Ensuring Knowledge Transfer: The Critical Role of "What-If" Discussions in Virtual Patient Simulation

Virtual Patient (VP) systems are widely used in medical education, yet evidence on how they support near and far transfer remains limited. This study investigates integrating VPs with role modelling, varied case practices, and "what-if" discussions. It aims to measure the students' overall experience with the intervention, improvement in performance scores on near- and far-transfer cases, and to explore how and why the intervention is perceived to enhance transfer.

An exploratory mixed-methods study was conducted with 21 second-year undergraduate medical students enrolled in the course "Personalised Medicine in Cancer Treatment and Care". Students engaged in role modelling performed by an oncologist, worked through authentic cases with varying patient characteristics, and participated in structured "what-if" discussions. Perceptions about the overall experience were gathered through a 19-item survey (n = 21). Performance scores were evaluated using pre- and post-assessments involving VPs and paper-based cases designed to measure near transfer (Case D) and far transfer (Case E) (n = 21). Group interviews (n = 8) provided deeper insights into enhancing transfer.

Survey results revealed positive student perceptions of role modelling (M = 4.44), varied case practices (M = 4.35), and "what-if" discussions (M = 3.76). Significant improvements were observed in tumour-stage reasoning for both near and far transfer (p < .001), in initial patient impressions (p = .007) for far transfer, and in the total score (p = .018) for far transfer. Thematic analysis indicated that students benefited from a stepwise build-up in case complexity, recognition of similar reasoning steps across cases, reflective "what-if" discussions that highlighted underlying principles, and peer dialogue around VP feedback that supported concept abstraction.

Students evaluated the VP session positively and performance data indicated significant improvements, suggesting that the intervention enhanced near and far transfer. Reflection through "what-if" discussions was perceived to deepen understanding of the underlying principles enabling transfer.