The Use of Virtual Standardized Patients for Practice in High Value Care

Abstract

Introduction: This study examined the influence of high value care (HVC)-focused virtual standardized patients (VSPs) on learner attitudes toward cost-conscious care (CCC), performance on subsequent standardized patient (SP) encounters, and the correlation of VSP performance with educational outcomes.

Method: After didactic sessions on HVC, third-year medical students participated in a randomized crossover design of simulation modalities consisting of 4 VSPs and 3 SPs. Surveys of attitudes toward CCC were administered before didactics and after the first simulation method. Performance markers included automated VSP grading and, for SP cases, faculty-graded observational checklists and patient notes. Performance was compared between modalities using t tests and analysis of variance and then correlated with US Medical Licensing Examination performance.

Results: Sixty-six students participated (VSP first: n = 37; SP-first: n = 29). Attitudes toward CCC significantly improved after training (Cohen d = 0.35, P = 0.043), regardless of modality. Simulation order did not impact learner performance for SP encounters. Learners randomized to VSP first performed significantly better within VSP cases for interview (Cohen d = 0.55, P = 0.001) and treatment (Cohen d = 0.50, P = 0.043). The HVC component of learner performance on the SP simulations significantly correlated with US Medical Licensing Examination step 1 ( r = 0.26, P = 0.038) and step 2 clinical knowledge ( r = 0.33, P = 0.031).

Conclusions: High value care didactics combined with either VSPs or SPs positively influenced attitudes toward CCC. The ability to detect an impact of VSPs on learner SP performance was limited by content specificity and sample size.