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Abstract：
BACKGROUND: Virtual patients (VPs) are widely used in health professions education. When they are well integrated into curricula, they are considered to be more effective than loosely coupled add-ons. However, it is unclear what constitutes their successful integration. The aim of this study was to identify and synthesise the themes found in the literature that stakeholders perceive as important for successful implementation of VPs in curricula.
METHODS: We searched five databases from 2000 to September 25, 2023. We included qualitative, quantitative, mixed-methods and descriptive case studies that defined, identified, explored, or evaluated a set of factors that, in the perception of students, teachers, course directors and researchers, were crucial for VP implementation. We excluded effectiveness studies that did not consider implementation characteristics, and studies that focused on VP design factors. We included English-language full-text reports and excluded conference abstracts, short opinion papers and editorials. Synthesis of results was performed using the framework synthesis method with Kern\'s six-step model as the initial framework. We appraised the quality of the studies using the QuADS tool.
RESULTS: Our search yielded a total of 4808 items, from which 21 studies met the inclusion criteria. We identified 14 themes that formed an integration framework. The themes were: goal in the curriculum; phase of the curriculum when to implement VPs; effective use of resources; VP alignment with curricular learning objectives; prioritisation of use; relation to other learning modalities; learning activities around VPs; time allocation; group setting; presence mode; VPs orientation for students and faculty; technical infrastructure; quality assurance, maintenance, and sustainability; assessment of VP learning outcomes and learning analytics. We investigated the occurrence of themes across studies to demonstrate the relevance of the framework. The quality of the studies did not influence the coverage of the themes.
CONCLUSIONS: The resulting framework can be used to structure plans and discussions around implementation of VPs in curricula. It has already been used to organise the curriculum implementation guidelines of a European project. We expect it will direct further research to deepen our knowledge on individual integration themes.
METHODS: We searched five databases from 2000 to September 25, 2023. We included qualitative, quantitative, mixed-methods and descriptive case studies that defined, identified, explored, or evaluated a set of factors that, in the perception of students, teachers, course directors and researchers, were crucial for VP implementation. We excluded effectiveness studies that did not consider implementation characteristics, and studies that focused on VP design factors. We included English-language full-text reports and excluded conference abstracts, short opinion papers and editorials. Synthesis of results was performed using the framework synthesis method with Kern\'s six-step model as the initial framework. We appraised the quality of the studies using the QuADS tool.
RESULTS: Our search yielded a total of 4808 items, from which 21 studies met the inclusion criteria. We identified 14 themes that formed an integration framework. The themes were: goal in the curriculum; phase of the curriculum when to implement VPs; effective use of resources; VP alignment with curricular learning objectives; prioritisation of use; relation to other learning modalities; learning activities around VPs; time allocation; group setting; presence mode; VPs orientation for students and faculty; technical infrastructure; quality assurance, maintenance, and sustainability; assessment of VP learning outcomes and learning analytics. We investigated the occurrence of themes across studies to demonstrate the relevance of the framework. The quality of the studies did not influence the coverage of the themes.
CONCLUSIONS: The resulting framework can be used to structure plans and discussions around implementation of VPs in curricula. It has already been used to organise the curriculum implementation guidelines of a European project. We expect it will direct further research to deepen our knowledge on individual integration themes.
摘要：
背景：虚拟患者（VP）在卫生专业教育中被广泛使用。当它们很好地融入课程时，它们被认为比松散耦合的附加组件更有效。然而,目前还不清楚什么是他们成功的整合。这项研究的目的是确定和综合文献中发现的主题，利益相关者认为这对于在课程中成功实施VPs很重要。
方法：我们检索了2000年至2023年9月25日的五个数据库。我们包括定性，定量,混合方法和描述性案例研究定义了，已识别,探索,或评估了一组因素，在学生的感知中，教师,课程主任和研究人员，对副总裁的实施至关重要。我们排除了不考虑实施特征的有效性研究，以及专注于VP设计因素的研究。我们包括英语全文报告和排除会议摘要，简短的意见文件和社论。以Kern的六步模型为初始框架，使用框架合成方法进行结果合成。我们使用QuADS工具评估了研究的质量。
结果：我们的搜索共产生4808个项目，其中21项研究符合纳入标准.我们确定了14个主题，形成了一个整合框架。主题是：课程目标；实施副总裁的课程阶段；有效利用资源；副总裁与课程学习目标保持一致；使用的优先次序；与其他学习方式的关系；围绕副总裁的学习活动；时间分配；小组设置；存在模式；为学生和教师提供副总裁的方向；技术基础设施；质量保证，维护,和可持续性；评估副总裁学习成果和学习分析。我们调查了研究中主题的发生，以证明框架的相关性。研究的质量并不影响主题的覆盖面。
结论：由此产生的框架可用于围绕课程中的VPs实施构建计划和讨论。它已经被用来组织欧洲项目的课程实施指南。我们希望它将指导进一步的研究，以加深我们对个人整合主题的了解。
方法：我们检索了2000年至2023年9月25日的五个数据库。我们包括定性，定量,混合方法和描述性案例研究定义了，已识别,探索,或评估了一组因素，在学生的感知中，教师,课程主任和研究人员，对副总裁的实施至关重要。我们排除了不考虑实施特征的有效性研究，以及专注于VP设计因素的研究。我们包括英语全文报告和排除会议摘要，简短的意见文件和社论。以Kern的六步模型为初始框架，使用框架合成方法进行结果合成。我们使用QuADS工具评估了研究的质量。
结果：我们的搜索共产生4808个项目，其中21项研究符合纳入标准.我们确定了14个主题，形成了一个整合框架。主题是：课程目标；实施副总裁的课程阶段；有效利用资源；副总裁与课程学习目标保持一致；使用的优先次序；与其他学习方式的关系；围绕副总裁的学习活动；时间分配；小组设置；存在模式；为学生和教师提供副总裁的方向；技术基础设施；质量保证，维护,和可持续性；评估副总裁学习成果和学习分析。我们调查了研究中主题的发生，以证明框架的相关性。研究的质量并不影响主题的覆盖面。
结论：由此产生的框架可用于围绕课程中的VPs实施构建计划和讨论。它已经被用来组织欧洲项目的课程实施指南。我们希望它将指导进一步的研究，以加深我们对个人整合主题的了解。
