluate effects of different integration strategies on students' satisfaction and perceptions of learning effectiveness with this innovation.

Method: A prospective, multiinstitutional study was conducted at six schools' pediatric clerkships to assess the impact of integrating Web-based virtual patient cases on students' perceptions of their learning during 2004-2005 and 2005-2006. Integration strategies were designed to meet the needs of each school, and integration was scored for components of virtual patient use and elimination of other teaching methodologies. A student survey was developed, validated, and administered at the end of the clerkship to 611 students. Data were analyzed using confirmatory factor analysis and structural equation modeling.

Results: A total of 545 students (89%) completed the survey. Overall student satisfaction with the virtual patients was high; students reported that they were more effective than traditional methods. The structural model demonstrated that elimination of other teaching methodologies was directly associated with perceived effectiveness of the integration strategies. A higher use score had a significant negative effect on perceived integration, but a positive effect on perceived knowledge and skills gain. Students' positive perceptions of integration directly affected their satisfaction and perception of the effectiveness of their learning.

Conclusions: Integration strategies balancing the use of virtual patients with elimination of some other requirements were significantly associated with students' satisfaction and their perceptions of improved knowledge and skills.

Publication types

  • Multicenter Study

MeSH terms

  • Attitude of Health Personnel*
  • Clinical Clerkship*
  • Clinical Competence
  • Computer-Assisted Instruction*
  • Curriculum
  • Humans
  • Models, Educational
  • Pediatrics / education*
  • Program Evaluation
  • Prospective Studies
  • User-Computer Interface*