The effectiveness of using virtual patient educational tools to improve medical students’ clinical reasoning skills: a systematic review

Background: Use of virtual patient educational tools could fll the current gap in the teaching of clinical reasoning skills. However, there is a limited understanding of their efectiveness. The aim of this study was to synthesise the evidence to understand the efectiveness of virtual patient tools aimed at improving undergraduate medical students’ clinical reasoning skills. Methods: We searched MEDLINE, EMBASE, CINAHL, ERIC, Scopus, Web of Science and PsycINFO from 1990 to January 2022, to identify all experimental articles testing the efectiveness of virtual patient educational tools on medical students’ clinical reasoning skills. Quality of the articles was assessed using an adapted form of the MERSQI and the Newcastle–Ottawa Scale. A narrative synthesis summarised intervention features, how virtual patient tools were evaluated and reported efectiveness. Results: The search revealed 8,186 articles, with 19 articles meeting the inclusion criteria. Average study quality was moderate (M=6.5, SD=2.7), with nearly half not reporting any measurement of validity or reliability for their clinical reasoning outcome measure (8/19, 42%). Eleven articles found a positive efect of virtual patient tools on reasoning (11/19, 58%). Four reported no signifcant efect and four reported mixed efects (4/19, 21%). Several domains of clinical reasoning were evaluated. Data gathering, ideas about diagnosis and patient management were more often found to improve after virtual patient use (34/47 analyses, 72%) than application of knowledge, fexibility in thinking and problem-solving (3/7 analyses, 43%). Conclusions: Using virtual patient tools could efectively complement current teaching especially if opportunities for face-to-face teaching or other methods are limited, as there was some evidence that virtual patient educational tools can improve undergraduate medical students’ clinical reasoning skills. Evaluations that measured more case specifc clinical reasoning domains, such as data gathering, showed more consistent improvement than general measures like problem-solving. Case specifc measures might be more sensitive to change given the context dependent nature of clinical reasoning. Consistent use of validated clinical reasoning measures is needed to enable a metaanalysis to estimate efectiveness