JMIR Publications

ABSTRACT

Background:

Clinical internal medicine practice training courses are primarily based on traditional case-based teaching, which limits the development of students' clinical thinking skills and also places pressure on instructors. The use of Virtual Standardized Patients (VSPs) applications could be an alternative. However, there is limited evidence regarding their feasibility and effectiveness.

Objective:

Utilizing the "Body Interact" interactive diagnostic and teaching system, which employs virtual standardized patients to provide 3D virtual simulated patients and mimic virtual clinical scenarios, medical students are trained through system-preset cases. This training encompasses the entire process from medical history collection, condition analysis, diagnosis and differential diagnosis, to treatment, aiming to cultivate their clinical thinking abilities.

Methods:

A randomized controlled trial was conducted from October 20, 2022, to October 20, 2024. Sixty medical students interning at Quzhou People's Hospital were enrolled and divided into two groups: the experimental group receiving VSP training (n=30, 50%) and the control group receiving traditional academic training (n=30, 50%). The teaching effectiveness was evaluated using basic knowledge assessments and virtual system scoring. After completing the course, students were surveyed with a questionnaire to assess their satisfaction with the course. Additionally, a satisfaction questionnaire was administered to six instructors to uncover their perceptions of VSPs.

Results:

All enrolled medical students completed the study. In the evaluation of training effectiveness, the experimental group showed significantly greater improvement in theoretical scores compared to the control group (mean 17.07, SD 4.24 vs. mean 10.67, SD 4.91, F=29.196, P<0.001); the total score improvement in the virtual clinical thinking training system test was also significantly better in the experimental group than in the control group (mean 42.60, SD 9.56 vs. mean 31.63, SD 7.24, F=25.102, P<0.001). Specifically, improvements in consultation skills (mean 8.76, SD 1.67 vs. mean 7.66, SD 2.08, F=31.092, P<0.001), overall objective improvement (mean 11.97, SD 2.77 vs. mean 8.15, SD 2.62; F=30.080, P<0.001), initial diagnostic ability (mean 8.74, SD 1.67 vs. mean 7.66, SD 2.08; F=4.913, P=0.031), and ability to provide patient treatment (mean 7.23, SD 2.41 vs. mean 5.72, SD 2.19; F=6.421, P=0.014) were significantly higher in the experimental group than in the control group. The questionnaire results indicated that 90% of the students who participated in the VSPs training believed it could enhance their clinical thinking abilities.

Conclusions:

VSPs reinforce the foundational knowledge of internal medicine among medical students and enhance their clinical thinking abilities, as well as improve their capacity for independent work. The VSPs system is feasible, practical, and cost-effective, making it worthy of further promotion in clinical education.