Exploring the validity and reliability of a questionnaire for evaluating virtual patient design with a special emphasis on fostering clinical reasoning

Huwendiek, Sören; De Leng, Bas A.; Kononowicz, Andrzej A.; Kunzmann, Romy; Muijtjens, Arno M.M.; Van Der Vleuten, Cees P.M.; Hoffmann, Georg Friedrich; Tönshoff, Burkhard; Dolmans, Diana H.J.M. (2014). Exploring the validity and reliability of a questionnaire for evaluating virtual patient design with a special emphasis on fostering clinical reasoning. Medical teacher, 37(8), pp. 775-782. Informa Healthcare 10.3109/0142159X.2014.970622

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Background: Virtual patients (VPs) are increasingly used to train clinical reasoning. So far, no validated evaluation instruments
for VP design are available.
Aims: We examined the validity of an instrument for assessing the perception of VP design by learners.
Methods: Three sources of validity evidence were examined: (i) Content was examined based on theory of clinical reasoning
and an international VP expert team. (ii) The response process was explored in think-aloud pilot studies with medical students
and in content analyses of free text questions accompanying each item of the instrument. (iii) Internal structure was assessed
by exploratory factor analysis (EFA) and inter-rater reliability by generalizability analysis.
Results: Content analysis was reasonably supported by the theoretical foundation and the VP expert team. The think-aloud
studies and analysis of free text comments supported the validity of the instrument. In the EFA, using 2547 student evaluations of a
total of 78 VPs, a three-factor model showed a reasonable fit with the data. At least 200 student responses are needed to obtain a
reliable evaluation of a VP on all three factors.
Conclusion: The instrument has the potential to provide valid information about VP design, provided that many responses per VP
are available.

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