Experimental use of patient simulations in medical education have been going on for the past fifteen years. The purpose of these simulations is to offer students a patient on whom they can practice taking medical history, perform physical examination, additional research, draw up a differential diagnosis and a treatment plan.
A student is provided with different kinds of feedback generated by the program. The feedback is dependent on the performance of the student and the state of the patient.
Patient simulations can be divided into groups. Although this division is not formal, we distinguish three different types of simulations, static patient simulations, dynamic patient simulations and virtual patient simulations.
Additionally we can distinguish between patient simulations and courseware. Within this last category of computer based training programs a medical problem is discussed with a student on the basis of a patient. These programs do not provide students with the opportunity to use their knowledge and practice their medical skills.
Static Patient Simulations
For the past ten years Static Patient Simulations (SPS) have been the most frequently used form of patient simulations in medical computer based training. Some examples are the programs Cases (followed up by CasCOO) and Master. Cases for example confronts students a patient with constant parameters. The patients complaints and symptoms do not alter during medical history taking and physical and additional research and does not vary for different students. The purpose of Cases is mainly to teach students to ask the relevant questions and select relevant research. Besides that students should recognize abnormal findings and come to a diagnosis, followed by appropriate treatment.
Dynamic Patient Simulations
In contrast to static simulations time plays an important role in Dynamic Patient Simulations (DPS). The patients complaints and symptoms change in time during medical history taking and physical and additional research. This provides the author of a case with the opportunity to pressure the student into making decisions during a simulations. The process of independent decision making is something a student or resident hardly every gets round to in medical practice.
Virtual Patient Simulations
Virtual Patient Simulations (VPS) make use of virtual reality (VR). VR is a computer technique that simulates reality as close as possible through the use of a VR-helmet or a dataglove. With this technique it could become possible to simulate actual physical examination or even perform an operation on a virtual patient. For now VR is a technique that still belongs to the future and is not yet used in medical education.