JMIR Publications

ABSTRACT

Background:

Effective, low-cost and easy-to-implement training tools may be useful to improve the quality of primary healthcare services in resource-limited settings. Virtual patients (VPs), sophisticated educational simulations designed to replicate authentic clinical scenarios, are considered as cost-effective and convenient tools for clinical training. The research team developed a smartphone-based VP tailored to the needs of primary healthcare physicians in rural China. The VP demonstrated high levels of feasibility and acceptability in this group.

Objective:

The proposed cluster randomized controlled trial (RCT) will compare the efficacy of clinical training delivered by a smartphone-based VP in increasing diagnosis and treatment competence among primary healthcare providers in rural China, as compared to a wait-list control.

Methods:

This is a partially blinded (outcome assessors and data analysts) and parallel group cluster RCT conducted in Lintao county, China. All 18 township health centres in Lintao will be randomized evenly into either the intervention or the wait-list control groups. The target sample size is 150 physicians per group. Physicians in the intervention group will receive clinical training delivered by the smartphone-based VP. They will be required to complete the diagnosis and treatment plan of 2 conditions randomly assigned by the VP within a 1-month intervention period. The VP will provide detailed feedbacks on their procedures. The intervention group can also access 9 other conditions in the VP and receive detailed feedbacks during the intervention period. Participants in the control group will not have access to any clinical training delivered by the VP during the 1-month intervention period. They will gain full access to the VP system after completion of the outcome assessment at T1 (one month after baseline [T0]). The primary outcome is the score representing overall diagnosis and treatment competence. To measure this outcome, participants will be invited to complete the diagnosis and treatment plan of a condition randomly assigned by the smartphone-based VP at both T0 and T1. Intention-to-treat analysis will be performed.

Results:

Study recruitment will start in August 2026. Recruitment will be completed by the end of May 2027. The follow-up evaluation will start in September 2026. The data collection is expected to be concluded in June 30, 2027.

Conclusions:

The findings will extend the application of smartphone-based VPs in medical training. If the smartphone-based VP is proven effective in increasing diagnosis and treatment competence among primary healthcare physicians in rural China, it will require relatively less resources to implement and maintain. It can be integrated into the existing training programs for primary healthcare providers and creates public health impacts. Clinical Trial: Chinese Clinical Trial Registry (Reference number: ChiCTR2600127364).