The Effectiveness of Virtual Patient Simulations in Enhancing‎Medical Education: A Systematic Literature Review with A Fo‎cus on Bahrain and The GCC

  • Authors

    https://doi.org/10.14419/488e7f44

    Received date: July 28, 2025

    Accepted date: August 30, 2025

    Published date: September 6, 2025

  • Virtual Patient Simulation (VPS); Medical Education; Clinical Reasoning; Communication Skills; Knowledge Retention; Arabian Gulf University (AGU); Bahrain; GCC Healthcare Education; Simulation-Based Learning; Virtual Reality in Medical Training‎.

  • Abstract

    This systematic literature review assesses the efficacy of Virtual Patient Simulations (VPS) in enhancing essential learning outcomes in ‎medical education, particularly regarding clinical reasoning, communication skills, and information retention. The evaluation, conducted per ‎PRISMA principles, combined information from 18 eligible studies published between 2014 and 2024. The results indicate that VPS ‎significantly improves clinical reasoning (66.7%), communication (44.4%), and information retention (88.9%) relative to conventional techniques. Tutorials, feedback, and debriefing exercises enhance critical thinking and student engagement.‎

    The research highlights advanced modalities that augment immersion and student involvement, such as first-person perspectives, natural ‎language processing, and voice input. Despite its promise, current research indicates limitations in generalizability, standardization, and ‎long-term impact evaluation, especially in the GCC context. Institutions like Arabian Gulf University (AGU) in Bahrain now use technology like Body Interact, underscoring the region's urgent need for culturally tailored VPS solutions. This report provides evidence-based ‎insights for educators, curriculum creators, and policymakers seeking to improve medical teaching using immersive technology in Bahrain and ‎the GCC area‎.

