Virtual Patient cases (VP cases) promote learning, teaching, and assessment of clinical reasoning and can stimulate and motivate active learning experiences in nursing education. The aim of the study was to investigate the use of VP cases for active student participation in nursing education regarding students’ learning experiences of clinical reasoning. After an intervention using VP cases in the graduate nursing program, 174 evaluation questionnaires were collected from the students. The questionnaire consisted of open-ended questions that covered students’ learning experiences using VP cases. Deductive content analysis was used with a focus on the students’ learning experiences. The results showed that the use of the VP cases provided a comprehensive view of the patient and encouraged the students to broaden their thinking and helped them in drawing conclusions and in structuring their problem - solving. The VP cases also stimulated their learning process and reflection. Their knowledge was challenged, and this motivated them to search for more knowledge that was then followed up in the VP cases. The students found that the VP cases provided support in translating theoretical knowledge into clinical reasoning, and they facilitated the application of theory in practice and encouraged the students to use their clinical reasoning. The VP cases allowed for self-evaluation, which was a motivating force and increased their awareness of their abilities for clinical reasoning. Learning experiences from VP cases seem to be applicable in higher education and seem especially useful in enabling nursing students to apply theory in their clinical practice. Experiential learning theory supports the learning experiences from VP cases in clinical reasoning. In addition, working with VP cases seems to promote active student participation.
Aper, L., Reniers, J., Derese, A., & Veldhuijzen, W. (2014). Managing the Complexity of Doing It All: An Exploratory Study on Students’ Experiences When Trained Stepwise in Conducting Consultations. BMC Medical Education, 14, 206. https://doi.org/10.1186/1472-6920-14-206
Barrineau, S., Engstrom, A., & Schnaas, U. (2019). An Active Student Participation Companion. Division for Quality Enhancement Unit for Academic Teaching and Learning. Uppsala, Sweden: Uppsala University.
Bengtson, C., Ahlqvist, M., Ekeroth, W., Nilsen-Moe, A., ProosVedin, N., Rodiuchkina, K., Ye, S., & Lundberg, M. (2017).Working as Partners: Course Development by a Student—Teacher Team. International Journal for the Scholarship of Teaching and Learning, 11, Article 6. https://doi.org/10.20429/ijsotl.2017.110206
Bergin, R. A., & Fors, U. G. (2003). Interactive Simulated Patient—An Advanced Tool for Student-Activated Learning in Medicine and Healthcare. Computers & Education, 40, 361-376. https://doi.org/10.1016/S0360-1315(02)00167-7
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
Bloomfield, J., Fordham-Clarke, C., Pegram, A., & Cunningham, B. (2010). The Development and Evaluation of a Computer-Based Resource to Assist Pre-Registration Nursing Students with Their Preparation for Objective Structured Clinical Examinations (OSCEs). Nurse Education Today, 30, 113-117. https://doi.org/10.1016/j.nedt.2009.06.004
Cendan, J., & Lok, B. (2012). The Use of Virtual Patients in Medical School Curricula. Advances in Physiology Education, 36, 48-53.
Consorti, F., Mancuso, R., Nocioni, M., & Piccolo, A. (2012). Efficacy of Virtual Patients in Medical Education: A Meta-Analysis of Randomized Studies. Computers & Education, 59, 1001-1008. https://doi.org/10.1016/j.compedu.2012.04.017
Cook, D. A., & Triola, M. M. (2009). Virtual Patients: A Critical Literature Review and Proposed Next Steps. Medical Education, 43, 303-311. https://doi.org/10.1111/j.1365-2923.2008.03286.x
Cook, D. A., Erwin, P., & Triola, M. M. (2010). Computerized Virtual Patients in Health Professions Education: A Systematic Review and Meta-Analysis. Academic Medicine, 85, 1589-1602. https://doi.org/10.1097/ACM.0b013e3181edfe13
