Sorting Out the Virtual Patient: How to Exploit Artificial Intelligence, Game Technology and Sound Educational Practices to Create Engaging Role-Playing Simulations

Since Dr. Howard Barrows (1964) introduced the human standardized patient in 1963, there have been attempts to game a computer-based simulacrum of a patient encounter; the first being a heart attack simulation using the online PLATO system (Bitzer, 1966). With the now ubiquitous use of computers in medicine, interest and effort have expended in the area of Virtual Patients (VPs). One problem in trying to understand VPs is that there are several quite distinct educational approaches that are all called a ‘virtual patient.’ This article is not a general review of virtual patients as current reviews of excellent quality exist (Poulton & Balasubramaniam, 2011; Cook & Triola, 2009). Also, research that demonstrates the efficacy of virtual patients is ample (Triola, et al., 2006). This article assesses the different kinds of things the authors call “virtual patients”, which are often mutually exclusive approaches, then analyzes their interaction structure or ‘game-play’, and considers the best use scenarios for that design strategy. This article also explores dialogue-based conversational agents as virtual patients and the technology approaches to creating them. Finally, the authors offer a theoretical approach that synthesizes several educational approaches over the course of a medical encounter and recommend the optimal technology for the type of encounter desired.