  • References

    1. A. A. Kononowicz et al., “Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration,” J Med Internet Res, vol. 21, no. 7, p. e14676, Jul. 2019, https://doi.org/10.2196/14676.
    2. P. Croskerry and G. Norman, “Overconfidence in Clinical Decision Making,” Am J Med, vol. 121, no. 5, pp. S24–S29, May 2008, https://doi.org/10.1016/j.amjmed.2008.02.001.
    3. E. P. Monico, “Patient Safety in Emergency Medicine,” Ann Emerg Med, vol. 54, no. 4, p. 644, Oct. 2009, https://doi.org/10.1016/j.annemergmed.2009.04.001.
    4. M. A. Musen, B. Middleton, and R. A. Greenes, “Clinical Decision-Support Systems,” in Biomedical Informatics, Cham: Springer International Publishing, 2021, pp. 795–840. https://doi.org/10.1007/978-3-030-58721-5_24.
    5. L. A. Shay and J. E. Lafata, “Where Is the Evidence? A Systematic Review of Shared Decision Making and Patient Outcomes,” Medical Decision Making, vol. 35, no. 1, pp. 114–131, Jan. 2015, https://doi.org/10.1177/0272989X14551638.
    6. D. A. ALQahtani, J. I. Rotgans, N. E. Ahmed, I. A. Alalwan, and M. E. M. Magzoub, “The Influence of Time Pressure and Case Complexity on Physicians׳ Diagnostic Performance,” Health Professions Education, vol. 2, no. 2, pp. 99–105, Dec. 2016, https://doi.org/10.1016/j.hpe.2016.01.006.
    7. S. Corrao and C. Argano, “Rethinking clinical decision-making to improve clinical reasoning,” Front Med (Lausanne), vol. 9, Sep. 2022, https://doi.org/10.3389/fmed.2022.900543.
    8. G. García-Castro and F. J. Ruiz-Ortega, “Clinical reasoning and medical education: Scoping Review,” Educación Médica, vol. 22, no. 2, pp. 106–110, Mar. 2021, https://doi.org/10.1016/j.edumed.2020.11.015.
    9. R. M. Jendyk, “Decision Making in Different Care Settings: Do Undergraduate Students Already Care?” Health Professions Education, vol. 2, no. 2, pp. 114–120, Dec. 2016, https://doi.org/10.1016/j.hpe.2016.01.008.
    10. D. Khullar, A. K. Jha, and A. B. Jena, “Reducing Diagnostic Errors — Why Now?,” New England Journal of Medicine, vol. 373, no. 26, pp. 2491–2493, Dec. 2015, https://doi.org/10.1056/NEJMp1508044.
    11. K. Macauley, “Evaluating Changes in Clinical Decision-Making in Physical Therapy Students After Participating in Simulation,” Health Professions Education, vol. 4, no. 4, pp. 278–286, Dec. 2018, https://doi.org/10.1016/j.hpe.2018.06.001.
    12. S. D. Monteiro, J. Sherbino, A. Patel, I. Mazzetti, G. R. Norman, and E. Howey, “Reflecting on Diagnostic Errors: Taking a Second Look is Not Enough,” J Gen Intern Med, vol. 30, no. 9, pp. 1270–1274, Sep. 2015, https://doi.org/10.1007/s11606-015-3369-4.
    13. T. Swanwick, “Understanding Medical Education,” in Understanding Medical Education, Wiley, 2018, pp. 1–6. https://doi.org/10.1002/9781119373780.ch1.
    14. P. F. Wimmers and G. F. Schauer, “Validating OSCE Performance: The Impact of General Intelligence,” Health Professions Education, vol. 3, no. 2, pp. 79–84, Dec. 2017, https://doi.org/10.1016/j.hpe.2016.12.002.
    15. G. E. Miller, “The assessment of clinical skills/competence/performance,” Academic Medicine, vol. 65, no. 9, pp. S63-7, Sep. 1990, https://doi.org/10.1097/00001888-199009000-00045.
    16. N. Bodagh, J. Bloomfield, P. Birch, and W. Ricketts, “Problem-based learning: a review,” Br J Hosp Med, vol. 78, no. 11, pp. C167–C170, Nov. 2017, https://doi.org/10.12968/hmed.2017.78.11.C167.
    17. A. Burgess et al., “Scaffolding medical student knowledge and skills: team-based learning (TBL) and case-based learning (CBL),” BMC Med Educ, vol. 21, no. 1, p. 238, Dec. 2021, https://doi.org/10.1186/s12909-021-02638-3.
    18. F. Chen, A. M. Lui, and S. M. Martinelli, “A systematic review of the effectiveness of flipped classrooms in medical education,” Med Educ, vol. 51, no. 6, pp. 585–597, Jun. 2017, https://doi.org/10.1111/medu.13272.