Crisp, N., Gawanas, B., & Sharp, I. (2008). Training the Health Workforce: Scaling Up, Saving Lives. The Lancet, 371, 689-691. https://doi.org/10.1016/S0140-6736(08)60309-8
Delany, C., & Golding, C. (2014). Teaching Clinical Reasoning by Making Thinking Visible: An Action Research Project with Allied Health Clinical Educators. BMC Medical Education, 14, 20. https://doi.org/10.1186/1472-6920-14-20
Edelbring, S., Dastmalchi, M., Hult, H., Lundberg, I. E., & Dahlgren, L. O. (2011). Experiencing Virtual Patients in Clinical Learning: A Phenomenological Study. Advances in Health Sciences Education, 16, 331-345. https://doi.org/10.1007/s10459-010-9265-0
Ellaway, R., Poulton, T., Fors, U., McGee, J. B., & Albright, S. (2008). Building a Virtual Patient Commons. Medical Teacher, 30, 170-174. https://doi.org/10.1080/01421590701874074
Eva, K. W. (2005). What Every Teacher Needs to Know about Clinical Reasoning. Medical Education, 39, 98-106. https://doi.org/10.1111/j.1365-2929.2004.01972.x
Forsberg, E., Georg, C., Ziegert, K., & Fors, U. (2011). Virtual Patients for Assessment of Clinical Reasoning in Nursing—A Pilot Study. Nurse Education Today, 31, 757-762. https://doi.org/10.1016/j.nedt.2010.11.015
Forsberg, E., Ziegert, K., Hult, H., & Fors, U. (2014). Clinical Reasoning in Nursing, a Think-Aloud Study Using Virtual Patients—A Base for an Innovative Assessment. Nurse Education Today, 34, 538-542. https://doi.org/10.1016/j.nedt.2013.07.010
Forsberg, E., Ziegert, K., Hult, H., & Fors, U. (2016). Assessing Progression of Clinical Reasoning through Virtual Patients: An Exploratory Study. Nurse Education in Practice, 16, 97-103. https://doi.org/10.1016/j.nepr.2015.09.006
Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., Fineberg, H., Garcia, P., Ke, Y., Kelley, P., Kistnasamy, B., Meleis, A., Naylor, D., Pablos-Mendez, A., Reddy, S., Scrimshaw, S., Sepulveda, J., Serwadda, D., & Zurayk, H. (2010). Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World. The Lancet, 376, 1923-1958. https://doi.org/10.1016/S0140-6736(10)61854-5
Georg, C., & Zary, N. (2014). Web-Based Virtual Patients in Nursing Education: Development and Validation of Theory-Anchored Design and Activity Models. Journal of Medical Internet Research, 16, e105. https://doi.org/10.2196/jmir.2556
Gesundheit, N., Brutlag, P., Youngblood, P., Gunning, W. T., Zary, N., & Fors, U. (2009). The Use of Virtual Patients to Assess the Clinical Skills and Reasoning of Medical Students: Initial Insights on Student Acceptance. Medical Teacher, 31, 739-742. https://doi.org/10.1080/01421590903126489
Graneheim, U. H., & Lundman, B. (2004). Qualitative Content Analysis in Nursing Research: Concepts, Procedures and Measures to Achieve Trustworthiness. Nurse Education Today, 24, 105-112. https://doi.org/10.1016/j.nedt.2003.10.001
Hsieh, H. F., & Shannon, S. E. (2005). Three Approaches to Qualitative Content Analysis. Qualitative Health Research, 15, 1277-1288. https://doi.org/10.1177/1049732305276687
Hunter, S., & Arthur, C. (2016). Clinical Reasoning of Nursing Students on Clinical Placement: Clinical Educators’ Perceptions. Nurse Education in Practice, 18, 73-79. https://doi.org/10.1016/j.nepr.2016.03.002
Huwendiek, S. (2016). Virtual Patients for Learning of Clinical Reasoning. Doctoral Thesis, Maastricht, Netherlands: Maastricht University.
Jessee, M. A., & Tanner, C. A. (2016). Pursuing Improvement in Clinical Reasoning: Development of the Clinical Coaching Interactions Inventory. Journal of Nursing Education, 55, 495-504. https://doi.org/10.3928/01484834-20160816-03
Johannesson, E., Silén, C., Kvist, J., & Hult, H. (2013). Students’ Experiences of Learning Manual Clinical Skills through Simulation. Advances in Health Sciences Education, 18, 99-114. https://doi.org/10.1007/s10459-012-9358-z
Kolb, D. A. (1984). Experiential Learning: Experience as the Source of Learning and Development (Vol. 1). Englewood Cliffs, NJ: Prentice-Hall.
