By Nicole Fauteux
Virtual patients may soon become a mainstay of education within the
health professions schools at the University of Pittsburgh (Pitt). A project
that began in the School of Medicine’s Laboratory for Educational Technology is
now influencing teaching and learning at the Schools of Dental Medicine, Pharmacy,
Nursing, and Health and Rehabilitation Sciences, thanks to an interprofessional
contract with the National Institutes of Health (NIH) and to individual
professors who have embraced the use of simulated clinical encounters.
Virtual patients are computer-based scenarios that simulate interactions
with actual patients. Students play the role of health professionals who
diagnose and plan treatments for the virtual patients. Case scenarios range
from the simple to the complex, following linear or branching narratives and
engaging students, to varying degrees, in problem-solving.
According to one systematic review of the use of virtual patients in
medical education, this teaching tool offers distinct benefits. It gives faculty
a way to expose students to rare but critical cases without putting actual
patients at risk and allows for the customization of student learning without
overburdening instructors. Despite these strengths, the review also found that
cost, the complexity of authoring virtual cases and the difficulty of
integrating them in curricula posed barriers to the widespread adoption of
At Pitt, a team at the Laboratory for Educational Technology appears
to have overcome many of these hurdles with their creation of vpSim™, an
authoring software that allows faculty to create virtual patient cases at a
reasonable cost and with relative ease. The work of Elizabeth Bilodeau, D.M.D.,
M.D., M.S.Ed., Assistant Professor, Oral & Maxillofacial Pathology, supports this notion. She has used vpSim to design several cases,
one of which is publicly available on the vpSim website (see Resources).
“I have a love/hate relationship with most technology, but I thought
this was approachable,” she says. “The process becomes quite intuitive.”
The vpSim software
provides templates for entering patient information and employs a drag-and-drop
interface that allows users to create a visual map of the nodes and branches
that make up each facet of a case. The use of a branching narrative structure
allows students to make mistakes, acquire new knowledge and then start again
down a different path.
has produced 10 virtual patient cases so far. She estimates that she can
complete a short, linear case in a couple of hours, or complete something more
complex over the course of several mornings. Last year, she began collaborating
with two colleagues in the emergency dental clinic on cases that could
supplement third- and fourth-year clinical instruction.
“Creating virtual cases is a great way for people to collaborate who
might not otherwise have that opportunity,” she says. “You learn how different
your perspectives are.”
Collaboration is the watchword on another project at Pitt that also uses
virtual patients. The university is one of 12 nationwide designated as a Center
of Excellence in Pain Education. Each center has been tasked with producing and
evaluating eLearning modules to improve education in pain management across the
Heiko Spallek, D.M.D., Ph.D., M.S.B.A., Associate Dean for Faculty
Affairs and Associate Professor of Dental Public Health in the School of Dental
Medicine, contributes his expertise in instructional technology to the project,
which he co-directs with nationally recognized pain expert Debra K. Weiner, M.D.,
Professor of Medicine, Psychiatry and Anesthesiology. Their interprofessional
team is using written information, graphics, audio and video to bring a series
of virtual patient cases to life.
Students respond well to this multi-media approach and enjoy the
interactivity of the cases, but Dr. Spallek does not think that an expert in
pain management should have to learn to use a video camera or coach actors to
take advantage of this technology.
people don’t repair their own cars or put shingles on their own roofs,” he
observes. “Why would we expect our dental educators to suddenly become movie
directors? I’m a big believer that faculty need support for this.”
The School of Dental Medicine provides that
support in the form of a studio with multiple cameras, professional audio, paid
standardized patients and a media specialist who devotes all of her time to
producing high quality educational media. Nevertheless, Dr. Spallek believes
that schools lacking these facilities and support staff can still create
“We all have PowerPoint slides and cases in our
electronic health records,” he notes. “You don’t have to do it as
professionally as we do.” As for cost, he points out that as more and more
information storage migrates to the Cloud, institutions can reallocate some of
their resources for IT support to instructional technology. That is one of the
ways the School of Dental Medicine is funding its support of eLearning.
As an NIH Pain Consortium Center, Pitt has contracted to produce six
curriculum modules in the form of virtual patient case scenarios that can be
integrated into curricula across the health professions. A research study into
the effectiveness of the first of these scenarios showed that medical students who
completed the virtual case were significantly better able than their peers to
evaluate chronic low back pain in an Objective Structured Clinical Examination.
Each finished scenario will be tested, added to a national database of virtual
patient cases and submitted to MedEdPORTAL.