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Smoking cessation counseling is a critical component of healthcare education, yet the effectiveness of different role-play-based learning approaches remains insufficiently investigated. The objective of this scoping review is to systematically map the existing evidence on the use of role-play-based learning approaches—including standardized patients, virtual patients, and other simulation methods—for training healthcare students and professionals in smoking cessation counseling.The review will follow the methodology for scoping reviews. Searches will be conducted in PubMed, Scopus, Web of Science, ERIC, IEEE Xplore for peer-reviewed English-language articles involving healthcare students or professionals, role-play-based learning approaches addressing tobacco cessation. Two reviewers will independently screen and chart the data.Findings will be presented through summary tables outlining intervention characteristics, target populations, educational settings, and outcomes, complemented by narrative descriptions highlighting key benefits, limitations, and implementation factors. Additionally, thematic mapping will be used to synthesize insights relevant to the development of virtual patient applications. The results will be disseminated through peer-reviewed publication and conference presentations.

The main goal of continuing medical education (CME) is to help healthcare providers (HCP) improve their knowledge and levels of competency with an ultimate enhancement of their performance in practice. Despite the long and well-intentional history of CME, the proof of success (based on improved clinical outcomes) is difficult to obtain objectively. In the past several years, the traditional CME world has been disrupted by replacing multiple-choice questions with virtual simulation. We utilised an innovative, next-generation virtual patient simulation (VPS) platform to develop objective measures to assess the success of educational activities that can be applied to the CME. This VPS platform was used at five distinct educational events designed to assess learners' knowledge and competency in the guideline-driven management of Type 2 diabetes, hyperlipidaemia, and hypertension. A total of 432 learners (medical doctors, nurse practitioners, and clinical pharmacists) participated in these educational events of whom 149 went through two consecutive cases with a similar clinical picture and educational goals. Their ability to achieve glycaemic, lipid, and blood pressure control improved significantly as they moved from the first to the second case. The participants improved their test performance in all categories - between 5 and 38%, achieving statistically significant increases in the many goals examined. In conclusion, this study employed the pioneering application of technology to produce, collect and analyse the VPS data to evaluate objectively educational activities. This VPS platform allows not only an objective assessment of the effectiveness of the CME activity but also provides timely and helpful feedback to both learners and providers of a given educational event.

Concept maps are a suitable method for teaching clinical reasoning (CR). For example, in a concept map, findings, tests, differential diagnoses, and treatment options can be documented and connected to each other. When combined with virtual patients, automated feedback can be provided to the students' concept maps. However, as CR is a nonlinear process, feedback concept maps that are created together by several individuals might address this issue and cover perspectives from different health professionals. In this study, we aimed to develop a collaborative process for creating feedback concept maps in virtual patient-based CR education. Health professionals of different specialties, nationalities, and levels of experience in education individually created concept maps and afterward reached a consensus on them in structured workshops. Then, medical students discussed the health professionals' concept maps in focus groups. We performed a qualitative content analysis of the transcribed audio records and field notes and a descriptive comparison of the produced concept maps. A total of 14 health professionals participated in 4 workshops, each with 3-4 participants. In each workshop, they reached a consensus on 1 concept map, after discussing content and presentation, as well as rationales, and next steps. Overall, the structure of the workshops was well-received. The comparison of the produced concept maps showed that they varied widely in their scope and content. Consensus concept maps tended to contain more nodes and connections than individual ones. A total of 9 medical students participated in 2 focus groups of 4 and 5 participants. Their opinions on the concept maps' features varied widely, balancing between the wish for an in-depth explanation and the flexibility of CR. Although the number of participating health professionals and students was relatively low, we were able to show that consensus workshops are a constructive method to create feedback concept maps that include different perspectives of health professionals with content that is useful to and accepted by students. Further research is needed to determine which features of feedback concept maps are most likely to improve learner outcomes and how to facilitate their construction in collaborative consensus workshops.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is a leading cause of mortality and morbidity. Patient knowledge about AF and its management is paramount but often limited. Patients need to be appropriately informed about treatment options, medicinal adherence, and potential consequences of nonadherence, while also understanding treatment goals and expectations from it. Mobile health apps have experienced an explosion both in their availability and acceptance as \"soft interventions\" for patient engagement and education; however, the prolific nature of such solutions revealed a gap in the evidence base regarding their efficacy and impact. Virtual patients (VPs), interactive computer simulations, have been used as learning activities in modern health care education. VPs demonstrably improved cognitive and behavioral skills; hence, they have been effectively implemented across undergraduate and postgraduate curricula. However, their application in patient education has been rather limited so far. This work aims to implement and evaluate the efficacy of a mobile-deployed VP regimen for the education and engagement of patients with AF on crucial topics regarding their condition. A mobile VP app is being developed with the goal of each VP being a simple scenario with a set goal and very specific messages and will be subsequently attempted and evaluated. A mobile VP player app is being developed so as to be used for the design of 3 educational scenarios for AF management. A pseudorandomized controlled trial for the efficacy of VPs is planned to be executed at 3 sites in Greece, Ukraine, and Kazakhstan for patients with AF. The Welch t test will be used to demonstrate the performance of patients' evaluation of the VP experience. Our study is at the development stage. A preliminary study regarding the system's development and feasibility was initiated in December 2022. The results of our study are expected to be available in 2024 or when the needed sample size is achieved. This study aims to evaluate and demonstrate the first significant evidence for the value of VP resources in outreach and training endeavors for empowering and patients with AF and fostering healthy habits among them. PRR1-10.2196/45946.

