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Durham VA Utilizing Virtual Patients for Training, Education

By Bradley T. Eisenberg, PharmD, Simulation Fellow 2018-2019; 
Mary E. Holtschneider, RN-BC, MEd; and Chan W. Park, MD, FAAEM
Co-Directors, Interprofessional Advanced Fellowship in Clinical Simulation
Durham VA Health Care System

DURHAM, N.C. – The use of virtual patients to help train health care professionals has the potential to streamline educational efforts while still retaining many of the interactive benefits of using standardized patients. According to the Society for Simulation in Healthcare’s Simulation Dictionary (June 2016), virtual patient is defined as a representation of an actual patient. Virtual patients can take many forms such as software-based physiological simulators, simulated patients, physical mannequins and simulators (p. 40*). A virtual patient can be an effective way to bridge the gap between classroom learning and applying those acquired skills and knowledge in real-world patient encounters.

In many ways, virtual patients provide a similar type of learning experience to standardized patients. They deliver the ability to practice and gain invaluable experience interacting with patients in a low stress environment where the learner can try out strategies, make mistakes and practice skills in a variety of scenarios. Virtual patients bring an immersive, interactive and engaging platform.

To serve as a platform to deliver and evaluate students’ learning, a games-based platform called nXhuman has been developed at the University of North Carolina School of Pharmacy at Chapel Hill for students to experience simulated opportunities with virtual patients. Patient encounters are being developed and scripted into the Unity game engine. These scripts contain dialogue that would typically ensue in a given patient encounter.

For example, a virtual patient named “Simone” is presented on the learner’s computer screen and responds in conversation as the session unfolds. Simone displays a wide range of mannerisms and body language that coincide with emotional and physical consequences involved in the encounter. The learner clicks through presented options that dictate the flow and direction of the conversation, thereby engaging in an immersive experience. The learner makes decisions regarding which topics to address, when to address them, what questions to ask, how to show empathy and ways to build rapport with the patient.

This type of engaging and immersive simulation is meant to build the confidence and comfort level of the learner as it pertains to their ability to lead a patient education session in a certain scenario. Many repetitions using the virtual patient in a variety of encounters will help the learner develop a professional voice and style of communication that will serve them well as they develop their practice.

Learners can observe the expected outcomes of simulated therapeutic interventions, as well as witness common side effects, drug interactions and other consequences of their clinical decision-making. Learners can encounter a wide variety of confounding conditions including patient age, gender, compliance, lifestyle choices, personal history and social status. Developing virtual patient cases and implementing them requires some effort, but their ability to be adaptive, distributed and individualized to different patients and conditions makes virtual patients a cost-effective and engaging approach to improving patient education.

 Though certainly useful in the preprofessional arena, there is ample opportunity for this technology to be used with practicing interprofessional clinicians in the hospital setting to hone interaction skills with diverse patients across a lifespan, as the virtual patient’s characteristics can be modified as desired. As this technology does not require a facilitator, it can be made available for staff 24/7. Though not a substitute for an actual patient encounter, it provides targeted practice time via an engaging platform.


*Definition by Ellaway, R., Poulton, T., Fors, U., McGee, J.B., & Albright, S. (2008). Building a virtual patient commons. Medical Teacher, 30(2), 170-4.