Cost-effectiveness of virtual patient integration in dermatology education: evidence for precision education by...

Educational technology adoption accelerates despite limited evidence of incremental value within already-effective curricula. Pragmatic evaluations examining cost-effectiveness and differential benefits across learner populations with varying expertise remain scarce.

To evaluate virtual patient integration into established flipped classroom curriculum, examining incremental educational outcomes, comprehensive cost-effectiveness, and systematic variation by training level.

Sequential implementation study at a tertiary teaching hospital in Taiwan (2022-2025). Flipped classroom (FC; 2022-2023, N = 131) was followed by FC with virtual patients (FC + VP; 2024-2025, N = 161).

knowledge acquisition (Cohen's d, achievement rates ≥ 80%). Incremental cost-effectiveness ratios (ICERs) were calculated by training level.

Both approaches achieved extremely large learning effects (FC: d = 2.27; FC + VP: d = 2.43; >98% achievement; between-group differences non-significant). FC + VP required 3.08-fold higher per-student investment ($163 vs. $53). Cost-effectiveness varied dramatically: undergraduates showed meaningful gains (Δd = + 0.29, ICER = $383/d), while postgraduates showed minimal benefit (Δd = + 0.02, ICER = $4,670/d)-a 12.2-fold difference. Germane cognitive load was associated with learning progress (r = .196, R² = 8.5%); critical thinking was not independently associated (p = .497).

Near-universal competency is attainable through multiple instructional approaches. Virtual patient integration was associated with differential incremental value by learner expertise-meaningful for novices but negligible for advanced learners achieving comparable outcomes more efficiently. Findings support precision education frameworks targeting technology investments based on cost-effectiveness profiles rather than universal deployment.