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Conference Paper 

Revolutionizing Healthcare Education: Mobile Virtual Patients 

for Digital Problem-Based Learning

Ioanna Dratsiou, Evangelia Romanopoulou, Annita Varella, Eleni Dafli and Panagiotis D. Bamidis*

Medical Physics and Digital Innovation Laboratory, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki 
(AUTH), Thessaloniki, Greece

* Corresponding Author Email: pdbamidis@gmail.com

ABSTRACT

The move to a student-centered medical curriculum places greater emphasis on active learning and the development of clinical 
reasoning skills. Virtual Patients, defined as computer-based programs that simulate real-life clinical scenarios, have become 
increasingly popular as an enhancement to medical training. This study explores the usability and effectiveness of Mobile Virtual 
Patients (MVPs) in supporting healthcare professionals and medical students in developing skills related to symptom manage-
ment, diagnosis, and treatment in the context of the H2020 SHAPES project for older adults. Fourteen participants, divided into 
two groups of seven each from the University of Nicosia and Aristotle University of Thessaloniki, respectively, participated in 
PBL sessions using MVPs. These cases encompassed various conditions, from neurodegenerative diseases to chronic conditions, 
focusing on participants active engagement and inquiry-based learning. The System Usability Scale (SUS) and the Electronic 
Virtual Patients (eViP) toolkit were applied, which brought usability, technology acceptance, and clinical reasoning into perspec-
tive. Results showed high usability, with healthcare professionals giving an SUS of 86.2, compared to 77.5 for medical students. 
Both groups reported positive experiences, but medical students rated the learning effect and coaching higher than healthcare 
professionals. This suggests that MVPs are valuable instruments in enhancing clinical reasoning and knowledge acquisition. It 
further emphasizes the customization of MVPs for the various needs of a medical student and a healthcare professional to real-
ize optimized educational outcomes. Future studies should address scalability, infrastructure needs, and inclusion in broader 
medical curricula to further advance the spread within healthcare education.

Keywords—Mobile virtual patients (MVPs), Problem-based learning, Clinical reasoning, Usability, Healthcare education.             

Copyright © 2024. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY): Creative Commons - 
Attribution 4.0 International - CC BY 4.0. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright 
owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduc-
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J Global Clinical Engineering Vol.6 Special Issue 6: 2024 110

INTRODUCTION

Medical education has shifted towards a student-centered 
approach, placing greater importance on active learning 
and the development of clinical reasoning skills rather 
than relying solely on passive information absorption 
and unproductive memorization.1,2 Several studies have 
demonstrated the efficiency of simulation for knowledge 
acquisition and for technical3 and nontechnical4,5 skills 
training in healthcare. Indeed, the rapid advancement of 
dependable information technologies has made it possible 
to develop contemporary learning activities that were 
previously unattainable. These innovations now have the 
potential to significantly enhance medical education and 
training in healthcare.6 

Under this perspective, Virtual Patients (VPs) are often 
defined as “specific types of computer-based programs 
that simulate real-life clinical scenarios where learners 
emulate the roles of health care providers to obtain a his-
tory, conduct a physical exam, and make diagnostic and 
therapeutic decisions”7, have seen a growing adoption 
as educational tools in numerous medical institutions.8 
One of the fundamental features inherent to VPs is their 
capacity to furnish a secure and risk-free environment 
for medical practice and also offer clinical skills learn-
ers the invaluable opportunity for repeated utilization, 
completely unhindered by the constraints of time and 
place. This multifaceted functionality not only ensures a 
safe learning environment but also promotes accessibility 
and convenience.9

There has certainly been a noticeable trend toward 
VPs creation and use among academic institutions as a 
result of the opportunities that they offer in contemporary 
medical education.10 In fact, the encouraging evaluation 
results of studies showed that VPs are highly accepted 
by both medical teachers and students, and also may 
improve cognitive and behavioral skills more effectively 
than traditional approaches do.2,10 In recent years, the 
School of Medicine of the Aristotle University of Thes-
saloniki (AUTH) has undertaken significant initiatives to 
enhance medical education by embracing contemporary 
educational approaches and modernizing the curriculum.11

As a result of these efforts, a comprehensive and 
accessible VPs repository has been established.12 This 

accomplishment has been further strengthened with 
more VPs, resulting from the sustainable exploitation 
of the outcomes of medical-oriented research projects, 
to support students and healthcare professionals in de-
veloping practical knowledge, clinical reasoning skills, 
and professional behavior. All these VPs have also been 
adapted and seamlessly integrated into a mobile environ-
ment functioning as Mobile Virtual Patients (MVPs).13 

Furthermore, these educational resources have been 
fully incorporated into Problem-Based Learning (PBL) 
sessions within the medical curriculum, serving both un-
dergraduate and postgraduate students2 and supporting 
healthcare professionals’ innovative learning. 

