Computer simulations of the clinical encounter : perceptions and emotional aspects

The aim of this thesis was to examine the issues surrounding affective learning, perceived effectiveness, student motivation and engagement in computer simulations of patient encounters. Offering a high degree of realism, authenticity and interactivity, the Interactive Simulation of Patients (ISP) system, a Virtual Patient (VP) environment, was found to be a good technological candidate for conducting this research.

Four studies were undertaken within the framework of this thesis: Study I investigated if shared VP environments would enhance student learning and support collaborative learning. Study 2 evaluated the potential of ISP-like systems as possible tools for assessment of clinical reasoning and problem solving ability among medical students. Study 3 assessed medical students appraisals of a mixed virtual reality simulation for endoscopic surgery by exploring the potential benefits of this kind of contextualized learning experience. Study 4 aimed to extend the empirical findings from the previous studies and achieve a better understanding of students feelings of patient presence and reactions to a video-mediated VP encounter.

The results support a number of conclusions about ISP-like learning environments: They are perceived as compelling, innovative, realistic, and effective learning tools. They support active student involvement in clinical problem solving. They seem to motivate students due to their meaningful, authentic, and contextualized learning environment. They stimulate student engagement in the learning activity and have the potential to promote social interaction. They encourage critical thinking and enhance learning when the VP cases are solved in a collaborative setting. Extensive interactivity, natural conversational interface and video-filmed patient (actor) are key factors for the sense of presence and emotional involvement. They are able to present and simulate realistic patient encounters to an acceptable level of complexity and allow differentiation of student s performance for assessment purposes. They might enhance contextualization and authenticity in mixed reality simulation.

The four studies demonstrated that high-fidelity computer simulations of the clinical encounter are good technological mediators to activate, motivate and engage students, resulting in possibilities of effective knowledge building, better understanding of the situated experience, increased confidence in clinical problem solving, and enhanced memory retention.

List of scientific papers

I. Bergin R, Youngblood Y, Ayers M, Boberg J, Bolander K, Courteille O, Dev P, Hindbeck H, Stringer J, Thalme A, Fors U (2003). Interactive simulated patient experiences with collaborative e-learning in medicine. Journal of Educational Computing Research. 29(3): 387-400.

II. Courteille O, Bergin R, Stockeld D, Ponzer S, Fors U (2008). The use of a virtual patient case in an OSCE-based exam--a pilot study. Med Teach. 30(3): e66-76.
https://pubmed.ncbi.nlm.nih.gov/18484444

III. Courteille O, Felländer-Tsai L, Hedman L, Kjellin A, Enochsson L, Lindgren G, Fors U (2008). Mixed reality simulation taking endoscopic simulation one step further. Medical Education. [Submitted]

IV. Courteille O, Larsson LO, Fors U (2008). Medical students perceptions, observed behaviors and attitudes towards a virtual patient driven computer-mediated learning experience. [Submitted]