1. Virtual Patients in a Virtual Clinic in a Virtual Hospital Neil Gesundheit, Patricia Youngblood, Pauline Brutlag, Eleonor Ekorn, Nabil Zary, Uno Fors, and Parvati Dev Stanford University School of Medicine 2006 SUMMIT, Stanford University School of Medicine; and LIME Department, Karolinska Institutet

2. Stanford University School of Medicine 2006 Standardized Patients and Virtual Patients in Medical Education Use of Standardized Patients (SP, trained actors used to simulate clinical cases) have become a standard method in the U.S. to assess clinical skills of medical students Virtual Patients (VP) are web-based cases that simulate a medical encounter. Are VPs useful to assess clinical skills of medical students?

3. Stanford University School of Medicine 2006 Comparative Attributes of Assessment Using Standardized Patients vs Virtual Patients Standardized Patients History elicited by use of spontaneous questions Physical exam with a real patient Physical exam abnormalities cannot be simulated easily Assessment includes interpersonal skills Not used to assess clinical reasoning and problem-solving Not used to examine therapeutic decision-making Virtual Patients History elicited by prompted questions on drop-down menu Physical exam is with a simulated model Physical exam abnormalities can be easily simulated Difficult or impossible to assess interpersonal skills Used to assess clinical reasoning and problem solving Used to examine therapeutic decision-making

4. Stanford University School of Medicine 2006 Comparative Attributes of Assessment Using Standardized Patients vs Virtual Patients Standardized Patients History elicited by use of spontaneous questions Physical exam with a real patient Physical exam abnormalities cannot be simulated easily Assessment includes interpersonal skills Not used to assess clinical reasoning and problem-solving Not used to examine therapeutic decision-making Virtual Patients History elicited by prompted questions on drop-down menu Physical exam is with a simulated model Physical exam abnormalities can be easily simulated Difficult or impossible to assess interpersonal skills Used to assess clinical reasoning and problem-solving Used to examine therapeutic decision-making

5. Stanford University School of Medicine 2006 Practical Aspects of Using Standardized Patients vs Virtual Patients Standardized Patients Expense is in clinic space, salary to actors Personnel expense is ongoing Staging restricted to availability of actors, clinic space Variability in case portrayal Possible variability in student assessment Significant effort needed to modify case Virtual Patients Expense is in software development, hardware Personnel expense is “one-time” Staging can occur at any place web is available, any time No variability in case portrayal Little or no variability in student assessment Little effort needed to modify a case

6. Stanford University School of Medicine 2006 Recently Completed Pilot Experiment Comparing SPs and VPs Matched cases created Standardized patient: 54-year-old woman, TIA on the prior day, resulting in transient weakness in her arm Virtual patient: 44-year-old man with a right cortical stroke resulting in left hemiparesis and hemianesthesia 15 second-year Stanford medical students recruited to complete both cases, in random order Performance check-lists created; scoring was simple (non-weighted); satisfaction questionnaires given to students after they completed the cases Focus-group interviews conducted after the web-based cases

7. Stanford University School of Medicine 2006 Comparison of Performance of Second-Year Medical Students on Patient Interview: VP vs. SP r=0.54

8. Stanford University School of Medicine 2006 Virtual Patient (VP) vs. Standardized Patient (SP)

9. Stanford University School of Medicine 2006 Virtual Patient (VP) vs. Standardized Patient (SP)

10. Stanford University School of Medicine 2006 Virtual Patient (VP) vs. Standardized Patient (SP)

11. Stanford University School of Medicine 2006 Conclusions of Pilot Experiment Students were able to master the software with relative ease and were engaged by the use of virtual patients (Case-Ex) Student satisfaction with most aspects of using virtual patients was high Good correlations have been observed in certain skill areas between SP and VP assessments There are complementary benefits to using standardized patients and virtual patients in the clinical assessment of medical students