RATIONALE OF THIS STUDY

MPVs were utilized within the context of the H2020 
SHAPES project14 aimed to establish a European open 
ecosystem enabling the deployment of a large-scale, EU 
standardized open platform for supporting and extend-
ing healthy and independent living for older adults. The 
SHAPES Pan-European Piloting Campaign was launched 
in fifteen pilot sites, including six European Innovation 
Partnership on Active and Healthy Ageing (EIP on AHA) 
Reference Sites, and involved hundreds of key stakehold-
ers, such as older adults, their families, caregivers, and 
healthcare professionals.15 The deployment of MVPs 
served a specific purpose within this broader project. They 
were employed to support healthcare professionals and 
medical students in enhancing their skills related to older 
adults’ symptoms management, diagnosis, and treatment 
as well as refining their reasoning and decision-making 
capabilities, contributing to improved healthcare practices 
for older individuals. 

In the context of our broader project, we deployed MVPs 
to assist healthcare professionals and medical students 
in enhancing their skills related to older adults’ symptom 
management, diagnosis, and treatment, while improving 
their reasoning and decision-making capabilities. Within 
this framework, the present study endeavors to address 
the following research question: 

How do healthcare professionals and medical students 
experience PBL with MVPs, while considering factors 

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111 J Global Clinical Engineering Vol.6 Special Issue 6: 2024

such as usability, technology acceptance, and their clinical 
reasoning perspectives on MVPs?

METHODS AND MATERIALS         

Participants 

Participants’ recruitment and pilot activities were sup-
ported by the Thessaloniki Action for Health & Wellbeing 
Living Lab (Thessaloniki Active and Healthy Ageing Living 
Labs, Thess-AHALL)16, which operated since 2014 under 
the auspices of the Lab of Medical Physics and Digital 
Innovation, School of Medicine, AUTH. Multifaceted re-
cruitment strategies have been implemented within the 
Thess-AHALL ecosystem (municipalities and public enti-
ties, hospitals, rehabilitation centers, and nursing homes, 
as well as a great number of individuals/beneficiaries) to 
approach and recruit eligible participants. 

A total of fourteen participants were recruited for the 
pilot activities, and divided into two distinct groups. One 
group consisted of medical students at the University of 
Nicosia Research Foundation (UNRF) (N = 7) and the 
pilot activity was conducted in Cyprus, while the other 
group comprised healthcare professionals (N = 7) and 
took place at AUTH in Greece (Table 1). The sample size 
was regarded as appropriate given the iterative approach 
guiding this preliminary investigation.                                             

TABLE 1. Participants’ demographics.

Groups Healthcare 
Professionals (N = 7)

Medical Students 
(N = 7)

Age M = 29.9 ± 10.9 M = 22.2 ± 2.3

Gender 85.7% Female
14.3% Male

71.4% Female
28.6% Male

Level of 
education

57.1% Bachelor’s degree
28.6% Master’s degree
14.3% Ph.D. or higher

71.4% Lower 
secondary school 

certificate
28.6% Bachelor’s 

degree

Level of 
digital 
literacy

42.8% Basic 
14.4% Intermediate

42.8% Advanced 

28.5% Basic 
28.5% Intermediate

43% Advanced 

Intervention

During their engagement with the scenarios, partici-
pants were exposed to interactive computer simulations 
replicating real-life healthcare and medical training sce-
narios, primarily designed for educational assessment 
and training purposes. Within this context, participants 
were provided with the opportunity to interact with a 
diverse array of virtual cases through the Mobile Virtual 
Patients App (Figure 1), allowing them to gain familiarity 
with a spectrum of neurodegenerative diseases, such as 
Alzheimer’s, Parkinson’s, dementia, and stroke, alongside 
other chronic diseases like diabetes and heart diseases. 
This interactive approach facilitated an inquiry-based 
learning methodology, fostering a deeper understanding 
of these medical conditions. In particular, both two groups 
interacted autonomously with virtual scenarios divided 
into four categories: 

• Diagnosis & Treatment Scenarios (55 scenarios) 
aimed to simulate various medical conditions and 
their corresponding treatment plans. 

• Educational Scenarios (7 scenarios) focused on 
providing educational content to learners about 
new medical techniques, procedures, or guidelines. 

• Symptoms Management (3 scenarios) is designed 
to simulate patients' symptoms and enable learners 
to practice managing and treating them effectively. 

FIGURE 1. Mobile Virtual Patients App interface. 