    19. D. Dolmans, L. Michaelsen, J. van Merriënboer, and C. van der Vleuten, “Should we choose between problem-based learning and team-based learning? No, combine the best of both worlds!,” Med Teach, vol. 37, no. 4, pp. 354–359, Apr. 2015, https://doi.org/10.3109/0142159X.2014.948828.
    20. J. C. Trullàs, C. Blay, E. Sarri, and R. Pujol, “Effectiveness of problem-based learning methodology in undergraduate medical education: a scoping review,” BMC Med Educ, vol. 22, no. 1, p. 104, Dec. 2022, https://doi.org/10.1186/s12909-022-03154-8.
    21. N. R. Wijesooriya, V. Mishra, P. L. P. Brand, and B. K. Rubin, “COVID-19 and telehealth, education, and research adaptations,” Paediatr Respir Rev, vol. 35, pp. 38–42, Sep. 2020, https://doi.org/10.1016/j.prrv.2020.06.009.
    22. R. Hilburg, N. Patel, S. Ambruso, M. A. Biewald, and S. S. Farouk, “Medical Education During the Coronavirus Disease-2019 Pandemic: Learning from a Distance,” Adv Chronic Kidney Dis, vol. 27, no. 5, pp. 412–417, Sep. 2020, https://doi.org/10.1053/j.ackd.2020.05.017.
    23. R. Hilburg, N. Patel, S. Ambruso, M. A. Biewald, and S. S. Farouk, “Medical Education During the Coronavirus Disease-2019 Pandemic: Learning from a Distance,” Adv Chronic Kidney Dis, vol. 27, no. 5, pp. 412–417, Sep. 2020, https://doi.org/10.1053/j.ackd.2020.05.017.
    24. N. Nimavat et al., “Online Medical Education in India – Different Challenges and Probable Solutions in the Age of COVID-19,” Adv Med Educ Pract, vol. Volume 12, pp. 237–243, Mar. 2021, https://doi.org/10.2147/AMEP.S295728.
    25. S. Rose, “Medical Student Education in the Time of COVID-19,” JAMA, vol. 323, no. 21, p. 2131, Jun. 2020, https://doi.org/10.1001/jama.2020.5227.
    26. P. J. Slanetz, U. Parikh, T. Chapman, and C. L. Motuzas, “Coronavirus Disease 2019 (COVID-19) and Radiology Education—Strategies for Sur-vival,” Journal of the American College of Radiology, vol. 17, no. 6, pp. 743–745, Jun. 2020, https://doi.org/10.1016/j.jacr.2020.03.034.
    27. A. A. Kononowicz, N. Zary, S. Edelbring, J. Corral, and I. Hege, “Virtual patients - what are we talking about? A framework to classify the mean-ings of the term in healthcare education,” BMC Med Educ, vol. 15, no. 1, p. 11, Dec. 2015, https://doi.org/10.1186/s12909-015-0296-3.
    28. H. Ahmed, M. Allaf, and H. Elghazaly, “COVID-19 and medical education,” Lancet Infect Dis, vol. 20, no. 7, pp. 777–778, Jul. 2020, https://doi.org/10.1016/S1473-3099(20)30226-7.
    29. F. Jones, C. Passos-Neto, and O. Melro Braghiroli, “Simulation in Medical Education: Brief history and methodology,” Principles and Practice of Clinical Research Journal, vol. 1, no. 2, pp. 56–63, Sep. 2015, https://doi.org/10.21801/ppcrj.2015.12.8.
    30. J. O. Lopreiato and T. Sawyer, “Simulation-Based Medical Education in Pediatrics,” Acad Pediatr, vol. 15, no. 2, pp. 134–142, Mar. 2015, https://doi.org/10.1016/j.acap.2014.10.010.
    31. G. Makransky et al., “Simulation based virtual learning environment in medical genetics counseling: an example of bridging the gap between theory and practice in medical education,” BMC Med Educ, vol. 16, no. 1, p. 98, Dec. 2016, https://doi.org/10.1186/s12909-016-0620-6.
    32. J. Moran, G. Briscoe, and S. Peglow, “Current Technology in Advancing Medical Education: Perspectives for Learning and Providing Care,” Aca-demic Psychiatry, vol. 42, no. 6, pp. 796–799, Dec. 2018, https://doi.org/10.1007/s40596-018-0946-y.
    33. C. Pinter et al., “SlicerVR for Medical Intervention Training and Planning in Immersive Virtual Reality,” IEEE Trans Med Robot Bionics, vol. 2, no. 2, pp. 108–117, May 2020, https://doi.org/10.1109/TMRB.2020.2983199.
    34. W. Song et al., “An Intelligent Virtual Standard Patient for Medical Students Training Based on Oral Knowledge Graph,” IEEE Trans Multimedia, vol. 25, pp. 6132–6145, 2023, https://doi.org/10.1109/TMM.2022.3205456.
