# Virtual vs. standardized patients - a preliminary comparison of advantages and disadvantages of a VR and a conventional learning unit for medical students in child and adolescent psychiatry

## TL;DR

This study compares virtual reality (VR) training with traditional methods for teaching medical students in child and adolescent psychiatry, finding that standardized patients outperformed VR in several aspects.

## Contribution

The study provides a preliminary comparison of VR and conventional learning units in medical education, highlighting specific advantages and disadvantages of each.

## Key findings

- Standardized patients were rated significantly higher in learning success, believability, empathy, and motivation.
- The virtual patient system's inferior performance was mainly attributed to an inappropriate speech recognition system.
- Both methods showed unique advantages and disadvantages, suggesting potential complementary use.

## Abstract

Constructivist learning theories are getting more and more attention in medical education, as generating understanding and knowledge through personal experience seems to be promising. In child and adolescent psychiatry, simulation-based training is challenging, as students’ access to real young patients is limited and there are no standardized patients of that age. Hence, we see Virtual Reality (VR) presenting virtual patients as a means to address these issues. VR enables the standardization of personal encounters in an adaptive learning environment that is cost-effective, scalable and applicable in a standardized way for different learners. Even though virtual patients have become more and more popular in medical education, less studies investigated the strengths and weaknesses of those compared to conventional standardized patients.

We present a within-subjects study with 50 students and compare our virtual patient system, a VR application that allows student to engage in a conversation with a virtual patient, with a conventional standardized patient unit. Students participated in small groups of up to five students alternately in the two units and filled out questionnaires regarding the estimated learning success, believability, empathy, and motivation subsequently. One student at a time conducted the interview with the virtual or standardized patient, while the others took on an observational role. Finally, all students were interviewed comparing both experiences.

Results showed that the standardized patients were rated significantly higher in all dependent variables. Qualitative results highlight an inappropriate speech recognition system as main reason why the virtual patient system proved to be inferior. Furthermore, we identified aspects that demonstrate advantages as well as disadvantages for both units each.

In its current technical implementation, the virtual patient system could not match standardized patients in interactional and affective dimensions. Nonetheless, we identified several aspects, that could be beneficial over or supplementary to the use of standardized patients. Furthermore, we derived implications for the future design of virtual patient systems and in which situation they should be considered.

The online version contains supplementary material available at 10.1186/s12909-026-08760-4.