The emergence of the COVID-19 pandemic has posed a significant ethical dilemma in the allocation of scarce, life-saving medical equipment to critically ill patients. It remains uncertain whether medical students are equipped to navigate this complex ethical process. This study aimed to assess the ability and confidence of medical students to apply principles of medical ethics in allocating critical medical devices through the scenario of virtual patients. The study recruited third- and fourth-year medical students during clinical rotation. We facilitated interactions between medical students and virtual patients experiencing respiratory failure due to COVID-19 infection. We assessed the students' ability to ethically allocate life-saving resources. Subsequently, we analyzed their written reports using thematic analysis to identify the ethical principles guiding their decision-making. We enrolled a cohort of 67 out of 71 medical students with a mean age of 34 (SD 4.7) years, 60% (n=40) of whom were female students. The principle of justice was cited by 73% (n=49) of students while analyzing this scenario. A majority of them expressed hesitancy in determining which patient should receive life-saving resources, with 46% (n=31) citing the principle of nonmaleficence, 31% (n=21) advocating for a first-come-first-served approach, and 25% (n=17) emphasizing respect for patient autonomy as key influencers in their decisions. Notably, medical students exhibited a lack of confidence in making ethical decisions concerning the distribution of medical resources. A minority, comprising 12% (n=8), proposed the exploration of legal alternatives, while 4% (n=3) suggested medical guidelines and collective decision-making as potential substitutes for individual ethical choices to alleviate the stress associated with personal decision-making. This study highlights the importance of improving ethical reasoning under time constraints using virtual platforms. More than 70% of medical students identified justice as the predominant principle in allocating limited medical resources to critically ill patients. However, they exhibited a lack of confidence in making ethical determinations and leaned toward principles such as nonmaleficence, patient autonomy, adherence to legal and medical standards, and collective decision-making to mitigate the pressure associated with such decisions.

