Interprofessional development of virtual patient cases: experiences and lessons learned – a qualitative study / Entwicklung interprofessionller virtueller Patient:innenfälle: Erfahrungen und lessons learned – eine qualitative Studie

Interprofessional collaboration (IPC) is becoming increasingly important amid complex challenges in the healthcare sector, including demographic, economic, and technological changes (Deloitte, 2024; Frenk et al., 2010; Sturm et al., 2022). IPC aims to improve patient care and safety and to increase job satisfaction among health professionals, thereby helping counteract the shortage of skilled workers (Charité, 2018; Sottas, 2016; WR, 2012). The ability to engage in IPC is seen as a key competence for sustainable healthcare (Cichon & Nock, 2024). Moreover, there is international consensus that these skills should be taught early on in Interprofessional Education (IPE) in medicine and health care studies (Räbiger & Beck, 2017). IPE has been shown to positively affect students' knowledge, skills, and attitudes (Guraya & Barr, 2018), and it is widespread worldwide. The range of courses is also increasing in Germany (Ewers & Walkenhorst, 2019; Nock, 2020; Schmitz et al., 2020).

Clear terminology and shared understanding of IPC and IPE goals are key to professional discourse and the development of interprofessional learning programs (Hollweg & Heinzelmann, 2024). This includes clarifying how IPC is to be understood —for example, to optimize care, solve patient problems, or improve processes. The didactic design of interprofessional learning programs must be adapted depending on the context, target group, and objectives (Handgraaf et al., 2016). Practical, case-based, and problem-based patient learning formats have proven effective in implementing interprofessional education (Dieterich, 2023; Glässel, 2024; Thistlethwaite et al., 2012). When developing interprofessional case scenarios, it is important to define objectives and clinical issues relevant to all participating students from different professions. Learning objectives can include both profession-specific objectives and interprofessional competence development (Behrend et al., 2021). For the success of interprofessional case scenarios, didactic planning and implementation (Nock, 2020) and a common learning and working culture between teachers and students seem to be important (Behrend et al., 2019; Prescher et al., 2021). Logistical and time constraints pose a challenge to in-person attendance in IPE (Kramer-Jackman et al., 2017).

The use of online IPE is therefore appealing not only for overcoming logistical and temporal barriers but also for didactic reasons. In recent years, an increasing number of online IPE has been observed in Germany and internationally (Evans et al., 2019; Grosser et al., 2020; Simonsohn et al., 2024). Designing digital IPE learning (synchronous, asynchronous, or blended) requires considering diverse learners, prior experience, and cultural and specialized language differences. Didactic and methodological considerations are identical to face-to-face formats (Handgraaf, 2016) regarding the question of “What do I want to achieve with the individual interprofessional teaching unit within the existing framework conditions?” The resulting considerations are decisive for the success of IPE (Hollweg & Heinzelmann, 2024).

Health professionals make numerous clinical decisions every day. This multidimensional process, also known as “clinical reasoning” (CR), encompasses the thinking and actions of health professionals in diagnostic (diagnostic reasoning) and management (management reasoning) processes in clinical situations, considering the specific circumstances and preferences of patients (Hege et al., 2023). In practice, various professional groups are often involved in both (Cook et al., 2023). Interprofessional perspectives are particularly necessary for solving complex clinical problems, as the expertise of a single profession is often insufficient (Kiesewetter et al., 2017). CR is considered a core competency that can help prevent diagnostic and treatment errors (Connor et al., 2020). Therefore, the importance of CR skills should be taught in medical education from the perspective of different professions (Gummerson et al., 2018). Learning CR in an interprofessional context requires a systematic structure that IPE developers from different professions must agree on (Kiesewetter et al., 2017; Packard et al., 2012). Case Based Learning (CBL) has proven to be particularly effective for training CR skills (Wagner et al., 2024). In particular, virtual patient (VP) cases are used to train clinical decision-making by working through a digital patient case (Faferek, 2024; Wagner et al., 2024). Interprofessional virtual case scenarios for training CR skills have rarely been addressed to date (ibid.). An interventional mixed-methods study with 476 students showed that online-based interprofessional CBL promotes joint knowledge increase (Lestari et al., 2023).

Developing interprofessional VP (IP VP) cases requires a shared understanding of CR, though CR varies by profession (Hege et al., 2023). Teams must therefore understand other professions' CR concepts, identify overlaps and differences, and make joint media-didactic decisions.

A threefold challenge was to develop interprofessional case scenarios that train CR skills and leverage the potential of digital learning scenarios (see figure 1). To date, little research has examined how different professional perspectives can be integrated into virtual case examples (Huesmann et al., 2023).

Figure 1:

Interprofessional virtual patient cases (IP VP cases) for CR training in IPE

This study was conducted within the framework of the project “Strengthening Digital Action and Decision-Making Skills” (HEDS) at Charité – Universitätsmedizin Berlin (2021–2025). HEDS is part of Charité's overarching digitalization strategy, which aims to promote digital competencies through a comprehensive blended learning concept for healthcare education. The project focuses on strengthening students' digital, action-oriented, and decision-making skills in healthcare professions through digital learning formats (Charité, 2024).

One component of HEDS addresses virtual interprofessional teaching and learning for students in health-related study programs. Within this component, VP cases were developed between 2022 and 2024, including both profession-specific and interprofessional cases for the study programs Dentistry, Medicine, Midwifery, and Nursing at Charité.

