Design and application of a stepwise nursing history-taking training model based on virtual patients

doi:10.3760/cma.j.cn115259-20250124-00096

Abstract

Abstract: Objective To design a virtual patient (VP)-based stepwise history-taking training model and to evaluate its effectiveness. Methods Based on the natural progression of history-taking ability training, this study developed a VP-based stepwise training model that transitions from single-symptom history to comprehensive case history. A total of 392 nursing undergraduates participated from March 2020 to June 2022. The grade 2019 of 206 students formed the experimental group and underwent stepwise VP history-taking training: symptom history-taking during the basic health assessment course and case history-taking during the professional internal medicine nursing course. The grade 2018 of 186 students received traditional teaching. Data were collected at the beginning of the health assessment course (T₀), the end of the health assessment course (T₁), and internal medicine nursing courses (T₂). Due to the data not following a normal distribution, Generalized Estimating Equations were used to conduct statistical analysis on the outcome indicators. Results The experimental group's self-assessed history-taking scores increased by 2.24 points at T₁ and 3.28 points at T₂; the between-group differences in score change were statistically significant at both time points (T₁:P =0.04; T₂: P=0.03). The experimental group's critical thinking scores increased by 3.26 points at T₁ and 4.60 points at T₂; the between-group difference in score change was statistically significant only at T₂ (T₁: P>0.05; T₂: P< 0.001). The difference in supportive communication score changes of two groups was not significant at T₁ and T₂ (P>0.05). Conclusions The stepwise VP history-taking training model can significantly improve students' history-taking skills and critical thinking abilities.

Key words: Nursing, Virtual patient, Stepwise teaching, History-taking skill, Communication skill, Critical thinking

CLC Number:

R-05

Du Jingrong, Wang Juan, Wang Ziwen, Zheng Jing, Zhu Xiaowen, Zhao Juanjuan, Li Kun. Design and application of a stepwise nursing history-taking training model based on virtual patients[J]. Chinese Journal of Medical Education, 2026, 46(1): 47-52.

References

[1] Fawcett T, Rhynas S. Taking a patient history: the role of the nurse[J]. Nurs Stand, 2012,26(24):41-48. DOI: 10.7748/ns2012.02.26.24.41.c8946.
[2] Du J, Zhu X, Wang J, et al. History-taking level and its influencing factors among nursing undergraduates based on the virtual standardized patient testing results: cross sectional study[J]. Nurse Educ Today, 2022,111:105312. DOI: 10.1016/j.nedt.2022.105312.
[3] Fink MC, Reitmeier V, Stadler M, et al. Assessment of diagnostic competences with standardized patients versus virtual patients: experimental study in the context of history taking[J]. J Med Internet Res, 2021,23(3):e21196. DOI: 10.2196/21196.
[4] Keifenheim KE, Teufel M, Ip J, et al. Teaching history taking to medical students: a systematic review[J]. BMC Med Educ, 2015,15:159. DOI: 10.1186/s12909-015-0443-x.
[5] 赵文晓,刘艳丽.虚拟病人联合模拟实践教学在护理本科生临床推理能力培养中的应用效果[J].护理研究,2021,35(19):3511-3513. DOI:10. 12102/j. issn. 1009-6493. 2021. 19. 028.
[6] Kelly S, Smyth E, Murphy P, et al. A scoping review: virtual patients for communication skills in medical undergraduates[J].BMC Med Educ, 2022, 22(1): 429. DOI: 10.1186/s12909-022-03474-9
[7] Sezer B, Sezer TA, Teker GT, et al. Developing a virtual patient: design, usability, and learning effect in communication skills training[J]. BMC Med Educ, 2023,23(1):891. DOI: 10.1186/s12909-023-04860-7.
[8] Plackett R, Kassianos AP, Mylan S, et al. The effectiveness of using virtual patient educational tools to improve medical students' clinical reasoning skills: a systematic review[J]. BMC Med Educ, 2022,22(1):365. DOI: 10.1186/s12909-022-03410-x.
[9] Carnell S, Halan S, Crary M, et al. Adapting virtual patient interviews for interviewing skills training of novice healthcare students.Brinkman W-P, Broekens J, Heylen D, et al.(eds) Intelligent Virtual Agents: 15th International Conference, IVA 2015, Proceedings. Germany: Springer Verlag, 2015: 50-59. DOI: 10.1007/978-3-319-21996-7_5.
[10] 何欢,杜景榕,王子文,等.虚拟病人护理问诊教学系统的开发与应用[J].中华护理教育,2021,18(11):972-977. DOI:10.3761/j.issn.1672-9234.2021.11.002.
[11] Marriner A , Gordon M. Nursing diagnosis: process and application[J]. Am J Nurs, 1983, 83(2): 315-318. DOI:10.2307/347031.
[12] Luo J, Zheng J, He H, et al. Quality of virtual patients on WeChat for nursing history-taking training[J]. Clin Simul Nurs, 2019, 36:37-46. DOI:10.1016/j.ecns.2019.07.001.
[13] Krathwohl D R. A revision of Bloom's taxonomy: an overview[J]. Theor Pract, 2002, 41(4): 212-218. DOI:10.1207/s15430421tip4104_2.
[14] 袁秋环. 护生评判性思维能力及其与人际沟通能力、自我效能感的相关性[D]. 济南: 山东大学, 2008.
[15] Bursac Z, Gauss C H, Williams D K, et al. Purposeful selection of variables in logistic regression[J]. Source Code Biol Med, 2008, 3(1): 17. DOI: 10.1186/1751-0473-3-17.
[16] Liu K, Zhang W, Li W, et al. Effectiveness of virtual reality in nursing education: a systematic review and meta-analysis[J]. BMC Med Educ, 2023,23(1):710. DOI: 10.1186/s12909-023-04662-x.
[17] Kasalaei A, Amini M, Nabeiei P, et al. Barriers of critical thinking in medical students' curriculum from the viewpoint of medical education experts: a qualitative study[J]. J Adv Med Educ Prof, 2020,8(2):72-82. DOI: 10.30476/jamp.2020.83053.1080.
[18] 谭玉婷,黄颖,严璐,等.低年级护理本科生评判性思维能力的调查研究[J].中华护理教育,2015,12(12):909-911. DOI:10.3761/j.issn.1672-9234.2015.12.007.
[19] Vogel D, Meyer M, Harendza S. Verbal and non-verbal communication skills including empathy during history taking of undergraduate medical students[J]. BMC Med Educ, 2018, 18(1): 157. DOI: 10.1186/s12909-018-1260-9.