Konak, A., Clark, T. K., & Nasereddin, M. (2014). Using Kolb’s Experiential Learning Cycle to Improve Student Learning in Virtual Computer Laboratories. Computers & Education, 72, 11-22. https://doi.org/10.1016/j.compedu.2013.10.013
Kononowicz, A., Zary, N., Edelbring, S., Corral, J., & Hege, I. (2015). Virtual Patients—What Are We Talking about? A Framework to Classify the Meanings of the Term in Healthcare Education. BMC Medical Education, 15, 11. https://doi.org/10.1186/s12909-015-0296-3
Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S. Y., Noble, D., Norton, C. A., Roche, J., & Hickey, N. (2010). The ‘Five Rights’ of Clinical Reasoning: An Educational Model to Enhance Nursing Students’ Ability to Identify and Manage Clinically ‘at Risk’ Patients. Nurse Education Today, 30, 515-520. https://doi.org/10.1016/j.nedt.2009.10.020
Mishra, A., Rani, S., & Bhardwaj, U. D. (2017). Effectiveness of E-learning Module on First Aid: A Study on Student Nurses. International Journal of Nursing Education, 9, 6-10. https://doi.org/10.5958/0974-9357.2017.00060.5
Padilha, J. M., Machado, P., Ribeiro, A., & Ramos, J. (2018). Clinical Virtual Simulation in Nursing Education. Clinical Simulation in Nursing, 15, 13-18. https://doi.org/10.1016/j.ecns.2017.09.005
Salminen, H., Zary, N., Bjorklund, K., Toth-Pal, E., & Leanderson, C. (2014). Virtual Patients in Primary Care: Developing a Reusable Model That Fosters Reflective Practice and Clinical Reasoning. Journal of Medical Internet Research, 16, e3. https://doi.org/10.2196/jmir.2616
Sandars, J. (2009). The Use of Reflection in Medical Education: AMEE Guide No. 44. Medical Teacher, 31, 685-695. https://doi.org/10.1080/01421590903050374
Statens Offentliga Utredningar (SOU) (2016). For digitalisering i tiden. Slutbetankande av Digitaliseringskommissionen (No. 89). Stockholm. https://www.regeringen.se/4af25c/contentassets/f7d07b214e2c459eb5757cea206e6701/sou-2016_89_webb.pdf https://www.regeringen.se/4af25c/contentassets/.../sou-2016_89_webb.pdf
Sperl-Hillen, J., O’Connor, P. J., Ekstrom, H. L., Rush, W. A., Asche, S. E., Fernandes, O. D., Apana, D., Amundson, G. H., Johnson, P. E., & Curran, D. M. (2014). Educating Resident Physicians Using Virtual Case-Based Simulation Improves Diabetes Management: A Randomized Controlled Trial. Academic Medicine, 89, 1664-1673. https://doi.org/10.1097/ACM.0000000000000406
Sunnqvist, C., Karlsson, K., Lindell, L., & Fors, U. (2016). Nurse Education in Practice Virtual Patient Simulation in Psychiatric Care: A Pilot Study of Digital Support for Collaborative Learning. Nurse Education in Practice, 17, 30-35. https://doi.org/10.1016/j.nepr.2016.02.004
Tiffany, J. M., & Hoglund, B. (2016). Using Virtual Simulation to Teach Inclusivity: A Case Study. Clinical Simulation in Nursing, 12, 115-122. https://doi.org/10.1016/j.ecns.2015.11.003
Tschannen, D., Aebersold, M., McLaughlin, E., Bowen, J., & Fairchild, J. (2012). Use of Virtual Simulations for Improving Knowledge Transfer among Baccalaureate Nursing Students. Journal of Nursing Education and Practice, 2, 15-24. https://doi.org/10.5430/jnep.v2n3p15
Wilson, J. I. (2012). A Qualitative Study of Postgraduate Students’ Perceptions of Virtual Patients in Emergency Medicine Tutorials. International Journal of Medical Education, 3, 115-123. https://doi.org/10.5116/ijme.4fea.1918
Yardley, S., Teunissen, P. W., & Dornan, T. (2012). Experiential Learning: AMEE Guide No. 63. Medical Teacher, 34, e102-e115. https://doi.org/10.3109/0142159X.2012.650741
Ypinazar, V. A., & Margolis, S. A. (2006). Clinical Simulators: Applications and Implications for Rural Medical Education. Rural and Remote Health, 6, 527.
Zary, N., Johnson, G., Boberg, J., & Fors, U. G. (2006). Development, Implementation and Pilot Evaluation of a Web-Based Virtual Patient Case Simulation Environment-Web-SP. BMC Medical Education, 6, 10. https://doi.org/10.1186/1472-6920-6-10