    35. S. Tabatabai, “Simulations and Virtual Learning Supporting Clinical Education During the COVID 19 Pandemic,” Adv Med Educ Pract, vol. Vol-ume 11, pp. 513–516, Aug. 2020, https://doi.org/10.2147/AMEP.S257750.
    36. R.-J. Wilcha, “Effectiveness of Virtual Medical Teaching During the COVID-19 Crisis: Systematic Review,” JMIR Med Educ, vol. 6, no. 2, p. e20963, Nov. 2020, https://doi.org/10.2196/20963.
    37. N. K. Dicheva, I. U. Rehman, A. Anwar, M. M. Nasralla, L. Husamaldin, and S. Aleshaiker, “Digital Transformation in Nursing Education: A Sys-tematic Review on Computer-Aided Nursing Education Pedagogies, Recent Advancements and Outlook on the Post-COVID-19 Era,” IEEE Ac-cess, vol. 11, pp. 135659–135695, 2023, https://doi.org/10.1109/ACCESS.2023.3337669.
    38. R. H. Ellawa, “Virtual patients as activities: exploring the research implications of an activity theoretical stance,” Perspect Med Educ, vol. 3, no. 4, pp. 266–277, Aug. 2014, https://doi.org/10.1007/S40037-014-0134-Z.
    39. A. Kleinsmith, D. Rivera-Gutierrez, G. Finney, J. Cendan, and B. Lok, “Understanding empathy training with virtual patients,” Comput Human Behav, vol. 52, pp. 151–158, Nov. 2015, https://doi.org/10.1016/j.chb.2015.05.033.
    40. A. Hirumi et al., “Advancing virtual patient simulations through design research and interPLAY: part I: design and development,” Educational Technology Research and Development, vol. 64, no. 4, pp. 763–785, Aug. 2016, https://doi.org/10.1007/s11423-016-9429-6.
    41. S. Krishnamurthy, “The future of business education: A commentary in the shadow of the Covid-19 pandemic,” J Bus Res, vol. 117, pp. 1–5, 2020, https://doi.org/10.1016/j.jbusres.2020.05.034.
    42. K. Krishnamurthy et al., “Benefits of gamification in medical education,” Clinical Anatomy, vol. 35, no. 6, pp. 795–807, Sep. 2022, https://doi.org/10.1002/ca.23916.
    43. J. Lee, H. Kim, K. H. Kim, D. Jung, T. Jowsey, and C. S. Webster, “Effective virtual patient simulators for medical communication training: A sys-tematic review,” Med Educ, vol. 54, no. 9, pp. 786–795, Sep. 2020, https://doi.org/10.1111/medu.14152.
    44. J. Pottle, “Virtual reality and the transformation of medical education,” Future Healthc J, vol. 6, no. 3, pp. 181–185, Oct. 2019, https://doi.org/10.7861/fhj.2019-0036.
    45. F. L. Ricci, F. Consorti, F. Pecoraro, D. Luzi, and O. Tamburis, “A Petri-Net-Based Approach for Enhancing Clinical Reasoning in Medical Educa-tion,” IEEE Transactions on Learning Technologies, vol. 15, no. 2, pp. 167–178, Apr. 2022, https://doi.org/10.1109/TLT.2022.3157391.
    46. S. Sai, A. Gaur, R. Sai, V. Chamola, M. Guizani, and J. J. P. C. Rodrigues, “Generative AI for Transformative Healthcare: A Comprehensive Study of Emerging Models, Applications, Case Studies, and Limitations,” IEEE Access, vol. 12, pp. 31078–31106, 2024, https://doi.org/10.1109/ACCESS.2024.3367715.
    47. B. Wheeler and E. Dippenaar, “The use of simulation as a teaching modality for paramedic education: a scoping review,” Br Paramed J, vol. 5, no. 3, pp. 31–43, 2020, https://doi.org/10.29045/14784726.2020.12.5.3.31.
    48. D. J. L. T. R. P. Michael Birtill James King and P. Simpson, “The use of immersive simulation in paramedicine education: a scoping review,” Inter-active Learning Environments, vol. 31, no. 4, pp. 2428–2443, 2023, https://doi.org/10.1080/10494820.2021.1889607.
    49. N. Rees, “ParaVR: a virtual reality training simulator for paramedic skills maintenance.,” Journal of Paramedic Practice, vol. 2(12), 478, 2020. https://doi.org/10.12968/jpar.2020.12.12.478.
    50. R. P. Strum and A. P. Costa, “Implementing machine learning in paramedicine,” CMAJ. Canadian Medical Association Journal, vol. 194, no. 2, p. E54, 2022, https://doi.org/10.1503/cmaj.80405.
