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Comparing classroom instruction to individual instruction as a teaching approach to avatar-based patient monitoring with the "Visual Patient": an experimental study.

  • Rössler, Julian1
  • Kaserer, Alexander1
  • Albiez, Benjamin1
  • Braun, Julia2
  • Breckwoldt, Jan1
  • Spahn, Donat Rudolf1
  • Nöthiger, Christoph Beat1
  • Tscholl, David Werner1
  • 1 University and University Hospital Zurich, Raemistrasse 100, Zurich, CH.
  • 2 University of Zurich, Biostatistics and Prevention Institute, Departments of Epidemiology and Biostatistics, Epidemiology, Zürich, CH.
Published Article
JMIR medical education
Publication Date
Mar 23, 2020
DOI: 10.2196/17922
PMID: 32205304


The Visual Patient is an avatar-based alternative to standard patient monitor displays, which significantly improves the perception of vital signs. Implementation in larger organizations would require the technology to be teachable in a brief class instruction to big groups of professionals. Therefore, our study aimed to investigate the efficacy of such a large-scale introduction of the Visual Patient. In this study, we aimed to compare two different educational methods, 1 on 1 instruction and class instruction, for training anesthesia providers in avatar-based patient monitoring. In this experimental study, we presented 42 anesthesia providers with a 30-minute instruction in a class to the Visual Patient (class instruction group). We further selected a historical sample of 16 participants from a previous study, who received an individual instruction (individual instruction group). After the instruction, participants were shown monitoring with either conventional displays or Visual Patient displays and asked to interpret vital signs. In the class instruction group, the number of correct perceptions was compared between the two technologies after seeing scenarios for either 3 or 10 seconds. Then, the teaching efficacy of the class instruction was compared with the individual instruction in the historical sample by a two-way mixed ANOVA and mixed regression. In the class instruction group, when presented with the 3 seconds scenarios there was a statistically significant median increase in perception of vital signs (3 vital signs) if participants were shown the Visual Patient compared to the conventional display, P < .0001, effect size r= -0.55. No significant difference was found in the 10 second scenarios. There was a statistically significant interaction between the teaching intervention and display technology on perceived vital signs, P = .036, partial η2 = 0.076. The mixed logistic regression model for correct vital sign perception yielded an odds ratio (OR) of 1.88 (95% confidence interval (CI) 1.41 to 2.52, P < .0001) for individual instruction compared to class instruction, as well as an OR of 3.03 (95% CI 2.50 to 3.70, P < .0001) for the Visual Patient compared to conventional monitoring. Although individual instruction to the Visual Patient is slightly more effective, class instruction is a viable teaching method facilitating the feasibility of large-scale introduction of health care providers to the novel technology.

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