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J Global Clinical Engineering Vol.6 Special Issue 6: 2024 112

• Empowerment Category (4 scenarios) aimed to 
help learners familiarize themselves with patient 
empowerment and active participation in their 
healthcare.                        

Overall, the study adhered to General Data Protection 
Regulation (GDPR) regulations, obtaining the necessary 
bioethics approval from the Aristotle University of Thes-
saloniki Bioethics Committee. Informed consent was ob-
tained from all participants, ensuring their understanding 
of the study’s scope and their rights as participants.

Measures                                 

System Usability Scale score (SUS score)17 was used to 
measure the level of usability along with the electronic 
Virtual Patient evaluation toolkit (eViP toolkit) to explore 
participants’ learning and clinical reasoning experiences   
with MPVs as well as their overall PBL experience. The 
eViP toolkit is an assessment tool for virtual patients 
created by the largest European program for virtual pa-
tients18 serving as an evaluation tool for the achievement 
of educational outcomes resulting from the use of digital 
virtual patients. It is based on a set of Likert-type state-
ment responses grouped clustered into five subsets: 1) 
Authenticity of the patient encounter and the consultation, 
2) Professional approach in the consultation, 3) Coaching 
during consultation, 4) Learning effect of the consultation, 
and 5) Overall, judgment of case workup. Dimensions of 
Perceived Usefulness (PU), Perceived Ease-of-Use (PEU), 
and Intention of Use (IU) were also measured to explore 
the technology acceptance of MVPs.                 

RESULTS 

Findings from the clinical reasoning tool analysis illu-
minated slight distinctions in the manner in which the two 
groups perceived their progress in achieving educational 
outcomes when utilizing MVPs. The analysis indicates that 
the coaching provided during consultation exhibits the 
most notable disparity, with medical students achieving 
significantly higher scores than healthcare professionals. In 
addition, the axis of learning effect within the consultation 
further underscores that medical students consistently 
achieve superior scores highlighting a clear difference in 
how they acquire knowledge. However, it is important to 
note that both groups’ participants’ overall evaluation of 

whether working through MPVs was a worthwhile learn-
ing experience remains favorable, as the scores in both 
groups exceed the M = 4 (see Figure 2).

The exceptionally high SUS score of M = 86.2 ± 11.1 
obtained from healthcare professionals undoubtedly vali-
dates the outstanding usability of the MVPs. This remark-
able score underscores the system’s user-friendliness and 
effectiveness in meeting the specific needs and demands 
of healthcare professionals, further enhancing its practi-
cal significance in the healthcare context. The SUS score 
derived from medical students’ feedback (M = 77.5 ± 6.6), 
suggests a good level of usability for the proposed MVPs 
among participants. When comparing these results with 
those of healthcare professionals, it’s notable that both 
groups reported above-average usability scores. While 
medical students’ scores are slightly lower than those 
of healthcare professionals, the overall trend indicates 
a consistent perception of the system’s usability across 
these different user groups, affirming its broad applicabil-
ity within the healthcare domain (Table 2).

TABLE 2. Usability, technology acceptance, and clinical reason-
ing results.

 Healthcare Professionals 
(N = 7)

Medical Students 
(N = 7)

SUS M = 86.2 ± 11.1 M = 77.5 ± 6.6

FIGURE 2. The e-ViP clinical reasoning results. 

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113 J Global Clinical Engineering Vol.6 Special Issue 6: 2024

ACKNOWLEDGMENTS  

We would like to express our sincere appreciation to 
the participants and collaborators whose involvement and 
contributions were essential to the successful comple-
tion of this study, especially Andreas Andreou and Prof. 
Constandinos Mavromoustakis from UNRF and Iraklis 
Tsoupouroglou from AUTH. 

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DISCUSSION

This study sought to assess the level of usability and 
technology acceptance concerning the MVPs between 
medical students and healthcare professionals as well as 
discern potential different viewpoints between these two 
distinct participant groups. Across healthcare professionals 
and medical students, the MVPs demonstrated favorable 
ratings, demonstrating their effectiveness in facilitating 
learning experiences. The high SUS score suggests that 
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sessments in dimensions like PU, PEU, and IU emphasize 
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CONCLUSIONS AND FUTURE WORK 

Overall, the results collectively underline the digital 
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aspiring medical students alike. Future research could 
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and expectations of each group to tailor the MVPs cases 
accordingly. Exploring their scalability of implementation 
on a larger scale within healthcare education institutions 
could provide valuable insights into their practicality and 
sustainability for widespread adoption. This research could 
involve assessing infrastructure requirements, training 
needs, and the financial implications of integrating the 
MVPs into the curriculum. 

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