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Table 4 Themes and Representative Quotations of Positive and Negative Medical Teachers’ Experiences with Virtual Patients

From: Curricular integration of virtual patients: a unifying perspective of medical teachers and students

CodesExamples of positive codesExamples of negative codes
Major Theme (1) Educational aspects of VP use (159)
Subtheme (1a) Clinical Care of patient (34)
1.Clinical Efficiency (10)“It makes the virtual visit go smoother…I take notes and prioritize knowledge… I don’t have to flip through a huge scenario” n = 8“The doctor spends too much time” n = 2
2.Case review (24)“I can go back and look at important test results” n = 23“There are ECHO reports, but it seems like I don’t find where there are in the scenario” n = 1
Subtheme (1b) Learning effect of the VP (55)
1.Facilitation of knowledge (11)“The case and virtual trainer was asking me questions to verify and make sure everything is correct” n = 10If they used some graphs or charts, I might say that was more effective” n = 1
2.Medical history (23)“I had easy access to the vp history at my convenience” n = 21“There are inaccuracies in at each scenario node I go to, they’re not always updating it” n = 2
3.Assessment of knowledge (21)“I think that learning with the virtual patients is important in order to do well in the final exam for this course” n = 17“It does not make you feel secure enough” n = 4
Subtheme (1c) Information Access (40)
1.Accessibility of information (20)“…with these records online I have easier access” n = 19“Sometimes the computer doesn’t work and I can’t access information.” n = 1
2.Suitable information (20)“Every node included information as in real life patients” n = 19“Some links to nodes were linked to inappropriate information” n = 1
Subtheme (1d) Quality of educational resource (30)
1.Authenticity of patient encounter (16)“While working on this case, it was like I had to make the same decisions a doctor would make” n = 15“I didn’t feel like being a real the doctor caring for a real patient” n = 1
2.Professional approach (14)“I was gathering the information I needed, to characterize the problem” n = 12“It was difficult to think which findings supported or refuted each diagnosis” n = 2
Major Theme (2) Communication aspects of VP use (59)
Subtheme (2a) Students engagement (37)
1.Use of media material (21)“Videos add realism in the scenario and makes you want to visit quickly the next step” n = 20“Avatars make it seem fake…better with real patients” n = 1
2.Facilitate the user discussion (12)“You can talk and look at results together in the computer…” n = 8“Everybody may work alone in front of a PC” n = 4
3.Student questions (4)“Students might have questions for the teacher that might forget, but going through the VP together may help them to remember their questions” n = 3“They may read what’s on the screen and forget to say something” n = 1
Subtheme (2b) Student collaboration (22)
1.Ideas sharing (13)“Students can discuss on several different decision pathways each scenario includes” n = 9“VPs may not discuss if it used as a self learning process” n = 4
2.Social presence (9)“You feel like part of a ‘community’ during the corresponding teaching events.” n = 6“Someone may feel insecure to openly share shortcomings” n = 3
  1. Most participants pointed out that VPs provide the opportunity for a more thorough clinical representation of medical educational scenarios, contact with rare clinical cases, distance learning and self-assessment in a controllable learning environment. It was mentioned that “students will have the opportunity to practice in rare cases written from experts of the specific field”. Moreover, it seemed that VPs support PBL, allow for realism and cognitive errors in a safe environment and contribute to critical thinking development. As important part of the realism of the educational environment was considered the sum of wrong choices that as a part of the educational activity offer the chance to students to experiment by following different diagnostic paths and see the consequences of their choices without impact on real patients. Furthermore, it was mentioned that the whole decision tree, including the right choices, as well, contributes to effective learning. They finally pointed out that VPs improve medical education and increase motivation for learning