Background: Variety of tools has been used to teach history-taking skills to novice learners. Standardized Patient (SP) is the gold standard for medical education. We hypothesized that the use of online simulation platforms CyberPatient TM (CP) is as effective as SP. Methods: In this prospective randomized controlled trial study, the educational effectiveness of CP was compared to SP in improving history taking skills. Twenty-two incoming students at University of British Columbia (UBC) were randomly divided in to two (SP and CP) groups. SP Group (n = 11) practiced their history taking skills with the standardized patients and CP Group (n = 11)—with CyberPatients. The content for both groups included 3 cases of GI pathology and the study time was 60 minutes. Assessment method included Objective Structured Clinical Examination (OSCE) before and after interventions. Data were analysed in a two- way between/within ANOVA and Wald test was used to deal with the violation of the ANOVA assumptions. Economic benefits were assessed as Cost-effectiveness (calculated as Cost/Effect Ratio) and Cost-Value Proposition (Cost-Vale Relationship). Results: Results of this study indicated that both groups had significant (SP group p = 0.006 and CP group p = 0.0001) improvement in the knowledge domain of history taking. The history taking knowledge variable in both groups manifested a significant main effect of time indicating that students did better after interventions, F (1, 15.1) = 10.5, p = 0.011. The groups performed at a similar level after intervention. Moreover, results show that the use of the CP is more cost-effective and has a better cost/value proposition for medical education. Conclusion: We conclude that CyberPatient TM is as effective as using standardized patients in delivery of practical knowledge for novice medical students, however, CyberPatient TM is more economically rewarding.
Barrows, H. S., & Abrahamson, S. (1964). The Programmed Patient: A Technique for Appraising Student Performance in Clinical Neurology. Journal of Medical Education, 39, 802-805.
Berman, N. B., Durning, S. J., Fischer, M. R., Huwendiek, S., & Triola, M. M. (2016). The Role for Virtual Patients in the Future of Medical Education. Academic Medicine, 91, 1217-1222. https://doi.org/10.1097/ACM.0000000000001146
Bosse, H. M., Nickel, M., Huwendiek, S., Schultz, J. H., & Nikendei, C. (2015). Cost-Effectiveness of Peer Role Play and Standardized Patients in Undergraduate Communication Training Approaches to Teaching and Learning. BMC Medical Education, 15, 183. https://doi.org/10.1186/s12909-015-0468-1
Bunn, A., & Korpela, M. (2008). An Introduction to dplR. Industrial and Commercial Training, 10, 11-18. https://doi.org/10.1108/eb003648
Cleland, J. A., Abe, K., & Rethans, J. J. (2009). The Use of Simulated Patients in Medical Education: AMEE Guide No. 42. Medical Teacher, 31, 477-486. https://doi.org/10.1080/01421590903002821
Colliver, J. A., & Williams, R. G. (1993). Technical Issues: Test Application. Academic Medicine: Journal of the Association of American Medical Colleges, 68, 454-460. https://doi.org/10.1097/00001888-199306000-00003
Consorti, F., Mancuso, R., Nocioni, M., & Piccolo, A. (2012). Efficacy of Virtual Patients in Medical Education: A Meta-Analysis of Randomized Studies. Computers and Education, 59, 1001-1008. https://doi.org/10.1016/j.compedu.2012.04.017
Courteille, O., Fahlstedt, M., Ho, J., Hedman, L., Fors, U., Von Holst, H., Fellander-Tsai, L., & Moller, H. (2018). Learning through a Virtual Patient vs. Recorded Lecture: A Comparison of Knowledge Retention in a Trauma Case. International Journal of Medical Education, 9, 86-92. https://doi.org/10.5116/ijme.5aa3.ccf2
Danforth, D. R., Procter, M., Chen, R., Johnson, M., & Heller, R. (2009). Development of Virtual Patient Simulations for Medical Education. Journal for Virtual Worlds Research, 2, 4-11. https://doi.org/10.4101/jvwr.v2i2.707
Enelow, A. J., Forde, D. L., & Brummel-Smith, K. (1996). The Interview in Clinical Medicine. In Interviewing and Patient Care (4th ed., pp. 3-11). Oxford: Oxford University Press, Inc.
Fall, L. H., Berman, N. B., Smith, S., White, C. B., Woodhead, J. C., & Olson, A. L. (2005). Multi-Institutional Development and Utilization of a Computer-Assisted Learning Program for the Pediatrics Clerkship: The CLIPP Project. Academic Medicine, 80, 847-855. https://doi.org/10.1097/00001888-200509000-00012
Fletcher, J. D., & Wind, A. P. (2013). Cost Considerations in Using Simulations for Medical Training. Military Medicine, 178, 37-46. https://doi.org/10.7205/MILMED-D-13-00258
Flexner, A. (2002). Extracted from: The Carnegie Foundation for the Advancement of Teaching, Bulletin Number Four, 1910. Bulletin of the World Health Organization, 80, 594-602.
Gillette, C., Stanton, R. B., Rockich-Winston, N., Rudolph, M., & Anderson, H. G. (n.d.). Cost-Effectiveness of Using Standardized Patients to Assess Student-Pharmacist Communication Skills.
Grand’maison, P., Lescop, J., Rainsberry, P., & Brailovsky, C. A. (1992). Large-Scale Use of an Objective, Structured Clinical Examination for Licensing Family Physicians. Canadian Medical Association Journal, 146, 1735-1740.
