Transformative learning through virtual patient simulations: Predicting critical student reflections

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Background: The Digital Clinical Experience™ is a simulation software that allows nursing students to interview and examine virtual patient and then write self-reflections on their performance. Methods: A secondary data analysis was conducted on 130 master of science in nursing students' performance in the Digital Clinical Experience™ using a framework of situated cognition and transformative learning theory. Employing a within-stage mixed-model design, content analysis of structured self-reflections was conducted using Cook's Reflection Rating Rubric. Multiple regression was performed using self-reflection scores as the dependent variable; independent variables included time spent in simulation, lines of dialog, and primary and secondary clinical items discovered. Results: Critical self-reflection indicating transformative learning was predicted by the number of secondary clinical items students uncover during their virtual patient interview. Yet, this level of self-reflection did not occur for students who discovered only the primary clinical findings. Conclusions: This study presents evidence that virtual patient simulations can provide transformative learning experiences in nursing. However, to facilitate a transformative learning experience, these simulations must allow students to explore the presentation, history, and backstory of the virtual patient in depth, beyond superficial clinical findings.

Original languageEnglish (US)
JournalClinical Simulation in Nursing
Issue number6
StatePublished - Jan 1 2014
Externally publishedYes


  • Clinical reasoning
  • Computer based learning
  • Digital Standardized Patient
  • Reflective journaling
  • Self-reflection
  • Simulation
  • Virtual patient

ASJC Scopus subject areas

  • Education
  • Modeling and Simulation
  • Nursing (miscellaneous)

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