A scoping review on the use of virtual patients for enhancing empathy in medical students

Virtual patients have been increasingly utilized in medical education to develop empathy in a structured and scalable manner. Compared with traditional methods such as clinical practice and standardized patients, virtual patients can offer reproducible, resource-efficient learning experiences. This scoping review maps the research on virtual patient-based interventions designed to foster empathy in medical students. It seeks to identify existing research gaps, including conceptual definitions of empathy, scenario design, instructional strategies, assessment methods, and outcome measures. The Joanna Briggs Institute's scoping review methodology was followed, and the PRISMA-ScR guidelines for reporting were used. A comprehensive search was conducted in PubMed, CINAHL, ERIC, Web of Science, Scopus, and the Cochrane Library. Two independent reviewers screened all titles, abstracts, and full texts; a third reviewer resolved any discrepancies. Findings were presented narratively and in tabular form to highlight key insights and research gaps. Eighteen studies involving 1,920 medical students were included. The most common study design was single-arm pre-post pilot studies (n = 4, 21.1%), followed by randomized controlled trials (n = 2, 10.5%) and mixed-methods designs (n = 2, 10.5%). Five research gaps were identified: 1) lack of explicit definitions of empathy, 2) limited diversity in clinical scenarios, 3) absence of repeated virtual patient interventions, 4) limitations in assessment methods, and 5) insufficient evidence on the sustained outcomes of empathy. These findings offer important insights into the current state of medical education, where standardized curricula for empathy training remain underdeveloped. Future efforts should address these challenges by integrating virtual patients into instructional designs that effectively foster empathy in medical students. This review provides a foundation for developing and implementing educational programs that meet the needs of students seeking to enhance their empathic abilities and contribute to improved patient outcomes and prevent clinician burnout.