The IP VP cases were designed collaboratively by project staff from five professional backgrounds—medicine, midwifery, nursing, psychology, and speech therapy—in various interdisciplinary combinations. The development process was supported by the eLearning team, using the VP case creation tool Campus Casus. Depending on the clinical context of each case, additional professions such as physiotherapy and emergency paramedicine were represented.

The interprofessional case development was initiated by the HEDS subproject “Interprofessionality”, with one team member responsible for moderation and documentation of the development process.

Members of the project team who developed IP VP cases during the project period were invited to an online interview via Microsoft Teams (n = 7). The participating health professions included (emergency) medicine, nursing, midwifery, and psychology. The individual group combinations for the VP cases varied, resulting in several teams with different time resources.

The interviews were conducted by a team of interviewers from the quality assurance in teaching (CK, HT, and MP) via Microsoft Teams. The interviewers were not involved in developing the VP cases and therefore had a neutral position towards the participants. The interviews were conducted using a semi-structured interview guide developed by the authors in accordance with Kruse (2015) (see Table 1).

The interviews were recorded in Microsoft Teams and then transcribed verbatim in f4x (Dr. Dresing & Pehl, GmbH) by FW. Speech contributions by the interviewee were marked with the assigned pseudo-anonymized number, and any information that could lead to conclusions about the interviewee or others was anonymized. All data was stored in compliance with the data protection regulations of the Charité and Germany.

The transcribed content was analyzed using the qualitative content analysis method outlined by Kuckartz & Rädiker (2022). The method consists of seven consecutive steps. (see Figure 2).

Figure 2:

Seven steps of qualitative content analysis (own representation after Kuckartz & Rädiker, 2022)

The categories were initially derived from the research questions and the interview structure. Key questions included the interviewees' personal understanding of interprofessional case development, their subjective experience of collaboration, changes during the work process, and insights for future interprofessional case development. Further inductive categories and subcategories were added based on the material. Coding rules were developed based on three interviews (WH, CK, RB). Subsequently, we created a coding guide with a category tree and anchor examples (CK, WH), which was used to code all materials (WH, CK, FW, RB) (see figure 3 and table 2). All authors coded at least one interview according to the coding guidelines. Two interviews were intercoded. Initially, the intercoder agreement was 55.17% and 51.35% respectively. After discussing ambiguous contents and adapting by consensus, the agreement increased to 93.83% and 97.44%, respectively. After reviewing the material, the results from the individual categories were then summarized to their core statements and sorted (WH, CK, FW, RB).

Figure 3:

Category tree with main categories and subcategories

In addition to their subjective perceptions of the collaboration, the interviewees identified several noteworthy findings and learning experiences that they felt would be valuable for future case development. These are structured according to three steps: preparation, case development, and reflection.

Before developing a VP case in an interprofessional team, several points must be jointly clarified to ensure a shared approach.

A common understanding of key concepts such as IPC and CR must first be established among the case developers. This includes a dialogue or discussions on how members understand IPC and CR.

The case development team should consist of specialists from different professional groups (e.g., medicine and nursing), with no profession being overrepresented. When forming groups, equal cooperation without hierarchies should be ensured.

It is crucial to clarify the competencies of team members from professional, didactic, and interprofessional perspectives, as well as their practical experience. For a successful collaboration, everyone should know the roles and competencies of the other professions. A willingness to be honest and authentic among team members must also be considered, as well as a clear allocation of roles and a common appreciative attitude towards one another. In addition, the time budget and the case objective should be discussed in advance to avoid misunderstandings about working methods and the schedule.

To ensure successful integration into specific existing modules, the following aspects are relevant: Already in the preparation phase, the team members should agree on common objectives. This includes defining basic objectives, such as promoting interprofessional competencies, developing case-specific learning objectives (both interprofessional and discipline-specific), and considering the different levels of interprofessionalism. It is important to clarify the coordination of objectives, such as solving the patient's problem, joint treatment planning, or promoting an understanding of the perspectives and needs of other professions.

A common didactic concept must be developed, and the target group clearly defined, considering students' previous experience and skill level to avoid over- or underchallenging them.

During the development of the case in the digital tool, it is important to design it so that all professional groups involved gain additional value and that different perspectives are visible. A narrative structure for the case (storytelling), avoiding overly long cases, and creating realistic and motivating scenarios are central. The moderation of the development process should be professionally neutral. Also, structured documentation is important.

During media production, clichés and stereotypes in case storytelling should be avoided.

Individual interviewees reported that the case development process itself increased knowledge and motivated the team, which led to improved methodology and a more efficient process.

Throughout the case creation process, it is essential to regularly review the aspects already considered in Step 1: Are all the necessary professions involved in the collaboration? Are the case's learning objectives clear? Is the time budget still on track, or does this vary between members? Is there a risk that the process will get bogged down in meetings that are too long? Being mindful of group dynamics and the possibility of hierarchies is also crucial to retaining trust in the process.

After the case development, broad reflection is necessary to assess what worked well and what could be improved. Team members should also reflect individually on what personal learning processes have taken place and how these can be transferred into further practice, for example, through the further development of CR at their respective institutes. Collaboration can be promoted through positive gains in knowledge and contributes to better IPC. It became apparent that the positive exchange between the professional groups is seen as particularly valuable. It is not only those formally responsible for IPC, such as moderators, who contribute ideas; the individual professional groups also play a key role by identifying cases where joint engagement adds value. This open, cooperative approach made many cases possible in the first place, as the need for involving other specialties often became apparent only during the development process.