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Table 1 Synopsis of themes and categories

From: Virtual patient simulation: what do students make of it? A focus group study

Theme Category Main results
Learning Clinical reasoning -Clinical reasoning development is linked to a stepwise approach to case solving.
-Input on factual and core knowledge is welcome as part of the VP "package", especially as feedback.
-Holistic view of the patient and closure sense.
  Transferable skills -Directly to the real patients, especially when the cases used in teaching were created from real life clinical records.
-To other types of exam.
  Retention Learning with VP enhances retention.
  Mistakes -Recognizing and correcting mistakes in a safe environment is crucial for successful learning.
- VP mistakes are less prone to be repeated in clinical practice.
Teaching Clinical specialties -VPS should be used in all major clinical specialties.
-Topics: frequent diseases and their complications; topics not included in the study plan and in the clinical rotations; diseases that might be easily missed during a short clinical rotation (due to seasonality or to being endemic in a different geographic area).
  Regulatory effect -Institutional level: instruction becomes uniform across rotations sites.
-Individual level: limiting the availability of the system externally regulates learning.
Assessment Qualitatively different -...and intrinsically better evaluation tool.
-VPS should not be the only assessment form used in a course. Implicit: VPS should be used for course assessment only.
-Allow increased retrieval of information in comparison with regular examinations.
  Motivation VPS can increase motivation for learning.
  Professional focus -Assessment and feedback on assessment are perceived as important learning tools.
-VP assessment should be relevant for future clinical practice as a general practitioner.
  Production assessment -Open questions make students think.
-Students favour open questions even if the grades lower.
Authenticity Design and content -Should reflect the real clinical practice and offer localized menu/content choices.
-Might consider including actual costs.
-Artificial menus/content options are misleading.
  Localization of the socio-cultural context Necessary for applications developed in one country and implemented in another.
  Realism and virtuality -Real life records thought to make better patient cases than fictitious scenarios.
-The knowledge derived from them is directly transferable to real patients.
-Strong emphasis on patient photo.
-Cases created from real life patient records no longer perceived as "virtual".
  Feedback Actual patient evolution and effect of treatment are highly desirable features of feedback, adding to realism.
Implementation Number of cases More than one case per topic can be necessary for common diseases which are often complicated/have co-morbidities at presentation. Min. 5-6 cases of tropical diseases.
  Access and availability The availability of the application should be restricted in time.
  VP exchange Tropical diseases cases should be exchanged with other HEIs.