Students' Experiences of Presence and Learning Across Simulated and Virtual Patient Formats: A Cross-Sectional Study

While traditional medical education emphasizes real patient interactions, practical and ethical constraints require alternatives, such as simulated patients (SPs) or virtual patients (VPs) in virtual reality. This study investigates medical students' experiential perceptions across different simulation formats within the same undergraduate medical curriculum, using a newly developed modality-spanning questionnaire.

A prospective cross-sectional study was conducted with 486 medical students across four curricular courses with differing educational content and objectives (two SP-based and two VP-based courses). A study-specific questionnaire applicable across both simulation formats captured "experience of presence" ('embodiment', 'involvement', 'coherence') and "experience of learning" ('experience of competence', 'tension', 'acquisition of skills', 'enthusiasm'). Exploratory and confirmatory factor analyses were used to examine internal structure and psychometric properties of the questionnaire.

Analyses indicated a stable internal structure with good sampling adequacy (Cronbach's α = 0.82 for "experience of presence" and α = 0.66 for "experience of learning"). While overall perceived learning did not differ between simulation formats, format-specific experiential profiles emerged. SPs were rated higher for "experience of presence", particularly regarding 'involvement' (M = 4.05 vs. 2.62), whereas VPs scored higher for 'coherence' (M = 4.50 vs. 3.98). Within learning-related dimensions, SPs were associated with greater 'tension' (M = 3.57 vs. 2.71) and 'acquisition of skills' (M = 4.66 vs. 4.24), while VPs elicited higher levels of 'enthusiasm' (M = 4.57 vs. 4.03; all p < 0.001).

This study provides insights into how medical students experience presence and learning across different simulation formats within an authentic curricular setting. While SPs appear to foster emotional engagement and perceived skill acquisition, VPs may particularly support spatial orientation and motivational aspects. Applying a single questionnaire across content-diverse courses and modalities may support educators in strategically aligning simulation formats with specific educational objectives and guiding the targeted development of curricula.