# Development, Implementation, and Evaluation of a ‘Virtual Patient’ with Chronic Low Back Pain: An Education Resource for Physiotherapy Students

## TL;DR

This paper describes a virtual patient simulation to teach physiotherapy students how to assess chronic pain in a person-centered way, improving their skills and confidence.

## Contribution

A novel virtual patient simulation was developed and evaluated to enhance physiotherapy students' biopsychosocial pain assessment skills.

## Key findings

- Students showed varying levels of confidence in person-centered inquiry, with higher confidence in simpler scenarios.
- Thematic analysis identified four key areas: learning environment preferences, engagement, professional development, and limitations.
- The simulation fostered insights into biases and emotional challenges in patient-centered care.

## Abstract

Background: The management of chronic pain is inherently multidisciplinary, requiring collaboration across health and care professions because pain is multidimensional, involving psychological, social, biomedical, cultural, and environmental factors. However, pain education has often focused more on biomedical aspects, limiting the capacity of professionals to deliver integrated, person-centred care. Shifting pain education away from biomedically driven curricula may better prepare graduates for meaningful consultations and biopsychosocial care. Objective: This manuscript reports the development and pilot evaluation of a virtual patient simulation designed to help physiotherapy students develop person-centred pain assessment skills. Methods: We developed and piloted a virtual patient with complex pain scenarios for physiotherapy students. To evaluate the simulation, students completed a self-reported questionnaire assessing their ability, self-confidence in person-centred assessment skills, and their attitudes and beliefs regarding the simulation. Results: Frequency and confidence in person-centred inquiry ranged from 100% to 16.3%, depending on the complexity of information. Inductive thematic analysis revealed four themes: (1) Environmental factors & preferences—students’ preference for the learning environment; (2) Learning experience—including engagement, feedback, discussions, and a ‘safe’ space for building confidence; (3) Professional development—insights into person-centred inquiry, personal biases, and emotional challenges; (4) Limitations—including the desire for more complexity, and technical challenges noted. Conclusions: The development of this virtual patient simulation enabled healthcare students to engage with a multidimensional perspective on pain, fostering skills essential for biopsychosocial pain assessment and patient-centred care. Although designed and piloted with physiotherapy students, this model holds potential for broader application across healthcare disciplines.