Real-Person, Real-Time Virtual Simulations: An Innovative Approach to Authentic Experiential Learning

Concurrent Session 2

Session Materials

Brief Abstract

Simulations using standardized patients offer health professional students highly authentic experiential learning opportunities to support the development of clinical skills. Participants will learn about two studies that investigated the potential to offer these experiences using virtual technologies, and discuss opportunities to use real-person, real-time online simulations in other learning domains.


Dr. Laurie Posey specializes in instructional design, online and blended learning, and the use of technology to support all aspects of health professional education. Her research and scholarship focuses on eLearning best practices, active- and authentic learning strategies, collaborative learning, continuous quality improvement, online simulation, and telehealth-enabled education. She is the Director of the Nursing Education Certificates program at the George Washington University School of Nursing, and teaches in the areas of Instructional Design, Teaching with Technology, Knowledge Management, and Health Information Technology. Dr. Posey was the Principle Investigator for two grant-funded studies investigating the use of online and telehealth technologies to provide distance learners with opportunities for real-time, authentic practice and assessment through virtual Standardized Patient (SP) encounters. The first study funded through GW's Cross Disciplinary Research Fund is developing and pilot testing a Virtual Standardized Patient Portal that will integrate an open-source Electronic Health Record (EHR) into the Adobe Connect web-conferencing platform. The second study funded by the National Council of State Boards of Nursing's Center for Regulatory Excellence will compare the educational outcomes of face-to-face and telehealth-enabled SP encounters. As the former Director of Instructional Design for the School of Nursing, Dr. Posey has supported faculty in the use of innovative pedagogical approaches to online teaching and led the design and development of several grant-funded eLearning programs including Nurses on the Frontline: Preparing for Emergencies and Disasters (; the Graduate School Bootcamp (; the Geriatric and Palliative Care Curriculum (; and Interprofessional Care of People with Multiple Chronic Conditions ( She was the Principle Investigator for the Teaching and Transforming through Technology (T3) program, through which the SON’s Accelerated Bachelor of Science in Nursing program transitioned from a face-to-face to blended learning format. Dr. Posey is an accomplished instructional designer with 20+ years of experience designing and developing eLearning programs for academia, government, and industry. Prior to coming to GW, she served as Deputy Director for the Robert Wood Johnson Foundation’s Partnerships for Training program, which used distance education to educate Nurse Practitioners, Physician Assistants and Certified Nurse Midwives in underserved communities.
Dr. Pintz is a Professor at the George Washington University School of Nursing. Dr. Pintz has published and presented both nationally and internationally on the use of educational technology to enhance graduate nursing education, interprofessional education, on the characteristics of hospital-based nursing research programs, and the self management of chronic illness. Dr. Pintz was awarded the National Library of Medicine Fellowship in Biomedical Informatics in 2007. In 2010, she received the GW Bender Teaching Award and in 2013, she was the recipient of the Sigma Theta Tau International Educational Technology Award and the Best in Technology Award. She is a fellow of the National Association of Nurse Practitioners and the National Academies of Practice. She is an evaluator for the Commission for Collegiate Nursing Education Accreditation Program and Middle States Commission on Higher Education. In addition to her faculty activities, she is a board-certified family and women’s health nurse practitioner.

Extended Abstract

From interactive eLearning featuring video-based scenarios to augmented and virtual reality, educators have explored a range of technologies with a goal of immersing participants in authentic learning experiences. These approaches often involve simulating an experience in which learners are challenged to make decisions based on interactions with other people. Developing virtual simulations that realistically simulate the range of potential responses and reactions of a real person is a complex and resource-intensive endeavor. One relatively simple alternative is to use webinar technology to engage learners with real people in real time.

In the field of healthcare, educators make extensive use of standardized patients (SPs) to teach and assess students’ clinical assessment and reasoning skills and for students to demonstrate competence with clinical skills. In addition, SP simulations allow students to practice without the risk of harming patients. SPs are actors who have been carefully trained to portray patients with different conditions and characteristics in a consistent way. Typically, SP simulations take place face-to-face in an on-campus center equipped with exam rooms and diagnostic equipment. To make these valuable learning experiences more accessible for online students, the presenters have completed two studies of virtual SP simulations.

The first study involved development and pilot testing of a Virtual Standardized Patient Portal that integrates a simulated electronic health record within a webinar interface. While meeting virtually with SPs, students review the patient history and results of diagnostic testing and document their findings and care plan within the online health record. For the pilot test, 10 nurse practitioner, 1 nurse midwifery and 9 medical students participated in virtual encounters with 4 SPs who had each been trained on a different clinical scenario. Each student completed two patient encounters for a total of 40 encounters and completed a follow up survey that included system usability scale items along with open-ended questions to gather their perceptions of the learning experience. Overall, students rated the platform as easy to use and valued the opportunity to participate in the virtual simulations. Revisions to the platform based on other learner feedback are currently underway.

The second study involved comparing learners’ performance in face-to-face and virtual SP encounters. A randomized, experimental repeated measures crossover design was used to generate quantitative data to compare student outcomes in the virtual and face-to-face conditions; and structured interviews were conducted to provide qualitative data related to students’ perceptions of these experiences. Trained faculty evaluators scored each student using the Diagnostic Reasoning Assessment (DRA), an observational tool that includes six items that assess different aspects of the diagnostic reasoning process with strong evidence of reliability and validity (Pintz, 2006). Forty-one students each completed two SP encounters, one using webinar technology and the other face-to-face. There were no statistical differences in students' diagnostic reasoning performance in the two modalities. Qualitative analysis of student interviews revealed that students are open to virtual SP simulations and viewed them as a good experiential learning opportunity. Findings also highlighted the need for orientation to the virtual platform and the need for a different approach to the clinical encounter due to a lack of face-to-face presence with the SPs.

This presentation will summarize the literature related to SP simulations and share the results of the two virtual SP studies, along with lessons learned and tips for developing and facilitating real person, real-time virtual simulations in healthcare and other disciplines. We will use an online polling application to engage participants in answering reflective questions throughout the presentation, including placing participants in the decision-making role of the learner using video recordings from the SP simulations. We will conclude with a think-pair-share interactive discussion to explore the potential use of real-person/real-time simulations in varied learning domains.

The opportunity to use actors to portray characters within virtual simulations is not limited to healthcare. We hope to plant the seeds for others to adapt this valuable and economical approach in their own educational settings.


Pintz, C. (2006). Assessment of diagnostic reasoning with standardized patients: Testing the reliability and validity of the diagnostic reasoning assessment. University of Maryland, Baltimore, ProQuest Dissertations Publishing. 3298422.