Dr Bas de Leng talks about the mini-symposium on virtual patients

“VPs will not replace real patient encouters”: Dr Bas de Leng talks about the mini-symposium on virtual patients

Sian Claire Owen

Dr Bas de Leng from the Faculty of Health Medicine and Life Sciences at Maastricht University in The Netherlands was instrumental in organizing the recent Mini-Symposium on Virtual Patients.

At this event medical teachers, learning technologists and students involved in the field of virtual patients and simulations in health care education had the opportunity to discuss, often frankly, issues in this area. Here, Bas discusses his ideas behind the symposium and the importance of holding these events.
Firstly Bas, can you tell us why you arranged this symposium?

There were three reasons why the e-learning task-group at the Faculty of Health Medicine and Life Sciences of Maastricht University organized this symposium.

Firstly, we wanted to raise awareness of eViP VP collection that the consortium develops within the Dutch community of eight University Medical Centres. We also wanted to encourage collaborations on a national level in exchanging and repurposing VPs, and to encourage the sharing of good practice with the implementation of VPs.

We also wanted to raise awareness of the feasibility of VPs as tools for different educational goals and settings among the medical educators at Maastricht University Medical Centre. Additionally, we aimed to show how other medical schools in Europe currently manage to implement VPs in their problem based learning (PBL) curriculum. Our aim was to get the medical teacher involved in constructing and implementing VPs in the Maastricht medical curriculum.

Finally, we wanted to share within the eViP consortium the results of local evaluations of VP use at different eViP partner institutions, and to use this mutual knowledge in the planning and coordination of activities of the workpack ‘evaluation and assessment’ in the last year of the eViP project.

Whilst the value of VPs was explained very well in the presentations, there did seem to be some concern that VPs could negate the experience of working with real patients. How do you respond to this?

Perhaps the specific focus on VPs in the presentations was a bit overwhelming for medical educators who mainly work with real patients during their education! Also the tendency to compare two different educational methods in a kind of ‘horserace manner’ might be a reason.

However, it is important to say that a real patient encounter can never be matched by a VP encounter!

But the question is whether the amount, diversity and the specificity of these encounters and their adaptability to the learner (e.g. cognitive load, feedback etc) is enough to serve all the students involved. One delegate stated this, but I wonder if that is true.

When it comes to supplementing the current supply of real patients in certain trajectories of the medical curriculum I can’t see a threat. Of course, we always have to be careful not to overload an already full program, but that is independent of whether it concerns VPs or other educational methods.
Are we over-estimating the obstacles in accessing real patients?

I don’t think so. Current short hospital stays of patients and a shortage of clinicians are often mentioned in the literature as a problem for medical education. And the fact that even the Liaison Committee on Medical Education is prepared to accept ‘simulated learning experiences’ as equivalents to real patient encounters for accreditation purposes indicates that there must be a serious problem with access to real patient for medical training.

Do you think the financial cost and time needed to create VPs is prohibitive?

It doesn’t need to be. By the collaborative and distribute development of VPs we can reduce effort and costs of individual medical schools because this can prevent ‘reinventing the wheel’ by, for instance, making an authoring tool that already exists. It can also prevent overlap in the local collections that are developed.

Re-using materials of others might prove to be more effective than developing from scratch. Also the teaching method and content can be peer reviewed increasing the acceptance by others than the initial developers.

For a bigger community it will be easier to arrange funding for maintenance and updating a collection, and sharing experiences and good practices will help teachers with the pedagogic and strategic problems they will encounter when using VPs.

Was the mini-symposium a success?

Yes it definitely was! We brought together European, national and local bodies involved or interested in VPs. This is very important for dissemination purposes and to further professionalize the use of VPs in medical education.

I was very happy to receive an e-mail response from a delegate responsible for part of the local medical curriculum, saying: “This was a very interesting symposium that gave us interesting ideas for our curriculum. I would like to work out plans together with some colleagues and the e-learning unit for a pilot with VPs in our education.” I was also approached by a delegate with a request to do a multi-centre study concerning the use of VPs for clinical reasoning, which was very encouraging!

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