Using a virtual patient to evaluate advanced assessment skills

Communication, organization of the physical examination, and accurate documentation of findings are essential aspects of physical exam skills that need to be developed and refined by an advanced practice nursing student.  Students have opportunities to practice these skills, but the ability of faculty to evaluate and provide feedback to individual students is not feasible without excessive cost and time.  During our “in-person” lab experience, faculty answer questions and observe selected portions of a physical exam (e.g., assessing cranial nerves), however students’ history taking skills and organization of the physical exam are not evaluated throughout the semester.  Students are evaluated based on use of correct format and terminology on assignments that require documentation of a history and physical exam.  The accuracy of the documentation cannot be verified by faculty without direct observation of each student’s history and physical exam or the use of some type of a standardized patient.  A virtual patient has been incorporated into an advanced assessment course to provide these essential learning and distinctive evaluative opportunities for students and faculty.  Digital Clinical Experience^TM (DCE) by Shadow Health^TM, is simulation software which uses a virtual patient to incorporate experiential practice, reflection and questioning to facilitate critical thinking and promote comprehension.  The virtual patient is a 28 single year old female patient with asthma, diabetes who can move, talk and understand over 50,000 questions.  Students can ask any question and select from physical exam skills that are appropriate for a particular system, however the logical sequence for the exam and how to use specific physical exam skills must be determined.  The purpose of incorporating a virtual patient into an advanced assessment course was twofold: 1) to provide students with the opportunity to obtain subjective data, select appropriate physical assessment skills, organize the sequence of the history and physical examination and document findings, and  2) to provide faculty with the opportunity to evaluate how students ask questions, organize history and physical examinations, and document history and physical exam findings.