Haist, S. A., Griffith, C. H., Hoellein, A. R., Talente, G., Montgomery, T., & Wilson, J. F. (2004). Improving Students’ Sexual History Inquiry and HIV Counseling with an Interactive Workshop Using Standardized Patients. Journal of General Internal Medicine, 19, 549-553. https://doi.org/10.1111/j.1525-1497.2004.30204.x
Halbach, J. L., & Sullivan, L. L. (2005). Teaching Medical Students about Medical Errors and Patient Safety: Evaluation of a Required Curriculum. Academic Medicine Journal of the Association of American Medical Colleges, 80, 600-606. https://doi.org/10.1097/00001888-200506000-00016
Huang, G., Reynolds, R., & Candler, C. (2007). Virtual Patient Simulation at U.S. and Canadian Medical Schools. Academic Medicine, 82, 446-451. https://doi.org/10.1097/ACM.0b013e31803e8a0a
Kandasamy, T., & Fung, K. (2009). Interactive Internet-Based Cases for Undergraduate Otolaryngology Education. Otolaryngology—Head and Neck Surgery, 140, 398-402. https://doi.org/10.1016/j.otohns.2008.11.033
Keifenheim, K. E., Teufel, M., Ip, J., Speiser, N., Leehr, E. J., Zipfel, S., & Herrmann-Werner, A. (2015). Teaching History Taking to Medical Students: A Systematic Review. BMC Medical Education, 15, Article No. 159. https://doi.org/10.1186/s12909-015-0443-x
Kelly, M., & Murphy, A. (2004a). An Evaluation of the Cost Designing, Delivering and Assessing an Undergraduate Communication Skills Module. Medical Teacher, 26, 610-614. https://doi.org/10.1080/01421590400005475
Lichstein, P. R. (1990). The Medical Interview. In H. K. Walker, W. D. Hall, & J. W. Hurst (Eds.), Clinical Methods: The History, Physical, and Laboratory Examinations (3rd ed., Chapter 3). Boston, MA: Butterworths. https://www.ncbi.nlm.nih.gov/books/NBK349
McEwan, P. J. (2012). Cost-Effectiveness Analysis of Education and Health Interventions in Developing Countries. Journal of Development Effectiveness, 4, 189-213. https://doi.org/10.1080/19439342.2011.649044
Medical Education/CyberPatient (n.d.). https://www.cyberpatient.ca
Power/Sample Size Calculator (n.d.). Rollin Brant Professor (Emeritus) Department of Statistics University of British Columbia. https://www.stat.ubc.ca/~rollin/stats/ssize/n2.html
Prince, K. J. A. H., & Boshuizen, H. P. A. (2006). From Theory to Practice in Medical Education. In Professional Learning: Gaps and Transitions on the Way from Novice to Expert (pp. 121-139). Berlin: Springer. https://doi.org/10.1007/1-4020-2094-5_7
Qayumi, A. K., Kurihara, Y., Imai, M., Pachev, G., Seo, H., Hoshino, Y., Cheifetz, R., Matsuura, K., Momoi, M., Saleem, M., Lara-Guerra, H., Miki, Y., & Kariya, Y. (2004). Comparison of Computer-Assisted Instruction (CAI) versus Traditional Textbook Methods for Training in Abdominal Examination (Japanese Experience). Medical Education, 38, 1080-1088. https://doi.org/10.1111/j.1365-2929.2004.01957.x
Reznick, R. K., Smee, S., Baumber, J. S., Cohen, R., Rothman, A., Blackmore, D., & Bérard, M. (1993). Guidelines for Estimating the Real Cost of an Objective Structured Clinical Examination. Academic Medicine, 68, 513-517. https://doi.org/10.1097/00001888-199307000-00001
Reznick, R., Smee, S., Rothman, A., Chalmers, A., Swanson, D., Dufresne, L., Lacombe, G., Baumber, J., Poldre, P., Levasseur, L., Cohen, R., Mendez, J., Patey, P., Boudreau, D., & Berard, M. (1992). An Objective Structured Clinical Examination for the Licentiate: Report of the Pilot Project of the Medical Council of Canada. Academic Medicine, 67, 487-494. https://doi.org/10.1097/00001888-199208000-00001
Standardized Patients—UBC Faculty of Medicine (n.d.). https://www.med.ubc.ca/about/careers/standardized-patient-program
Swartz, M. H., Colliver, J. A., Bardes, C. L., Charon, R., Fried, E. D., & Moroff, S. (1997). The Validity of Standardized Patient Assessment Using Faculty-Physician Global Ratings as the Gold-Standard Criterion. In Advances in Medical Education (pp. 725-727). Berlin: Springer. https://doi.org/10.1007/978-94-011-4886-3_219
UBC 2018/2019 Budget (Issue April 2018) (2019). https://vpfinance.ubc.ca/files/2018/06/2018_2019_Operating_Budget.pdf
Vash, J. H., Yunesian, M., Shariati, M., Keshvari, A., & Harirchi, I. (2007). Virtual Patients in Undergraduate Surgery Education: A Randomized Controlled Study. ANZ Journal of Surgery, 77, 54-59. https://doi.org/10.1111/j.1445-2197.2006.03978.x