    51. P. Eggers, A. Ward, and S. Ensmann, “Augmented Reality in Paramedic Training: a Formative Study,” J Form Des Learn, vol. 4, no. 1, pp. 17–21, 2020, https://doi.org/10.1007/s41686-020-00041-7.
    52. M. M. Honda M , Alshebani et al., “Application of Artificial Intelligence in Paramedic Education: Current Scenario and Future Perspective: A Nar-rative Review,” The Journal of Medicine, Law & Public Health, vol. 4, no. 1, pp. 299–306, 2023, https://doi.org/10.52609/jmlph.v4i1.98.
    53. Balaram Yadav Kasula, “View of Ethical and Regulatory Considerations in AI-Driven Healthcare Solutions.pdf,” 2021. [Online]. Available: https://meridianjournal.in/index.php/IMJ/article/view/23/9.
    54. W. Zhang, M. Cai, H. J. Lee, R. Evans, C. Zhu, and C. Ming, “AI in Medical Education: Global situation, effects and challenges,” Educ Inf Tech-nol (Dordr), 2023, https://doi.org/10.1007/s10639-023-12009-8.
    55. I. J. Kuckelman, P. H. Yi, M. Bui, I. Onuh, J. A. Anderson, and A. B. Ross, “Assessing AI-Powered Patient Education: A Case Study in Radiolo-gy,” Acad Radiol, vol. 31, no. 1, pp. 338–342, 2024, https://doi.org/10.1016/j.acra.2023.08.020.
    56. J. J. Park, J. Tiefenbach, and A. K. Demetriades, “The role of artificial intelligence in surgical simulation,” Front Med Technol, vol. 4, no. December, 2022, https://doi.org/10.3389/fmedt.2022.1076755.
    57. A. M. Fazlollahi et al., “Effect of artificial intelligence tutoring vs expert instruction on learning simulated surgical skills among medical students a randomized clinical trial,” JAMA Netw Open, vol. 5, no. 2, pp. 1–15, 2022, https://doi.org/10.1001/jamanetworkopen.2021.49008.
    58. J. J. M. Sim, K. D. Bin Rusli, B. Seah, T. Levett-Jones, Y. Lau, and S. Y. Liaw, “Virtual Simulation to Enhance Clinical Reasoning in Nursing: A Systematic Review and Meta-analysis.,” Clin Simul Nurs, vol. 69, pp. 26–39, Aug. 2022, https://doi.org/10.1016/j.ecns.2022.05.006.
    59. J. Ramakrishnan, T. Liu, F. Zhang, K. Seshadri, R. Yu, and U. Creative, “Assessing Artificial Intelligence Awareness and Identifying Essential Competencies: Insights from Key Stakeholders in Integrating Ai into Medical Education,” no. Feb, pp. 1–34, 2024, [Online]. Available: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4713042.
    60. M. U. Sattar, S. Palaniappan, A. Lokman, N. Shah, U. Khalid, and R. Hasan, “Motivating medical students using virtual reality based education,” International Journal of Emerging Technologies in Learning, vol. 15, no. 2, pp. 160–174, 2020, https://doi.org/10.3991/ijet.v15i02.11394.
    61. G. Zhao, M. Fan, Y. Yuan, F. Zhao, and H. Huang, “The comparison of teaching efficiency between virtual reality and traditional education in medical education: a systematic review and meta-analysis,” Ann Transl Med, vol. 9, no. 3, pp. 252–252, 2021, https://doi.org/10.21037/atm-20-2785.
    62. K. S. Tang, D. L. Cheng, E. Mi, and P. B. Greenberg, “Augmented reality in medical education: a systematic review,” Can Med Educ J, vol. 11, no. 1, pp. 81–96, 2019, https://doi.org/10.36834/cmej.61705.
    63. J. Labovitz and C. Hubbard, “The Use of Virtual Reality in Podiatric Medical Education,” Clin Podiatr Med Surg, vol. 37, no. 2, pp. 409–420, 2020, https://doi.org/10.1016/j.cpm.2019.12.008.
    64. H. S. Maresky, A. Oikonomou, I. Ali, N. Ditkofsky, M. Pakkal, and B. Ballyk, “Virtual reality and cardiac anatomy: Exploring immersive three-dimensional cardiac imaging, a pilot study in undergraduate medical anatomy education,” Clinical Anatomy, vol. 32, no. 2, pp. 238–243, 2019, https://doi.org/10.1002/ca.23292.
