Background: Virtual patients are a recent addition to the educational arsenal to develop non-technical skills in\nundergraduate health professionals. The Virtual Simulated Patient Resource (www.vspr.net.au) is a web-based\nresource that uses branching, narrative virtual patients to develop knowledge, attitude and practice of all categories of\nnon-technical skills in undergraduate health professionals. However, there is limited literature exploring how the\ninteraction with a virtual patient influences the development of knowledge, attitude and practice of non-technical skills\nin undergraduate nursing students.\nMethods: An intrinsic case study method, using focus groups and individual interviews, enabled exploration of the\nexperience of undergraduate nursing students when interacting with a virtual patient to develop non-technical skills.\nPurposive sampling identified participants to address the research question. Framework analysis supported by\na codebook enabled deductive and inductive data analysis.\nResults: Forty-five first-year and 31 third-year students consented to participate. Findings indicated that the\ndifferent years interacted differently with the virtual patients. Four themes were recognised in the data: how\nthe virtual patients enabled learning non-technical skills, learning surrounding the virtual patient encounter,\nchanging the way students perceive practice and potential limitations to learning.\nConclusions: Interactions with virtual patients influence learning knowledge, attitudes and practice of nontechnical\nskills in undergraduate nursing students via authenticity in the virtual patient interaction, socialisation to the\nprofessional role, vicarious learning and learning by making mistakes. Potential limitations to learning from\nvirtual patient interactions include fear, overconfidence, groupthink and confusion. To manage limitations to\nlearning, facilitation approaches, opportunities for reflection, constructive feedback and debriefing may be key.\nThis study demonstrates learning non-technical skills via interactions with virtual patients can change the way\nstudents perceive practice, with learning transferable to the clinical setting to support safe and competent\npatient care.
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