Case Studies: Karolinska Institutet

Uno Fors and Nabil Zary from the Karolinska Institutet talk about how they have used VPs in their institution.


Karolinska Institutet used the Web-SP virtual patient player. Information about the VP system can be found here, and the entry point for students here.

VPs were used by the following students:

  • Medical students (pre-clinical and clinical undergraduate)
  • Nursing students (clinical undergraduate and postgraduate)
  • Dentistry and related professions (pre-clinical and clinical undergraduate, training prior to licensing for dentists with foreign degrees)
  • Physiotherapists (undergraduates)
  • Laboratory engineers (undergraduate)
  • Coaching (k12 schools, unemployment agency)
  • Teacher training (“Virtual Students”)

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Educational Scenarios

Currently, our VPs are mainly used in the undergraduate clinical courses, both for self learning/assessment and jointly with scheduled seminars. The students targeted are on campus, in hospitals and in remote locations.

Different types of VPs were used, each one customizable for a discipline and/or educational level. All VPs included multimedia such as images, audio, movies and flash animations. The VP flow and interactivity is unrestricted. Feedback provided to the students was partly individualized and generic where the students compared their answers with the experts.

Finally, VPs have replaced paper-based cases in several disciplines.
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Curricula Integration

VPs are used by the faculty during lectures to illustrate a clinical disease and as a student activating method.

A bank of VPs is being developed and provided as a mandatory activity during the clinical rotations to ensure that students have encountered the most common diseases.

With the implementation of the Bologna process VPs are, to a greater extent, coupled to specific learning objectives.
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Integration with Other e-Learning Opportunities

In distance learning courses, VPs are usually made accessible via Ping Pong (Ki’s official learning management system) embedded as a required course activity.

For campus students VPs are accessible via the course portal, tied to a scheduled activity or via a separate entry point (
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Technical Integration

A single sign-in procedure is currently being tested to ease the administration. We are also evaluating whether some of the tools in the VLE could be made available within the VPs (e.g., synchronous/asynchronous communication tools).

Finally, an integration of the administrative tools and scoring tools is being investigated.
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VPs for Assessment

Web-SP is used in formative assessment in medicine (paediatrics), dentistry (comprehensive dentistry) and nursing (clinical diagnostics).
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Evaluation of VPs

We have conducted evaluations in several disciplines (medicine, nursing and dentistry) with focus on the acceptance, usability and learning as an assessment method.

N Zary, G Johnson, J Boberg, U Fors. Development, implementation and pilot evaluation of a web-based virtual patient case simulation environment – Web-SP. Biomed Central Medical Education 2006.

Zary N, Johnson G, Fors U. Web-based virtual patients in dentistry: Factors influencing the use of cases in the Web-SP system. (Accepted for publication in the European Journal of Dental Education, 2007).

Sandberg M, Youngblood P, Hayes J, et al. Student acceptance of web-based simulated patients for assessment. E-Learn 2007, Quebec, Canada.

Gunning W, Crist K, Zary N, Fors U. Medical student attitudes and perceptions of a web-based virtual patient case simulation environment (Web-SP) for problem-based learning discussion groups. AMEE 2007, Trondheim, Norway.

P Brutlag, P Youngblood, E Ekorn, et al. Determining the best methods: Validation of content and scoring for a web-based assessment tool in medical education. E-Learn 2006, Honolulu, Hawaii, USA.

N Zary, N Gesundheit, Dev P, et al. Case-based exams using a Web-based patient case simulation system (Web-SP). AMEE 2006, Genoa, Italy.
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Future Plans

The main focus will be on creating a bank of VPs that match the curricular learning objectives set as part of the Bologna process, combined with the increased implementation of VPs throughout all the curricula at KI.

Additionally we envisage the creation of a national repository of VPs during the lifetime of the eViP project.
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Any Advice?

Evaluate the need to use VPs based on the set learning objectives. Adopt a student-centered approach and when creating VPs seek best evidence in the published scientific literature.
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