Blended learning, which combines face-to-face learning and e-learning, has grown rapidly to be commonly used in education. Nevertheless, the effectiveness of this learning approach has not been completely quantitatively synthesized and evaluated using knowledge outcomes in health education. The aim of this study was to assess the effectiveness of blended learning compared to that of traditional learning in health education. We performed a systematic review of blended learning in health education in MEDLINE from January 1990 to July 2019. We independently selected studies, extracted data, assessed risk of bias, and compared overall blended learning versus traditional learning, offline blended learning versus traditional learning, online blended learning versus traditional learning, digital blended learning versus traditional learning, computer-aided instruction blended learning versus traditional learning, and virtual patient blended learning versus traditional learning. All pooled analyses were based on random-effect models, and the I statistic was used to quantify heterogeneity across studies. A total of 56 studies (N=9943 participants) assessing several types of learning support in blended learning met our inclusion criteria; 3 studies investigated offline support, 7 studies investigated digital support, 34 studies investigated online support, 8 studies investigated computer-assisted instruction support, and 5 studies used virtual patient support for blended learning. The pooled analysis comparing all blended learning to traditional learning showed significantly better knowledge outcomes for blended learning (standardized mean difference 1.07, 95% CI 0.85 to 1.28, I =94.3%). Similar results were observed for online (standardized mean difference 0.73, 95% CI 0.60 to 0.86, I =94.9%), computer-assisted instruction (standardized mean difference 1.13, 95% CI 0.47 to 1.79, I =78.0%), and virtual patient (standardized mean difference 0.62, 95% CI 0.18 to 1.06, I =78.4%) learning support, but results for offline learning support (standardized mean difference 0.08, 95% CI -0.63 to 0.79, I =87.9%) and digital learning support (standardized mean difference 0.04, 95% CI -0.45 to 0.52, I =93.4%) were not significant. From this review, blended learning demonstrated consistently better effects on knowledge outcomes when compared with traditional learning in health education. Further studies are needed to confirm these results and to explore the utility of different design variants of blended learning.

History-taking is crucial in medical training. However, current methods often lack consistent feedback and standardized evaluation and have limited access to standardized patient (SP) resources. Artificial intelligence (AI)-powered simulated patients offer a promising solution; however, challenges such as human-AI consistency, evaluation stability, and transparency remain underexplored in multicase clinical scenarios. This study aimed to develop and validate the AI-Powered Medical History-Taking Training and Evaluation System (AMTES), based on DeepSeek-V2.5 (DeepSeek), to assess its stability, human-AI consistency, and transparency in clinical scenarios with varying symptoms and difficulty levels. We developed AMTES, a system using multiple strategies to ensure dialog quality and automated assessment. A prospective study with 31 medical students evaluated AMTES's performance across 3 cases of varying complexity: a simple case (cough), a moderate case (frequent urination), and a complex case (abdominal pain). To validate our design, we conducted systematic baseline comparisons to measure the incremental improvements from each level of our design approach and tested the framework's generalizability by implementing it with an alternative large language model (LLM) Qwen-Max (Qwen AI; version 20250409), under a zero-modification condition. A total of 31 students practiced with our AMTES. During the training, students generated 8606 questions across 93 history-taking sessions. AMTES achieved high dialog accuracy: 98.6% (SD 1.5%) for cough, 99.0% (SD 1.1%) for frequent urination, and 97.9% (SD 2.2%) for abdominal pain, with contextual appropriateness exceeding 99%. The system's automated assessments demonstrated exceptional stability and high human-AI consistency, supported by transparent, evidence-based rationales. Specifically, the coefficients of variation (CV) were low across total scores (0.87%-1.12%) and item-level scoring (0.55%-0.73%). Total score consistency was robust, with the intraclass correlation coefficients (ICCs) exceeding 0.923 across all scenarios, showing strong agreement. The item-level consistency was remarkably high, consistently above 95%, even for complex cases like abdominal pain (95.75% consistency). In systematic baseline comparisons, the fully-processed system improved ICCs from 0.414/0.500 to 0.923/0.972 (moderate and complex cases), with all CVs ≤1.2% across the 3 cases. A zero-modification implementation of our evaluation framework with an alternative LLM (Qwen-Max) achieved near-identical performance, with the item-level consistency rates over 94.5% and ICCs exceeding 0.89. Overall, 87% of students found AMTES helpful, and 83% expressed a desire to use it again in the future. Our data showed that AMTES demonstrates significant educational value through its LLM-based virtual SPs, which successfully provided authentic clinical dialogs with high response accuracy and delivered consistent, transparent educational feedback. Combined with strong user approval, these findings highlight AMTES's potential as a valuable, adaptable, and generalizable tool for medical history-taking training across various educational contexts.

