Please use this identifier to cite or link to this item:
Title: Virtual patient simulations in health professions education: systematic review and meta-analysis by the digital health education collaboration
Authors: Kononowicz, Andrzej A.
Woodham, Luke A.
Edelbring, Samuel
Stathakarou, Natalia
Davies, David
Saxena, Nakul
Tudor Car, Lorainne
Carlstedt-Duke, Jan
Car, Josip
Zary, Nabil
Keywords: Science::Medicine
Professional Education
Computer Simulation
Issue Date: 2019
Source: Kononowicz, A. A., Woodham, L. A., Edelbring, S., Stathakarou, N., Davies, D., Saxena, N., . . . Zary, N. (2019). Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. Journal of Medical Internet Research, 21(7), e14676-. doi:10.2196/14676
Series/Report no.: Journal of Medical Internet Research
Abstract: Background: Virtual patients are interactive digital simulations of clinical scenarios for the purpose of health professions education. There is no current collated evidence on the effectiveness of this form of education. Objective: The goal of this study was to evaluate the effectiveness of virtual patients compared with traditional education, blended with traditional education, compared with other types of digital education, and design variants of virtual patients in health professions education. The outcomes of interest were knowledge, skills, attitudes, and satisfaction. Methods: We performed a systematic review on the effectiveness of virtual patient simulations in pre- and postregistration health professions education following Cochrane methodology. We searched 7 databases from the year 1990 up to September 2018. No language restrictions were applied. We included randomized controlled trials and cluster randomized trials. We independently selected studies, extracted data, and assessed risk of bias and then compared the information in pairs. We contacted study authors for additional information if necessary. All pooled analyses were based on random-effects models. Results: A total of 51 trials involving 4696 participants met our inclusion criteria. Furthermore, 25 studies compared virtual patients with traditional education, 11 studies investigated virtual patients as blended learning, 5 studies compared virtual patients with different forms of digital education, and 10 studies compared different design variants. The pooled analysis of studies comparing the effect of virtual patients to traditional education showed similar results for knowledge (standardized mean difference [SMD]=0.11, 95% CI −0.17 to 0.39, I2=74%, n=927) and favored virtual patients for skills (SMD=0.90, 95% CI 0.49 to 1.32, I2=88%, n=897). Studies measuring attitudes and satisfaction predominantly used surveys with item-by-item comparison. Trials comparing virtual patients with different forms of digital education and design variants were not numerous enough to give clear recommendations. Several methodological limitations in the included studies and heterogeneity contributed to a generally low quality of evidence. Conclusions: Low to modest and mixed evidence suggests that when compared with traditional education, virtual patients can more effectively improve skills, and at least as effectively improve knowledge. The skills that improved were clinical reasoning, procedural skills, and a mix of procedural and team skills. We found evidence of effectiveness in both high-income and low- and middle-income countries, demonstrating the global applicability of virtual patients. Further research should explore the utility of different design variants of virtual patients.
ISSN: 1439-4456
DOI: 10.2196/14676
Schools: Lee Kong Chian School of Medicine (LKCMedicine) 
Organisations: Centre for Population Health Sciences
Games for Health Innovations Centre
Rights: © 2019 Andrzej A Kononowicz, Luke A Woodham, Samuel Edelbring, Natalia Stathakarou, David Davies, Nakul Saxena, Lorainne Tudor Car, Jan Carlstedt-Duke, Josip Car, Nabil Zary. Originally published in the Journal of Medical Internet Research (, 01.07.2019. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.
Fulltext Permission: open
Fulltext Availability: With Fulltext
Appears in Collections:LKCMedicine Journal Articles

Files in This Item:
File Description SizeFormat 
Virtual Patient Simulations in Health Professions Education.pdf547.39 kBAdobe PDFThumbnail

Citations 5

Updated on May 27, 2024

Web of ScienceTM
Citations 5

Updated on Oct 30, 2023

Page view(s) 50

Updated on Jun 14, 2024

Download(s) 10

Updated on Jun 14, 2024

Google ScholarTM




Items in DR-NTU are protected by copyright, with all rights reserved, unless otherwise indicated.