Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Virtual Reality (VR) is a technology that allows the user to explore and manipulate computer-generated real or artificial three-dimensional (3D) multimedia sensory environments in real time to gain practical knowledge that can be used in clinical practice. Objective: The aim of this systematic review was to evaluate the effectiveness of virtual reality (VR) for educating health professions and improving their knowledge, cognitive skills, attitudes and satisfaction. Methods: We performed a systematic review of the effectiveness of virtual reality in pre- and post-registration health professions education following the gold standard Cochrane methodology. We searched seven databases from the year 1990 up to August 2017. No language restrictions were applied. We included randomized controlled trials and cluster-randomized trials. We independently selected studies, extracted data and assessed risk of bias, then compared the information in pairs. We contacted study authors for additional information if necessary. All pooled analyses were based on random-effects models. We used the GRADE approach to rate the quality of the body of evidence. Results: Thirty-one studies (N = 2407) were included. Meta-analysis of eight trials found that VR slightly improves post-intervention knowledge scores when compared with traditional learning (SMD = 0.44, 95% CI: 0.18, 0.69, I2 = 49%, N = 603) or to other types of digital education such as online or digital education (SMD = 0.43, 95% CI: 0.07, 0.79, I2 = 78%, N = 608, low certainty evidence). Another meta-analysis of four trials found that VR improves health professions cognitive skills when compared with traditional learning (SMD = 1.12, 95% CI: 0.81, 1.43, I2 = 0%, N = 235). Two studies compared VR to other forms of digital education on skills, favoring the VR group (SMD = 0.50, 95% CI: 0.32, 0.69, I2 = 0%, N = 467, moderate effect size, low certainty evidence). The findings for attitudes and satisfaction were mixed and inconclusive. No studies reported patient-related outcomes, behavior change or unintended/adverse effects of the VR. Overall, the certainty of evidence according to the GRADE criteria ranged from low to moderate. We downgraded our certainty of the evidence primarily because of the risk of bias and/or inconsistency. Conclusions: We found evidence suggesting that virtual reality improves post-intervention knowledge and skills outcomes of health professions when compared to traditional education or other types of digital education such as online or offline digital education. The findings on other outcomes are limited. Future research should evaluate more on the effectiveness of immersive and interactive forms of VR and evaluate other outcomes such as attitude, satisfaction, cost-effectiveness and clinical practice or behavior change.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

The term “virtual patients” (VPs) has been used for many years in academic publications, but its meaning varies, leading to confusion. Our aim was to investigate and categorize the use of the term “virtual patient” and then classify its use in healthcare education. A literature review was conducted to determine all articles using the term “virtual patient” in the title or These articles were categorized into: Education, Clinical Procedures, Clinical Research and E-Health. All educational articles were further classified based on a framework published by Talbot et al. which was further developed using a deductive content analysis approach. 536 articles published between 1991 and December 2013 were included in the study. From these, 330 were categorized as educational. Classifying these showed that 37% articles used VPs in the form of Interactive Patient Scenarios. VPs in form of High Fidelity Software Simulations (19%) and Virtual Standardized Patients (16%) were also frequent. Less frequent were other forms, such as VP Games. Analyzing the literature across time shows an overall trend towards the use of Interactive Patient Scenarios as the predominant form of VPs in healthcare education. The main form of educational VPs in the literature are Interactive Patient Scenarios despite rapid technical advances that would support more complex applications. The adapted classification provides a valuable model for VP developers and researchers in healthcare education to more clearly communicate the type of VP they are addressing avoiding misunderstandings.

Objective The purpose of this article is to explore learners’ perceptions of using virtual patients in a behavioral medicine Massive Open Online Course (MOOCs) and thereby describe innovative ways of disseminating knowledge in health-related areas. Methods A 5-week MOOC on behavioral medicine was hosted on the edX platform. The authors developed two branched virtual patients consisting of video recordings of a live standardized patient, with multiple clinical decision points and narration unfolding depending on learners’ choices. Students interacted with the virtual patients to treat stress and sleep problems. Answers to the exit survey and participant comments from the discussion forum were analyzed qualitatively and quantitatively. Results In total, 19,236 participants enrolled in the MOOC, out of which 740 received the final certificate. The virtual patients were completed by 2317 and 1640 participants respectively. Among survey respondents (n = 442), 83.1% agreed that the virtual patient exercise was helpful. The qualitative analysis resulted in themes covering what it was like to work with the virtual patient, with subthemes on learner-centered education, emotions/eustress, game comparisons, what the participants learned, what surprised them, how confident participants felt about applying interventions in practice, suggestions for improvement, and previous experiences of virtual patients. Conclusions Students were enthusiastic about interacting with the virtual patients as a means to apply new knowledge about behavioral medicine interventions. The most common suggestion was to incorporate more interactive cases with various levels of complexity. Further research should include patient outcomes and focus on interprofessional aspects of learning with virtual patients in a MOOC.

Background: Clinical reasoning is a key ability essential for practising health professionals. However, little is known about the current global adoption of clinical reasoning teaching and assessment. Purpose: We aimed to provide insights into how clinical reasoning is deliberately taught and assessed in curricula worldwide and to identify needs and perceived barriers for teaching clinical reasoning to students and educators. Methods: A questionnaire was devised by an international expert group and distributed in a large international medical education community. Data were collected in 2018 and analysed using descriptive statistics. We identified themes in free-text responses using content analysis. Results: Three hundred and thirteen responses from 76 countries were collected. Most respondents were from Europe (34%). While the presence of a longitudinal clinical reasoning curriculum was only reported by 28%, 85% stated that such a curriculum was needed. The lack of awareness of the need to explicitly teach clinical reasoning was the most commonly identified barrier. For assessment, the greatest need identified was for more workplace-based assessment. Conclusions: Global respondents indicate the need to implement explicit longitudinal clinical reasoning curricula. Our findings suggest that efforts should be put into improving faculty development, including evidence-based materials on how to teach and assess clinical reasoning.

A fundamental challenge in medical education is creating high-quality, clinically relevant multiple-choice questions (MCQs). ChatGPT-based automatic item generation (AIG) methods need well-designed prompts. However, the use of these prompts is hindered by the time-consuming process of copying and pasting, a lack of know-how among medical teachers, and the generalist nature of standard ChatGPT, which often lacks the medical context. The Case-based MCQ Generator, a custom GPT, addresses these challenges. It has been trained by using GPT Builder, which is a platform designed by OpenAI for customizing ChatGPT to meet specific needs, in order to allow users to generate case-based MCQs. By using this free tool for those who have ChatGPT Plus subscription, health professions educators can easily select a prompt, input a learning objective or item-specific test point, and generate clinically relevant questions. It enhances the efficiency of MCQ generation and ensures the generation of contextually relevant questions, surpassing the capabilities of standard ChatGPT. It streamlines the MCQ creation process by integrating prompts published in medical education literature, eliminating the need for manual prompt input. Future development aims at sustainability and addressing ethical and accessibility issues. It requires regular updates, integration of new prompts from emerging health professions education literature, and a supportive digital ecosystem around the tool. Accessibility, especially for educators in low-resource countries, is vital, demanding alternative access models to overcome financial barriers.