J. Med. Internet Res. - Virtual patients in primary care: developing a reusable model that fosters reflective practice and clinical reasoning.


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CKGROUND: Primary care is an integral part of the medical curriculum at Karolinska Institutet, Sweden. It is present at every stage of the students' education. Virtual patients (VPs) may support learning processes and be a valuable complement in teaching communication skills, patient-centeredness, clinical reasoning, and reflective thinking. Current literature on virtual patients lacks reports on how to design and use virtual patients with a primary care perspective.OBJECTIVE: The objective of this study was to create a model for a virtual patient in primary care that facilitates medical students' reflective practice and clinical reasoning. The main research question was how to design a virtual patient model with embedded process skills suitable for primary care education.METHODS: The VP model was developed using the Open Tufts University Sciences Knowledgebase (OpenTUSK) virtual patient system as a prototyping tool. Both the VP model and the case created using the developed model were validated by a group of 10 experienced primary care physicians and then further improved by a work group of faculty involved in the medical program. The students' opinions on the VP were investigated through focus group interviews with 14 students and the results analyzed using content analysis.RESULTS: The VP primary care model was based on a patient-centered model of consultation modified according to the Calgary-Cambridge Guides, and the learning outcomes of the study program in medicine were taken into account. The VP primary care model is based on Kolb's learning theories and consists of several learning cycles. Each learning cycle includes a didactic inventory and then provides the student with a concrete experience (video, pictures, and other material) and preformulated feedback. The students' learning process was visualized by requiring the students to expose their clinical reasoning and reflections in-action in every learning cycle. Content analysis of the focus group interviews showed good acceptance of the model by students. The VP was regarded as an intermediate learning activity and a complement to both the theoretical and the clinical part of the education, filling out gaps in clinical knowledge. The content of the VP case was regarded as authentic and the students appreciated the immediate feedback. The students found the structure of the model interactive and easy to follow. The students also reported that the VP case supported their self-directed learning and reflective ability.CONCLUSIONS: We have built a new VP model for primary care with embedded communication training and iterated learning cycles that in pilot testing showed good acceptance by students, supporting their self-directed learning and reflective thinking.

Resumo Limpo

ckground primari care integr part medic curriculum karolinska institutet sweden present everi stage student educ virtual patient vps may support learn process valuabl complement teach communic skill patientcentered clinic reason reflect think current literatur virtual patient lack report design use virtual patient primari care perspectiveobject object studi creat model virtual patient primari care facilit medic student reflect practic clinic reason main research question design virtual patient model embed process skill suitabl primari care educationmethod vp model develop use open tuft univers scienc knowledgebas opentusk virtual patient system prototyp tool vp model case creat use develop model valid group experienc primari care physician improv work group faculti involv medic program student opinion vp investig focus group interview student result analyz use content analysisresult vp primari care model base patientcent model consult modifi accord calgarycambridg guid learn outcom studi program medicin taken account vp primari care model base kolb learn theori consist sever learn cycl learn cycl includ didact inventori provid student concret experi video pictur materi preformul feedback student learn process visual requir student expos clinic reason reflect inact everi learn cycl content analysi focus group interview show good accept model student vp regard intermedi learn activ complement theoret clinic part educ fill gap clinic knowledg content vp case regard authent student appreci immedi feedback student found structur model interact easi follow student also report vp case support selfdirect learn reflect abilityconclus built new vp model primari care embed communic train iter learn cycl pilot test show good accept student support selfdirect learn reflect think

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