Virtual Patient Cases: Do students like ‘em? Do they do them? Impact of Required Versus Self-Directed Use of Virtual Patient Cases on Clerkship Performance: A Mixed-Methods Study? Kim S, Willett LR, Pan W, Afran J, Walker JA, Shea JA. Academic Medicine. 93 (5): 742-749.

posted in: 2018 Journal Clubs, July 2018 | 0

Reviewed by Miriam Schechter

What was the study question?
Is there a difference in perceived value or educational benefit of virtual patient cases between groups of
clerkship students who are assigned online cases and those allowed to choose the ones they complete?

How was the study done?
In two consecutive years at one institution, students on Pediatrics, FM and IM clerkships were given full
access to MedU courses but in one year were assigned a specific number of virtual patient cases to
complete (core-requirement group) and in the other had no assignment (self-directed
group). Investigators compared the total number of cases completed and time spent on them between
the 2 study groups as well as their NBME subject exam scores and summative clinical evaluation scores
in the domains of knowledge and clinical reasoning. They also compared student surveys of perceived
usefulness of the virtual cases and ran focus groups to discuss advantages and disadvantages.

What were the results?
The mean number of virtual patient cases completed was significantly higher in the core requirement
group compared with the self-directed group. The time spent was also much higher in the group
assigned to cases.
The mean ratings on relative usefulness of virtual cases as compared to other learning methods, and on
overall value of the virtual patient cases were relatively low and were similar across the two groups.
Students considered virtual patient cases to be a poor use of their time. Students admitted that they
often clicked through the cases.
There were no significant differences between groups in NBME performance or clinical ratings for
medical knowledge and clinical reasoning.

What are the implications of these findings?
While virtual patient cases may be a useful substitute for real patient encounters, their actual and
perceived value in enhancing student learning on the clerkships may not meet the expectations of
clerkship directors. Finding innovative ways of integrating virtual cases may be warranted.

Editors’ note: It is often said that evaluation drives the curriculum. From my own experience with
students and virtual cases, they are not much appreciated or even looked at unless there is a linked
evaluation component. (RR)