    65. S. F. M. Alfalah, J. F. M. Falah, T. Alfalah, M. Elfalah, N. Muhaidat, and O. Falah, “A comparative study between a virtual reality heart anatomy system and traditional medical teaching modalities,” Virtual Real, vol. 23, no. 3, pp. 229–234, 2019, https://doi.org/10.1007/s10055-018-0359-y.
    66. V. C. Pandrangi, B. Gaston, N. P. Appelbaum, F. C. Albuquerque, M. M. Levy, and R. A. Larson, “The Application of Virtual Reality in Patient Education,” Ann Vasc Surg, vol. 59, pp. 184–189, 2019, https://doi.org/10.1016/j.avsg.2019.01.015.
    67. H. Y. So, P. P. Chen, G. K. C. Wong, and T. T. N. Chan, “Simulation in medical education,” Journal of the Royal College of Physicians of Edin-burgh, vol. 49, no. 1, pp. 52–57, 2019, https://doi.org/10.4997/jrcpe.2019.112.
    68. Y. El Miedany, “Virtual Reality and Augmented Reality,” in Rheumatology Teaching: The Art and Science of Medical Education, Cham: Springer International Publishing, 2019, pp. 403–427. https://doi.org/10.1007/978-3-319-98213-7_20.
    69. P. Dhar, T. Rocks, R. M. Samarasinghe, G. Stephenson, and C. Smith, “Augmented reality in medical education: students’ experiences and learning outcomes,” Med Educ Online, vol. 26, no. 1, 2021, https://doi.org/10.1080/10872981.2021.1953953.
    70. N. Raafat, A. D. Harbourne, K. Radia, M. J. Woodman, C. Swales, and K. E. A. Saunders, “Virtual patients improve history-taking competence and confidence in medical students,” Med Teach, vol. 46, no. 5, pp. 682–688, May 2024, https://doi.org/10.1080/0142159X.2023.2273782.
    71. V. Carrard, C. Bourquin, S. Orsini, M. Schmid Mast, and A. Berney, “Virtual patient simulation in breaking bad news training for medical students,” Patient Educ Couns, vol. 103, no. 7, pp. 1435–1438, Jul. 2020, https://doi.org/10.1016/j.pec.2020.01.019.
    72. R. R. Gulati, D. McCaffrey, J. Bailie, and E. Warnock, “Virtually prepared! Student-led online clinical assessment,” Education for Primary Care, vol. 32, no. 4, pp. 245–246, Jul. 2021, https://doi.org/10.1080/14739879.2021.1908173.
    73. S. I. , S. J. M. and S. I. M. Saniya Raghib Sabzwari1, “Creation of Virtual Patients for Undergraduate and Postgraduate Medical Education: An Experience from Pakistan,” Journal of the College of Physicians and Surgeons Pakistan, vol. 33, no. 04, pp. 457–459, Apr. 2023, https://doi.org/10.29271/jcpsp.2023.04.457.
    74. T. Dale MacLaine, N. Lowe, and J. Dale, “The use of simulation in medical student education on the topic of breaking bad news: A systematic re-view,” Patient Educ Couns, vol. 104, no. 11, pp. 2670–2681, Nov. 2021, https://doi.org/10.1016/j.pec.2021.04.004.
    75. P. and P. F. C. M. C. Donald Combs, “Emerging Roles of Virtual Patients in the Age of AI,” AMA J Ethics, vol. 21, no. 2, pp. E153-159, Feb. 2019, https://doi.org/10.1001/amajethics.2019.153.
    76. J. H. Hepps, C. E. Yu, and S. Calaman, “Simulation in Medical Education for the Hospitalist,” Pediatr Clin North Am, vol. 66, no. 4, pp. 855–866, Aug. 2019, https://doi.org/10.1016/j.pcl.2019.03.014.
    77. W. F. Bond et al., “Virtual Standardized Patient Simulation,” Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, vol. 14, no. 4, pp. 241–250, Aug. 2019, https://doi.org/10.1097/SIH.0000000000000373.
    78. C. Tay, A. Khajuria, and C. Gupte, “Simulation training: A systematic review of simulation in arthroscopy and proposal of a new competency-based training framework,” International Journal of Surgery, vol. 12, no. 6, pp. 626–633, Jun. 2014, https://doi.org/10.1016/j.ijsu.2014.04.005.

  • Downloads

  • How to Cite

    Jaber, F. A. ., Al-Balasmeh, H., Jaber, N. A. ., Jaber, A. A. ., Abdulsattar, S. S. ., & Mahmood, A. . (2025). The Effectiveness of Virtual Patient Simulations in Enhancing‎Medical Education: A Systematic Literature Review with A Fo‎cus on Bahrain and The GCC. International Journal of Basic and Applied Sciences, 14(5), 159-173. https://doi.org/10.14419/488e7f44