효과적인 가상환자 설계를 위한 평가 척도 개발 : The Development of an Assessment Rating Scale for Designing Effective Virtual Patients

다국어 초록 (Multilingual Abstract)

The purpose of this study was to identify (a) the design features of the virtual patient through an overall review of virtual patients and (b) a number of factors for virtual patient assessment. A virtual patient is an interactive 3D animated computer simulation program that replicates real-life clinical scenarios for medical education. In order to identify the features of virtual patients for design factors, a literature review was conducted, focusing on publications retrieved from PubMeD, ScienceDirect and ProQuest with the keywords “virtual patient.” In total, 317 articles were reviewed, in which 234 came from PubMeD, 67 from ScienceDirect, and 16 from ProQuest. The final number of articles maintained for the study was 17, which were reviewed to develop the virtual patient assessment survey items. These 23 survey items consisted of initial factors, such as usefulness, scenario authenticity, realistic appearance, behavior, and overall evaluation. A series of exploratory factor analyses were applied to identify the appropriate dimensionality of virtual patient assessment, the sample size of this study was 125 undergraduate students.
The exploratory factor analysis supported six factors, including facial expression, usefulness, gesture, overall evaluation, scenario authenticity, and behavior of virtual patient, and the final number of survey items extracted was 19. The definition of each factor is as follows. First, facial expression is how well virtual patient express emotional states naturally and is important when interacting with users. Second, usefulness of virtual patient is defined as user’s perception of how helpful the virtual patient system is for clinical learning. The factor focused on enhancing clinical learning and preparing students for real patient encounters. Third, gesture of virtual patient refers to how well virtual patients express bodily actions and helps convey attitudes and emotions with users for interaction. Fourth, overall evaluation is defined as the overall perception or attitude of the users to the virtual patient system and reflects satisfaction and perception of users about virtual patient system. Fifth, scenario authenticity pertains to the degree of scenario realism and similarity to real clinical situations and can improve learning transfer to real clinical situations. Finally, behavior of virtual patient is defined as how naturally a virtual patient behaved. This factor focused on the behavior of virtual patients as to assess how alike in appearance and attitude the virtual patient was to a real patient.
Two main findings resulted from this exploratory study. First, the realistic appearance of virtual patient was divided into two sub-categories: facial expression and gesture. In the initial model, although the realistic appearance correlated with outlook of the virtual patient, the analysis revealed that realistic appearance consisted of both facial expression and gesture. The facial expression is an important factor because it facilitates interactions with users and expresses emotional states. Also, realistic appearance plays a role in non-verbal communication. Second, the factor facial expression had a considerably greater impact on the rest of factors. In light of this, facial expression might be the most important factor for assessing virtual patient. In the correlation analysis among the factors, facial expression showed a stronger association with the two factors gesture and behavior of virtual patient. The three factors seem to be critical when developing non-verbal features of virtual patients.

목차 (Table of Contents)

• Ⅰ. INTRODUCTION 1
• 1. Background of Statement 1
• 2. Purpose of the Study 3
• 3. Research Questions 3
• 4. Definition of Terms 4
• 1) Virtual patient 4
• 2) Medical simulation 4
• Ⅱ. LITERATURE REVIEW 5
• 1. Simulation in Medical Education 5
• 1) Medical education for clinical training 5
• 2) Standardized patient in simulation 9
• 3) Virtual patient 11
• 2. Design of Virtual Patient 13
• 1) Typological framework 13
• 2) Appearance and voice 16
• 3) Scenarios 19
• 3. Implementation of Virtual Patient 20
• 1) Clinical context 20
• 2) Effects of virtual patient 22
• 3) Examples of virtual patients 25
• 4. Initial Instrument of Virtual Patient Design Factors 30
• 1) Literature review 30
• 2) Initial factors 31
• Ⅲ. METHOD 36
• 1. Participants 36
• 2. Experiment Materials 36
• 1) Virtual patient 36
• 2) Scenario 37
• 3) Interface design 39
• 3. Survey Items 42
• 4. Experiment Setting 44
• 5. Experiment Procedure 45
• 6. Data Analysis 46
• 1) Preliminary analysis 46
• 2) Extraction of initial model 47
• 3) Selection of dimensionality 47
• 4) Rotation 47
• 5) Label the factors and interpretation 48
• Ⅳ. RESULTS 49
• 1. Preliminary Analysis 49
• 2. Extraction of Initial Model 51
• 3. Selection of Dimensionality 56
• 4. Rotation 58
• 5. Label the Factors and Interpretation 64
• Ⅴ. DISCUSSION 66
• 1. Discussion of the Results 66
• 2. Limitations of the Present Study and Directions for Future Research 70
• REFERENCES 72
• APPENDIX 80