Advances in Health Sciences Education

, Volume 16, Issue 3, pp 331–345 | Cite as

Experiencing virtual patients in clinical learning: a phenomenological study

  • Samuel Edelbring
  • Maryam Dastmalchi
  • Håkan Hult
  • Ingrid E. Lundberg
  • Lars Owe Dahlgren
Article

Abstract

Computerised virtual patients (VPs) are increasingly being used in medical education. With more use of this technology, there is a need to increase the knowledge of students’ experiences with VPs. The aim of the study was to elicit the nature of virtual patients in a clinical setting, taking the students’ experience as a point of departure. Thirty-one students used VPs as a mandatory part of an early clinical rotation in rheumatology. Using the qualitative approach of phenomenology, we interviewed these students and then analysed data regarding their experiences of VPs as a learning activity. The result shows that students perceived VP activities in relation to actual patients, the clinical context and other learning activities. The VPs represented typical clinical cases which encouraged clinical reasoning and allowed for decision making. The students experienced the activities as integrating biomedical knowledge and clinical experience, providing structure that prepared for the unstructured clinical environment and patient encounters under unstressful conditions. However, the VPs were experienced as lacking the emotional interactivity and complexity of actual patients. Theoretical frameworks of clinical reasoning and experiential learning are suggested as foundations for further educational integration of VPs in the clinical environment. VP activities during clinical rotations provide experiences of clinical reality and allow students to solve problems actively. These features are dependent on VP technology but are also contingent on the surrounding environment.

Keywords

Clinical reasoning Clinical workplace learning Experiential learning Life-world perspective Phenomenology Research interview Computerised virtual patients 

Notes

Acknowledgments

We would like to thank Marika Kvarnström who managed the rotations and facilitaded the interview sessions. The first author wishes to acknowledge the constructive feedback on earlier drafts given by C. Van der Vleuten and J. Van Merriënboer at Maastricht University and at the CME doctoral seminar at Karolinska Institutet. Part of the analysis was presented at the AMEE conference in Malaga in 2009. This study has been made possible through the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet.

