Virtual patients and learning communication skills at “double speed”: a qualitative study using the TPACK framework

Abstract

Effective communication is central to patient-centred care, but achieving sufficient practice opportunities with access to expert feedback during busy clinical placements can be challenging. Virtual Patients (VPs) simulate doctor-patient consultations and have been used successfully in medical education to teach communication skills. Four VPs were created with filmed patient encounters, using a branching decision format and scripted expert clinician feedback, to provide students with opportunities to practise challenging, infrequently seen, communication encounters. One focus group and six individual interviews were conducted with medical students as a quality improvement measure prior to the implementation of VPs into the year 4 medical curriculum. After transcription, deductive thematic analysis was undertaken using the TPACK framework as a conceptual lens to examine technological, pedagogical, content and contextual knowledge. Students described the VP content as authentic, emotive and supportive of their clinical, communication and cultural learning. They reported enhanced confidence through scaffolded exposure, but emphasised VP inferiority to real-world patient encounters. Pedagogically, students learnt through observation of videos modelling good communication under challenging circumstances, such as communication of a miscarriage, and suicide risk assessment following self-harm. However, students tended to skip or minimise VP reflective tasks, and they described the automated feedback as didactic and non-memorable, limiting educational impact. Students’ technology expectations exceeded the platform capabilities. They sought to speed through sections where possible and the VP activity was described as “clicking”, rather than communicating. Despite these limitations, students gained contextual knowledge and suggested the integration of VP into the curriculum as preparatory learning rather than communication skills practice, as they recognised that despite enhanced confidence, mastery requires repeated engagement with real or simulated patients. This VP platform did not meet the needs of students to practise challenging communication skills, with technology insufficiently integrated to align content delivery to pedagogical intent. Our findings suggest that although useful to complement live or simulated patient communication encounters, to realise their potential, VP technologies must enable more authentic interactivity such as voice-to-text, nuanced individualised feedback and stronger alignment between TPACK domains.