Open Access Research article

Educational potential of a virtual patient system for caring for traumatized patients in primary care

Solvig Ekblad1*, Richard F Mollica13, Uno Fors2, Ioannis Pantziaras1 and James Lavelle3

Author Affiliations

1 Department of Learning Informatics, Management and Ethics (LIME), Cultural Medicine Unit, Karolinska Institutet, Tomtebodavägen 18A, plan 3, SE-171 77, Stockholm, Sweden

2 Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden

3 Harvard Program in Refugee Trauma (HPRT), Massachusetts General Hospital, Boston, MA, USA

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BMC Medical Education 2013, 13:110  doi:10.1186/1472-6920-13-110

Published: 19 August 2013



Virtual Patients (VPs) have been used in undergraduate healthcare education for many years. This project is focused on using VPs for training professionals to care for highly vulnerable patient populations. The aim of the study was to evaluate if Refugee Trauma VPs was perceived as an effective and engaging learning tool by primary care professionals (PCPs) in a Primary Health Care Centre (PHC).


A VP system was designed to create realistic and engaging VP cases for Refugee Trauma for training refugee patient interview, use of established trauma and mental health instruments as well as to give feedback to the learners. The patient interview section was based on video clips with a Bosnian actor with a trauma story and mental health problems. The video clips were recorded in Bosnian language to further increase the realism, but also subtitled in English. The system was evaluated by 11 volunteering primary health clinicians at the Lynn Community Health Centre, Lynn, Massachusetts, USA. The participants were invited to provide insights/feedback about the system’s usefulness and educational value. A mixed methodological approach was used, generating both quantitative and qualitative data.


Self-reported dimensions of clinical care, pre and post questionnaire questions on the PCPs clinical worldview, motivation to use the VP, and IT Proficiency. Construct items used in these questionnaires had previously demonstrated high face and construct validity. The participants ranked the mental status examination more positively after the simulation exercise compared to before the simulation. Follow up interviews supported the results.


Even though virtual clinical encounters are quite a new paradigm in PHC, the participants in the present study considered our VP case to be a relevant and promising educational tool. Next phase of our project will be a RCT study including comparison with specially prepared paper-cases and determinative input on improving clinical diagnosis and treatment of the traumatized refugee patient.

Primary health care; Virtual patients; Virtual encounters; Refugees; PTSD; Depression