References

  1. Bearman, M. (2003). Is virtual the same as real? Medical students’ experiences of a virtual patient. Academic Medicine, 78(5), 538–545.CrossRefGoogle Scholar
  2. Bergin, R., Youngblood, P., Ayers, M. K., Boberg, J., Bolander, K., Courteille, O., et al. (2003). Interactive simulated patient: Experiences with collaborative e-learning in medicine. Journal of Educational Computing Research, 29(3), 387–400.CrossRefGoogle Scholar
  3. Berman, N. B., Fall, L. H., Maloney, C. G., & Levine, D. A. (2008). Computer-assisted instruction in clinical education: a roadmap to increasing CAI implementation. Advances in Health Sciences Education Theory and Practice, 13(3), 373–383.CrossRefGoogle Scholar
  4. Berman, N., Fall, L. H., Smith, S., Levine, D. A., Maloney, C. G., Potts, M., et al. (2009). Integration strategies for using virtual patients in clinical clerkships. Academic Medicine, 84(7), 942–949.CrossRefGoogle Scholar
  5. Boud, D., & Prosser, M. (2002). Appraising new technologies for learning: A framework for development. Educational Media International, 39, 237–245.CrossRefGoogle Scholar
  6. Boud, D., & Walker, D. (1993). Barriers to reflection on experience. In D. Boud, R. Cohen, & D. Walker (Eds.), Using experience for learning. Bristol: Society for Research into Higher Education and Open University Press.Google Scholar
  7. Bowen, J. L. (2006). Educational strategies to promote clinical diagnostic reasoning. New England Journal of Medicine, 355(21), 2217–2225.CrossRefGoogle Scholar
  8. Brown, J. S., Collins, A., & Duguid, P. (1989). Situated cognition and the culture of learning. Educational Researcher, 18(1), 32–42.Google Scholar
  9. Bryce, D. A., King, N. J., Graebner, C. F., Myers, J. H. (1998). Evaluation of a diagnostic reasoning program (DxR): Exploring student perceptions and addressing faculty concerns. Journal of Interactive Media in Education, 98(1).Google Scholar
  10. Colaizzi, P. F. (1978). Learning and existence. In R. S. Valle & M. King (Eds.), Existential-phenomenological alternatives for psychology (pp. 119–135). New York: Oxford U.P.Google Scholar
  11. Cook, D. A. (2005). The research we still are not doing: An agenda for the study of computer-based learning. Academic Medicine, 80(6), 541–548.CrossRefGoogle Scholar
  12. Cook, D. A., Bordage, G., & Schmidt, H. G. (2008). Description, justification and clarification: A framework for classifying the purposes of research in medical education. Medical Education, 42(2), 128–133.CrossRefGoogle Scholar
  13. Cook, D. A., Erwin, P. J., & Triola, M. M. (2010). Computerized virtual patients in health professions education: A systematic review and meta-analysis. Academic Medicine, 85(10), 1589–1602.CrossRefGoogle Scholar
  14. Cook, D. A., & Triola, M. M. (2009). Virtual patients: A critical literature review and proposed next steps. Medical Education, 43(4), 303–311.CrossRefGoogle Scholar
  15. Dall’Alba, G., & Barnacle, R. (2005). Embodied knowing in online environments. Educational Philosophy and Theory, 37(5), 719–744.CrossRefGoogle Scholar
  16. de Leng, B. A., Muijtjens, A. M., & van der Vleuten, C. P. (2009). The effect of face-to-face collaborative learning on the elaboration of computer-based simulated cases. Simulation in Healthcare, 4(4), 217–222.CrossRefGoogle Scholar
  17. Dornan, T., Boshuizen, H., King, N., & Scherpbier, A. (2007). Experience-based learning: A model linking the processes and outcomes of medical students’ workplace learning. Medical Education, 41(1), 84–91.CrossRefGoogle Scholar
  18. Edelbring, S. (2010). A threefold framework for relating to innovations and technology in education: Learning from, with and about technology. In A. Bromage, L. Clouder, J. Thistlethwaite, & F. Gordon (Eds.), Interprofessional e-learning and collaborative work: Practices and technologies. Hershey: IGI Global.Google Scholar
  19. Ellaway, R., Poulton, T., Fors, U., McGee, J. B., & Albright, S. (2008). Building a virtual patient commons. Medical Teacher, 30(2), 170–174.CrossRefGoogle Scholar
  20. Fern, E. F. (1982). The use of focus groups for idea generation: The effects of group size, acquaintanceship, and moderator on response quantity and quality. Journal of Marketing Research, 19(1), 1–13.CrossRefGoogle Scholar
  21. Friedman, C. P. (1994). The research we should be doing. Academic Medicine, 69(6), 455–457.CrossRefGoogle Scholar
  22. Gallagher, S., & Zahavi, D. (2008). The phenomenological mind: An introduction to philosophy of mind and cognitive science. London, New York: Routledge.Google Scholar
  23. Giorgi, A. (1985). Phenomenology and psychological research. Pittsburgh: Duquesne University Press.Google Scholar
  24. Heidegger, M. (1962). Being and time (1 English ed.). Oxford: Blackwell.Google Scholar
  25. Huang, G. M. D., Reynolds, R. M. P. A., & Candler, C. M. D. (2007). Virtual patient simulation at US and Canadian medical schools. Academic Medicine, 82(5), 446–451.CrossRefGoogle Scholar
  26. Huwendiek, S., De Leng, B. A., Zary, N., Fischer, M. R., Ruiz, J. G., & Ellaway, R. (2009). Towards a typology of virtual patients. Medical Teacher, 31(8), 743–748.CrossRefGoogle Scholar
  27. Irby, D. M. (1994). Three exemplary models of case-based teaching. Academic Medicine, 69(12), 947–953.CrossRefGoogle Scholar
  28. Karlsson, G. (1993). Psychological qualitative research from a phenomenological perspective. Stockholm: Almqvist & Wiksell International.Google Scholar
  29. Kenny, N. P., & Beagan, B. L. (2004). The patient as text: A challenge for problem-based learning. Medical Education, 38(10), 1071–1079.CrossRefGoogle Scholar
  30. Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, N.J.: Prentice-Hall.Google Scholar
  31. Larsson, S. (2009). A pluralist view of generalization in qualitative research. International Journal of Research & Method in Education, 32(1), 25–38.CrossRefGoogle Scholar
  32. Lou, Y., Abrami, P. C., & d’Apollonia, S. (2001). Small group and individual learning with technology: A meta-analysis. Review of Educational Research, 71(3), 449–521.CrossRefGoogle Scholar
  33. Marton, F., & Booth, S. (1997). Learning and awareness. Mahwah, N.J.: Erlbaum.Google Scholar
  34. Merriënboer, J. J. V., & Sweller, J. (2010). Cognitive load theory in health professional education: Design principles and strategies. Medical Education, 44(1), 85–93.CrossRefGoogle Scholar
  35. Moustakas, C. (1994). Phenomenological research methods. Thousand Oaks: Sage.Google Scholar
  36. Newble, D., Norman, G., & van der Vleuten, C. (2000). Assessing clinical reasoning. In J. Higgs & M. A. Jones (Eds.), Clinical reasoning in the health professions (2nd ed., pp. 156–168). Oxford: Butterworth-Heinemann.Google Scholar
  37. Norman, G. (2005). Research in clinical reasoning: Past history and current trends. Medical Education, 39(4), 418–427.CrossRefGoogle Scholar
  38. Norman, G. (2006). Editorial—Less is more. Advances in Health Science Education Theory and Practice, 11(2), 111–114.CrossRefGoogle Scholar
  39. Sandroni, S. (1997). Enhancing clinical teaching with information technologies: What can we do right now? Academic Medicine, 72(9), 770–774.CrossRefGoogle Scholar
  40. Shotter, J. (1993). Conversational realities: Constructing life through language. London: Sage.Google Scholar
  41. Sixsmith, J. A., & Sixsmith, A. J. (1987). Empirical phenomenology: Principles and method. Quality & Quantity, 21(3), 313–333.CrossRefGoogle Scholar
  42. Spencer, J. (2003). Learning and teaching in the clinical environment. BMJ, 326(7389), 591–594.CrossRefGoogle Scholar
  43. Wahlgren, C. F., Edelbring, S., Fors, U., Hindbeck, H., & Stahle, M. (2006). Evaluation of an interactive case simulation system in dermatology and venereology for medical students. BMC Medical Education, 6, 40.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Samuel Edelbring
    • 1
  • Maryam Dastmalchi
    • 2
  • Håkan Hult
    • 3
  • Ingrid E. Lundberg
    • 2
  • Lars Owe Dahlgren
    • 3
  1. 1.Department of Learning, Informatics, Management and EthicsKarolinska InstitutetStockholmSweden
  2. 2.Rheumatology Unit, Department of MedicineKarolinska University Hospital, Solna, Karolinska InstitutetStockholmSweden
  3. 3.Department of Behavioural Science and LearningLinköping UniversityLinköpingSweden

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