In the field of health care, knowledge and clinical reasoning are key with regard to quality and confidence in decision making. The development of knowledge and clinical reasoning is influenced not only by students' intrinsic factors but also by extrinsic factors such as satisfaction with taught content, pedagogic resources and pedagogic methods, and the nature of the objectives and challenges proposed. Nowadays, professors play the role of learning facilitators rather than simple \"lecturers\" and face students as active learners who are capable of attributing individual meanings to their personal goals, challenges, and experiences to build their own knowledge over time. Innovations in health simulation technologies have led to clinical virtual simulation. Clinical virtual simulation is the recreation of reality depicted on a computer screen and involves real people operating simulated systems. It is a type of simulation that places people in a central role through their exercising of motor control skills, decision skills, and communication skills using virtual patients in a variety of clinical settings. Clinical virtual simulation can provide a pedagogical strategy and can act as a facilitator of knowledge retention, clinical reasoning, improved satisfaction with learning, and finally, improved self-efficacy. However, little is known about its effectiveness with regard to satisfaction, self-efficacy, knowledge retention, and clinical reasoning. This study aimed to evaluate the effect of clinical virtual simulation with regard to knowledge retention, clinical reasoning, self-efficacy, and satisfaction with the learning experience among nursing students. A randomized controlled trial with a pretest and 2 posttests was carried out with Portuguese nursing students (N=42). The participants, split into 2 groups, had a lesson with the same objectives and timing. The experimental group (n=21) used a case-based learning approach, with clinical virtual simulator as a resource, whereas the control group (n=21) used the same case-based learning approach, with recourse to a low-fidelity simulator and a realistic environment. The classes were conducted by the usual course lecturers. We assessed knowledge and clinical reasoning before the intervention, after the intervention, and 2 months later, with a true or false and multiple-choice knowledge test. The students' levels of learning satisfaction and self-efficacy were assessed with a Likert scale after the intervention. The experimental group made more significant improvements in knowledge after the intervention (P=.001; d=1.13) and 2 months later (P=.02; d=0.75), and it also showed higher levels of learning satisfaction (P<.001; d=1.33). We did not find statistical differences in self-efficacy perceptions (P=.9; d=0.054). The introduction of clinical virtual simulation in nursing education has the potential to improve knowledge retention and clinical reasoning in an initial stage and over time, and it increases the satisfaction with the learning experience among nursing students.

Following their introduction at the beginning of the 21st century, interactive or dynamic Virtual Patients are beginning to be used more widely in clinical education. They can be seen as being at the end of a continuum of simulation technical complexity, having been earlier developed on a wide range of “media”: human actors, paper, video, physical mannequins, etc. This paper focuses on the current emergent more complex Virtual Patients in three-dimensional (3D) immersive clinical environments. In these environments, 3D patient avatars interact directly in response to virtual clinical interventions undertaken by avatars, each of which is controlled by one or more users. The paper explores the issues of authoring, deploying, and managing these real-time, dynamic Virtual Patients using as an example the immersive clinical environment CliniSpace. As clinician-accessible Virtual Patient authoring is now becoming available in immersive clinical environments, so these wider clinical and managerial non-technical issues are coming rapidly to the fore.

Numerous reports indicate that the incidence of posttraumatic stress disorder (PTSD) in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) military personnel has created a significant behavioural healthcare challenge. These findings have served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. The current article presents the use of Virtual Reality (VR) as a clinical tool to address the assessment, prevention, and treatment of PTSD, based on the VR projects that were evolved at the University of Southern California Institute for Creative Technologies since 2004. A brief discussion of the definition and rationale for the clinical use of VR is followed by a description of a VR application designed for the delivery of prolonged exposure (PE) for treating Service Members (SMs) and Veterans with combat- and sexual assault-related PTSD. The expansion of the virtual treatment simulations of Iraq and Afghanistan for PTSD assessment and prevention is then presented. This is followed by a forward-looking discussion that details early efforts to develop virtual human agent systems that serve the role of virtual patients for training the next generation of clinical providers, as healthcare guides that can be used to support anonymous access to trauma-relevant behavioural healthcare information, and as clinical interviewers capable of automated behaviour analysis of users to infer psychological state. The paper will conclude with a discussion of VR as a tool for breaking down barriers to care in addition to its direct application in assessment and intervention.