Virtual patients can help nurses in real-life situations
When health care providers meet patients, communication is key. If the nurse doesn’t ask relevant questions, important information may be left out which could lead to the wrong diagnosis and treatment. Virtual patients are here to help with clinical reasoning.
Photo: Nappy/Unsplash.
In Rwanda, trained nurses work independently at health centres. They are the patient’s first point of contact and as such, they have a lot of responsibility. The nurse meets with patients and then decides whether they should be sent home with some medication, or if they need to go to a hospital and see a physician.
To make sure that nurses are qualified for their job, they need to renew their license every year.
“This is the case also for Australia and many other countries”, Gerard Nyiringango explains.
“To renew the license, the nurse may have to go to training somewhere and leave work for maybe a week. Online learning is another option. In my thesis work, I have explored how virtual patient cases can complement other types of learning”, he continues.
Gerard Nyiringango. Photo: Åse Karlén.
Virtual patient cases are computer simulations of real-life clinical scenarios. The learner can interact with an avatar, ask questions and get various replies. This helps their clinical reasoning abilities.
There are a number of different virtual patient cases available. For his qualitative and quantitative studies, Nyiringango used the Virtual Case System developed at Stockholm University.
“This system is used in education of medical students, for example at Halmstad University. I wanted to see if it can also be of use in the continuous learning of health care professionals. The results are very positive”, says Gerard Nyiringango.
The nurse has a huge responsibility
He started his work in the midst of the pandemic. New diseases like COVID-19 are one of many reasons why health care providers need to update their knowledge and practices. New, improved ways of assessing and managing patients is another reason.
Traditionally, continuous learning takes place face to face: At conferences and meetings, but most importantly at the bedside of patients. When nurses work side by side, juniors learn from seniors. This is not the case for the nurses in Rwandan primary health centers.
“They are alone with the patient in the examination room, and they have to make the right decisions. Any mistake can lead to serious complications. In other words, this is a huge responsibility.”
“Also, when the nurse has sent a patient home or to a hospital, they rarely get feedback. This means that they don’t get the opportunity to learn from their actions. Virtual patients can help bridge that gap”, says Gerard Nyiringango.
Valuable feedback
When the nurse interacts with the system, he or she can ask the virtual patient: How are you? What is your complication? When did it start? And this interaction can go on.
“The best part is the assessment afterwards. If the nurse has concluded that the patient has diabetes, they get to know if they were correct or if they misinterpreted the symptoms. The assessment includes information on questions that could have been asked, or tests that should have been taken.”
“The system also gives feedback on how the nurse interacted with the patient, for example if he or she showed empathy.”
Improved clinical reasoning
56 nurses participated in the study, and they interacted with virtual patients who suffered from hypertension, depression, gastric cancer and prostate cancer. Results show that their clinical reasoning skills improved, and that the nurses were positive towards this type of training.
“There are both pedagogical and professional benefits. Virtual patient cases are easy to use, motivating and provide a safe learning environment. Nurses learn how to reason and their clinical decision making improves. This is very beneficial when they meet real patients.”
Nyiringango sees a lot of potential in virtual patients, both for medical schools and for continuous professional development. And he knows what he’s talking about. With 15 years of experience as a trained nurse and a nurse educator, Gerard Nyiringango has worked with various forms of simulations, telemedicine and ICT (information and communications technology).
“Rwanda is a developing country and the quality of care is one important area of development. I think that systems like this will be available, not only for nurses but also for physicists, dentists and others in health care. And I will strive to have virtual patients in medical schools too, I know that it works in Sweden”, says Gerard Nyiringango.
“I was scared at first”
Gerard Nyiringango’s doctoral studies started out with a competition – which he won. He embarked on his PhD journey in 2020.
“I was a bit nervous and scared at first. I thought: This is ICT – and I am a nurse”, Nyiringango says with a smile.
His PhD studies involved several partners: Stockholm University, University of Rwanda, and Sida, The Swedish International Development Cooperation Agency, which funded the project.
“The first course I took involved Java programming. It terrified me, but I worked hard and I passed. My supervisors and everyone else have been very helpful”, says Gerard Nyiringango.
Congratulations, Dr. Nyiringango! Main supervisor Uno Fors and Gerard Nyiringango celebrating with cakes and gifts. Photo: Åse Karlén.
Gerard Nyiringango successfully defended his PhD thesis at the Department of Computer and Systems Sciences (DSV), Stockholm University, on February 14, 2025.
The title of the thesis is “Exploring the Potential of Using Virtual Patient Cases for Continuous Professional Development of Nurses Working in Primary Health Centres in Rwanda”.
The thesis can be downloaded from Diva
Ing-Marie Carlsson, Halmstad University, was the external reviewer at the defence.
Main supervisor for the thesis was Uno Fors, DSV. Supervisors were Elenita Forsberg, Halmstad University, and David Tumussime, University of Rwanda.
Contact Uno Fors
DSV professor Teresa Cerratto-Pargman congratulates Gerard Nyiringango. Photo: Åse Karlén.
Last updated: 2025-02-19
Source: Department of Computer and Systems Sciences, DSV