Modeling Virtual Patients for Learning and Assessment in Nursing Education


Carina Georg
Nabil Zary


Virtual Patients and eCase Studies


Virtual Patients


Dept of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden


Research studies have shown that nursing students find it difficult to translate and apply their theoretical knowledge in a clinical context. Virtual patients (VPs) have been proposed as a learning activity that can support students in their learning of scientific knowledge and help nursing students integrate theory and practice.   Since most reported VPs aimed at the medical curricula, there is a need to investigate how to model VPs for nursing education.


Using theory anchored Vps can support nursing students understanding of scientific knowledge and development understanding about patients needs, patient care, nursing solutions and nursing interventions.

Take-home Messages

Virtual Patientss adapted to the nursing paradigm can support nursing students development of clinical reasoning skills in nursing.

Summary of Work

Modeling of the VPs was based the 3rd generation nursing process model, also named the outcome presents test (OPT) model. 

 Virtual Patient Nursing Model (VPNM)



 We investigated how the VP model supported nursing students' understanding of scientific knowledge and training in clinical reasoning.

Summary of Results

Five VPs were created and implemented in the undergraduate nursing education at Karolinska Institutet.


The evaluation showed that the students perceived VPs as an appropriate learning activity to support the development of their clinical reasoning.


We would like to acknowledge the help and support of the students, researcher, teacher and administrators for help and participants’ in this study. We also want to gratefully acknowledge the The Perioperative Interactive Education (PIE) group for kindly providing the use and translation of the virtual Interactive patient system (VIC).


Cook, D.A., Triola, M.M.(2009).  Virtual patients: a critical literature review and proposed next steps. Medical Education; 43(4):303-311.

Cook, DA, Erwin, PJ. Riola, MM.(2010).  Computerized virtual patients in health professions education: systematic review and meta analysis. Academic Medicine, 2010; 85: 1589- 1602.

Ellaway, R., Poulton, T., Smothers,V,. Green, P. (2009). Virtual patient come of age. Medical Teacher;, 31(8) ,683-684.

Ellaway, R. Poulton, T. Fors,  U. McGee, JB.  Albright, S.  Building a Virtual Patient Commons. Medical Teacher,2008; 30 (2), 170 – 174.

Pesut, H. and Herman, JA. (1998) OPT: Transformation of Nursing Process for Contemporary Practice. Nursing Outlook, 46 (1):29-36.

Pesut, H. and Herman, JA. Clinical Reasoning the art and science of critical and creative thinking. Albany, NY: Delmar Publisher, 1999.


There are several different definitions for the concept virtual patient, and the term virtual patients are often used in an ambiguous manner. The definition used in this paper is; “An interactive computer simulation of real-life clinical scenarios for the purpose of healthcare and medical training, education or assessment “.  A particular strength of VPs is that it seems to support learning on clinical reasoning and decision making. The advantage is that students may be exposed to a large number of cases in a safe and controlled environment. Most VP systems have common features including medical history taking, physical examinations, lab/imaging tests as well as features for suggesting an appropriate diagnosis and treatment.  An essential characteristic of VPs is the interactive interface that enables the user to query the patient and receive a patient response supplied by the computer.

Take-home Messages
Summary of Work

Modeling of the VPs was based the 3rd generation nursing process model, also named the outcome presents test (OPT) model. This theoretical framework is outcome driven and builds-on earlier versions of the nursing process. The OPT model provides structure for the iterative clinical reasoning necessary for contemporary nursing practice.

The OPT model emphasizes reflection, outcome specification and tests for judgment within the context of individual patient story and provides a way for nursing students to frame and attribute meaning to patients stories while concurrently considering relationships among diagnoses intervention and outcomes, with attention to evidence based nursing and the decision making process



The virtual patient nursing model was inspierd of the OPT Model and in an iterative manner, developed and optimized to the field of virtual patients. The virtual patient nursing model is composed of three main layers

Layer 1 – patient centric data collection (shows different ways of collecting data about the patient).

Layer 2 – Iterative clinical reasoning

Layer 3– Measurable outcomes

VPs were then created based on the developed model. The studens experience of working whith this VPs was evalueted whit an online questionare developed of Huwndiek an deLang in coperation whith teh EVIP projekt.

Summary of Results
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