Designing and Evaluating a Virtual Patient Simulation—The Journey from Uniprofessional to Interprofessional Learning

Round 1

Reviewer 1 Report

The research deals with two important issues. One is dealing with the simulation of a virtual patient, the other one is showing an innovative teaching method.

Although the paper is written well, it needs some minor improvements. 

In spite of the fact that the title of the paper inspires designing virtual patient simulation, mainly a user manual is written. The paper would be better if it contains some technical part about the development of the virtual patient simulation.

There is a reference to Table 4 (see line 652) but the paper does not have any table 4.

The situation is the same in line 652, where the authors refer to Table 3, despite the fact there is not any table 3 in the paper.

To sum it up, after the above mentioned minor correction the reviewer suggests this paper for publication.

Author Response

The research deals with two important issues. One is dealing with the simulation of a virtual patient, the other one is showing an innovative teaching method.

Thank you.

Point 1: In spite of the fact that the title of the paper inspires designing virtual patient simulation, mainly a user manual is written. The paper would be better if it contains some technical part about the development of the virtual patient simulation.

Our paper currently contains 2206 words, over 5 pages, on the technical development of the R2P simulation before reporting on the results of our study. This includes subsections on topics such as the need and origin of the simulation, the simulation rationale, clinical script choice and development, programming tools used, VP design considerations, descriptions of how parts I, II and III proceed during the simulation and why, and initial user experiences that fine-tuned the design. We believe anyone wanting to create a screen-based VP simulation could follow our approach and develop a simulation of their own given this information, although clearly the choice of care episode would dictate a number of these aspects. However, we have added the following sentence indicating that further technical detail is available from the corresponding author:

"Further technical detail on the design and development of the VP is available from the corresponding author."

Point 2: There is a reference to Table 4 (see line 652) but the paper does not have any table 4.

The situation is the same in line 652, where the authors refer to Table 3, despite the fact there is not any table 3 in the paper.

Thank you, we have corrected these tables.

Reviewer 2 Report

This is a very well-designed study on the use of Virtual Patient's simulations for professional and interprofessional learning. It stands on a concrete case, and seems attractive to both medical and pharmacy students.

One interesting aspect of the study is that 1) it follows a strong current trend, using simulations to train professionals in "safe" conditions and 2) the technology involved is rather simple, but definitely proves its value.

The study scenario is precise and meaningful. I would suggest illustrating the three successive parts, in order to let the reader appreciate the evolution of the scenario.

Another appreciable aspect of the experimental design is to compare the behaviour of medical and pharmacy students alone and working together. Also, the presence of quantitative and qualitative data (structured interviews) is valuable. The analysis of interview outcome is quite informative on many aspects (including interprofessional perceptions). 

Concerning quantitative data, why not conduct a general ANOVA on the different groups of participants?

Author Response

This is a very well-designed study on the use of Virtual Patient's simulations for professional and interprofessional learning. It stands on a concrete case, and seems attractive to both medical and pharmacy students.

Thank you for the kind words.

Point 1: The study scenario is precise and meaningful. I would suggest illustrating the three successive parts, in order to let the reader appreciate the evolution of the scenario.

We agree, and have added Figure 3 and 4 illustrating Part III of the simulation.

Point 2: Concerning quantitative data, why not conduct a general ANOVA on the different groups of participants?

We did consider this approach. However, given that we were interested in the RIPLS domain-specific effects split by those undergoing interprofessional vs uniprofessional simulation training, this would have involved three ANOVAs, and we considered that this was a case of over analysis on relatively small group n’s. Our main interests were: does the VP improve RIPLS scores? And does interprofessional vs uniprofessional training make a difference? Hence we took a conservative approach and answered the first question (in the affirmative) by a simple t-test between all before and after groups. This allowed us to investigate the source of the affirmative overall result, by answering the second question using a series of post-hoc tests corrected for the risk of multiple comparisons using Holm-Bonferroni correction. We feel confident in the security of our reported results given this approach.