According to a study published in the AMA Journal of Ethics, the use of virtual patients for healthcare simulation is promising but requires educators to define appropriate roles of virtual patients in medical teaching, specifically how they are to be constructed and used.

Authors sought to examine the potential of virtual patients and the underlying technology in medical education, identifying the promises and perils posed by using virtual patients in psychiatric intake teaching.

The investigators searched relevant databases for literature on virtual patients and underlying virtual reality technology, examining the specific application of virtual patients in teaching psychiatric intake. The intake process gathers patient characteristics and history; using virtual patients in this context helped facilitate the learner’s acquisition of core knowledge in psychiatry, history taking, interviewing, clinical reasoning, decision making, and assessing suicide risk.

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Use of virtual patients offers advantages over traditional medical education: virtual patients are accessible anytime and anywhere; virtual patient software can be reused and updated without recurrent costs; there is no variation in the behavior of virtual patients and no need to be physically present to interact with a learner. Unlike standardized patients, virtual patients do not rely on recall and may combine images, animations, videos, and more to help students learn appropriate clinical and ethical skills.

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In the context of clinic-based teaching, virtual patients via modern simulations are still limited vs symptoms reported by real patients. Other shortcomings include a lack of diverse representation in current virtual patients and potential biases reflected in virtual patient construction and artificial intelligence programming, which may occur when biased data is used in machine learning algorithms. The authors suggest that by diversifying the software development workforce some of these issues may be addressed.

Malicious intent, potentially flawed feedback, and diminished face-to-face interactions between teachers and learners are all perils of using virtual patients in medical education. However, the use of virtual patients and VR to facilitate core-knowledge learning is promising, and the future use of these technologies in medical education should clarify the appropriate roles of virtual patients in education and how they should be constructed and used.


Combs CD, Combs PF. Emerging roles of virtual patients in the age of AI. AMA J Ethics. 2019; 21(2):E153-159.