Teaching decision-making skills through inexpensive virtual scenarios

Emily Conradi, Dr Terry Poulton, Dr Jonathan Round, E-learning Unit, St. George’s, University of London, Tooting.



Scenario-based gaming can be has great potential as a powerful tool for teaching reasoning and decision-making skills in competency-based training. Virtual patients (VPs) are an form of educational game, that usestest these skills in medicine and healthcare training. St George’s University of London (SGUL) have created a generic ‘model’ for VP design, simple to use, yet flexible enough to simulate real decision-making.


For each VP an ideal pathway is described, with 3-4 critical points that control progression through the case. To navigate between nodes, a map of different interconnected possibilities is designed, with 3-4 steps and 3-4 choices at each step, mimicking the choices found in of a real patient encountersscenario.


Using thisAs a result, a simple educational model can be used to create ergonomically designed educational games can be created. Other disciplines requiring forms of competency-based training could also use similar virtual scenariosthe same techniques. Possible applications for educational games such as VPs include interactive problem-based learning tutorials, m-learning, and assessment.

Key words: virtual patients, simulation, decision-making, reasoning, problem-solving, choice, medicine, healthcare


Computer simulations have been used to support the development of competencies, skills, and critical thinking for many years (Wild, 1996; Malone, 1981; de Jong, 1991). Within medical and healthcare education, the use of simulated patients provides an excellent tool by which to learn and practice clinical competency (Bergin & Fors 2003). Broadly, simulated patients can either be physical or virtual models. Physical models, generally referred to as patient simulators, teach clinical skills. Virtual models – or virtual patients - are tools for teaching clinical reasoning.


A virtual patient is defined as: “an interactive computer simulation of real-life clinical scenarios for the purpose of medical training, education, or assessment.” (Ellaway, Candler et al., 2006). In its simplest form a VP allows the user, usually via a computer, to make a choice based on some presented information. The user is then given feedback dependent on their choice. More complex VPs will offer more choices, and then link pages together, so that the information and choices available at any stage depend on the choices made earlier in the scenario.


Although virtual patients address the needs of medicine and healthcare disciplines, they are essentially problem-solving exercises – the user must apply knowledge to make decisions and progress through the scenario (Henderson, 1998). This model is applicable to any discipline where the user needs to practice reasoning and decision-making skills. Decision-making and problem-solving are core skills reflected in all aspects of learning. Many vocational courses can find use for modelling real-life scenarios within a virtual world – law students can practice a court case; an architect can test their design choices; project managers can practice running an effective project.


Practising application of knowledge and skills within a virtual environment can offer some advantages over learning through real-life practice including:


[1] A Lo-Fi VP: http://www.elu.sgul.ac.uk/virtualpatients/examples/sarah_jane/SJP_h_21_NT_HM.html

[2] A Hi-Fi VP: http://anesth.utmb.edu/simcenter/

[3] VUE: http://vue.uit.tufts.edu/index.cfm [last accessed 06/07/07]

[4] Labyrinth: http://labyrinth.mvm.ed.ac.uk/ [last accessed 06/07/07]

[5] For more information on the eViP project please visit the SGUL e-learning site: http://www.elu.sgul.ac.uk/virtualpatients/ [last accessed 30/03/07]