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The use of a virtual patient to simulate a pharmacist-patient anticoagulation consultation: a mixed methods evaluation

Richardson, Charlotte Lucy

The use of a virtual patient to simulate a pharmacist-patient anticoagulation consultation: a mixed methods evaluation Thumbnail


Charlotte Lucy Richardson


Stephen Chapman

Simon White


Patients commencing new medications, particularly those that are high risk such as non-vitamin K oral anticoagulants (NOACs), require counselling to ensure safe, effective and empowering use of the medicine. Pharmacists are well placed to provide this counselling, but they require an underpinning ability to do so. Training on NOACs is unstandardised and variable. A virtual patient (VP) educational tool on the topic of NOACs has been developed to help develop counselling skills relating to NOAC use in atrial fibrillation. VPs have been used to provide training for undergraduate students, but they are largely uninvestigated for use by qualified healthcare professionals. This study aims to evaluate the VP application and explore perspectives of pharmacists and pre-registration trainees on its use and potential.

The study followed a sequential exploratory mixed methods design using a sample of pharmacists and pre-registration trainees from sites across England. The participants completed a questionnaire pre and post-VP use. Following an interim analysis, a sample of the respondents were selected to undertake a follow-up semi-structured interview. Questionnaire results were analysed using a mixture of descriptive and inferential statistics; qualitative results were analysed using the Framework approach to thematic analysis. