As an early adopter of virtual patient simulation (VPS) for graduate nursing education, a trusted colleague, and Kaplan partner, Elaine Kauschinger, Ph.D., MSN, APRN, FNP-BC, is the ideal person to take us on a deep dive into her history with VPS―as well as her experiences through COVID-19 and her optimism for the innovation-driven future. In the first of her two part series, Dr. Kauschinger explores the value of integrating VPS into her curricula, including her insights into i-Human Patients, as well as advice for educators about increasing engagement and student success through virtual simulation.

INTRODUCING VPS INTO GRAD NURSING CURRICULA

When did you start incorporating virtual simulation into your grad nursing curricula and what were your initial impressions?

Technology Novice: About a decade ago, I became interested in how technology can engage students in their learning process. I wanted to know what makes a student actively involved in learning and how could I create an environment that supports them. This was a great concern since the program I teach in was preparing to move to an online program. I had taught for 20 years in a traditional university setting, and I realized that things were going to be changing rapidly. 

Technology as a Tool in Active Engagement: My interest in technology was sparked from seeing my son playing video games―as an adolescent and then as an adult with a full-time job! I thought about how totally immersed he was when playing these ‘games,” and the large amount of time he spent in these activities, and how it looked like fun! All games teach. So, it was a reasonable assumption that game-based technology, like VPS, could engage students with course content and enhance their learning. 

The use of time in the learning process is a critical issue. Graduate students in my program are usually full-time RNs with other social commitments, so their time is very valuable. We know that individuals generally remember 10% of what they read, 20% of what they hear, and 90% of what they do. The use of VPS has the student ‘doing’ a case in a virtual environment, with multiple attempts, with the same patient. They are actively learning course content, as is evident by the individual and cohort analytics that is produced for each case.

Pilot Project: In 2016, I had investigated the commercially available VPS products that were available. Following consideration of how I wanted to use VPS as a supplemental tool in my courses, I developed and implemented a pilot project using i-Human Patients cases. The initial intent was to see how feasible and effective it would be to integrate VPS into a distance-based graduate nursing course. I was taking VPS out for a ‘test drive’. 

At the end of the project, survey results indicated that students liked the interactive component of VPS as well as the clinical experience simulation. Due to the positive student and faculty outcomes, VPS was successfully implemented in all of my adolescent and adult courses.

Now, as a result of COVID-19, many of the other MSN clinical courses at my school now utilize i-Human Patients throughout the semester. 

Why did you/your institution decide to partner with i-Human Patients by Kaplan as your virtual simulation provider?

I had investigated the products and services available by several vendors of virtual patient simulation software. I was looking to partner with a company that would provide a great clinical experience to my students, but also be able to support myself and other faculty new to VPS. 

Additionally, great customer service for both my students and faculty was an important factor. Graduate students have very busy schedules. When they schedule a time to complete their i-Human Patient cases, if there are any problems (e.g., they have timed out of a case and are unable to access it again), they need to have a solution provided in a timely manner and have it resolved the first time around. I can’t remember any time that a student let me know that they had issues with customer service. 

VPS FOR STUDENT & COHORT SUCCESS

In what ways does VS help students build clinical judgment? 

Developing Clinical Judgement: Clinical judgement is a critical area to develop since it determines the decisions students will apply to the diagnosis and management of patients.The key to VPS is repetition of cases and this really helps students to perfect their clinical judgement. (Practice makes perfect, as the saying goes.)

Educators of advanced nurse practitioner students often find it a challenge to evaluate students’ clinical judgement development. However, the available VPS analytics aids faculty in this evaluation. 

Debriefing: Faculty should plan on using VPS to its fullest potential. This includes using the feedback provided from the software, and even taking it one step further to include individual and group debriefing activities that the faculty and students participate in.

Debriefing is one of the most important aspects of simulation. Reflection on decision making, after a virtual case has been completed, provides individual feedback to the student. This is how students learn their actions have consequences. This enables them to link their decisions to clinical outcomes, as well as permits them to formulate higher level questions. In a safe, virtual environment students are able to ‘see’ the outcomes of their decisions, learn immediately from this, and then return back to the same scenario to apply this experience to the same patient. They then have the ability to reflect again, and to discover their successes and remaining areas of challenges, before once again going back into the scenario for final. (Again, we can go back to the adage, Practice makes perfect.)

How do virtual patient encounters effectively prepare students for real-world scenarios?

Unlike reading assignments or listening to narrated lectures, VPS provides for students to actively participate in the NP role. Cases are developed from real patients by expert clinicians. The evolving case compels students into the decision-making process of a clinician.  

Another unique feature of VPS is the real time feedback/debriefing, not only on what decisions were made by the student, but the order in which they. This provides a ‘roadmap’ for the student to see how their decisions impacted the evolving case (e.g., if questions were missed or an element of the physical exam was not performed, this impacted the ability to develop a specific differential diagnosis.) 

Can you share an example of how VPS helped a student increase their confidence and/or success on their exams?

About two years ago, a student of mine was in her first clinical rotation. She was a highly experienced RN in the hospital setting, but was new to primary care. She contacted me one day to let me know how grateful she was to have had the experience with VPS since it enabled her to provide timely and appropriate care for a patient that she had seen that day. She reported that she met a “Florence Blackman” (the name of a VPS patient with a cardiac disorder). Because the patient was very similar to the avatar, the student ‘knew’ how to proceed with the real clinical encounter. 

She was able to quickly obtain subjective and objective data, and felt very confident in her case presentation to her preceptor. The student mentioned that her preceptor asked what the next step was, and she replied to order an EKG―which she had already done knowing this is what had been performed in her VPS case. As a result, her preceptor was very impressed by her confidence and asked her to interpret the EKG and what was the plan of action. Due to the acute cardiac event, a call to 911 was placed and the patient was transported to the nearest emergency department. 

This was an outstanding experience for the student to have the ability to critically evaluate a patient under a high-stakes situation. 

ADVICE

Do you have any advice to share with fellow grad nursing educators about virtual teaching?

The most important thing is to have a strategic plan developed for the use of VPS in individual courses and throughout  the curriculum before your students use VPS for the first time. I’ve found that the objectives in course syllabi and program outcomes should be your guide on how to intentionally use virtual patient simulation. 

With technology, there will always be ‘bumps in the road’ or glitches. Keep in mind the overall outcomes and value that VPS brings to our students and their learning environment. 

RESOURCES

WEBINARS

To learn more about incorporating virtual patient simulations into graduate nursing curricula, be sure to watch Dr. Kauschinger and her colleagues in two recent Kaplan Webinars:

Beyond COVID-19: Utilizing Virtual Simulation for Student Success

Integrating Virtual Simulation into Grad Nursing Curricula

BLOGS

Technological Advances Change the Way We Learn, Master, and Retain Information

Reflections on a Pandemic and Choosing the Path Forward

REQUEST A DEMO

If you have any questions or would like to learn more about how virtual simulation can help prepare your graduate nursing students for success, visit the i-Human Patients website to request a demo today.