gms | German Medical Science

Objective: Virtual patients (VPs) represent an important pillar of clinical reasoning (CR) training in undergraduate curricula, and their effectiveness has been empirically demonstrated [1]. This work aims to develop a theory-based framework that (1) proposes a didactic conceptualisation of clinical reasoning and its components optimised for VPs, and (2) provides an author’s guide for effective VP design.

Methods: The didactic part of the CR framework was developed iteratively, involving literature reviews and CR journal club discussions. The main components were identified and synthesised regarding their didactic communicability through VP scenarios. For the development of the authors’ guide, medical education experts and students reviewed approximately 100 VP cases from a national VP project using validated instruments [2]. Best practice recommendations from successful case scenarios were compiled and categorised according to content, didactic and technical recommendations. This synthesis was reviewed and finalised by educational researchers.

Results: The result is a worksheet with checklists that systematically guides authors through the content, technological and didactic components of creating VP scenarios. The didactic core of the guideline consists of a 6-step process for the didactic teaching of diagnostic reasoning using VPs, which was derived following the logic of clinical bedside encounters (1. get a first impression, 2. get an overview, 3. make lists for differential diagnoses, 4. narrow down diagnoses clinically, 5. narrow down differential diagnoses by specific diagnostics, 6. commit to a diagnosis).

Discussion: Our resulting approach is a theory-based, peer process with an optimised didactic concept for utilising VPs to teach components of clinical reasoning and providing a corresponding guide to creating effective VP cases. The following steps will be student evaluations to analyse to what extent the developed concept supports the acquisition of CR competencies through VP scenarios.

Take home message: The creation of VPs to teach CR competencies should follow a didactic concept that takes into account both the theoretical complexity of CR and the opportunities of the online platforms where CR training is offered.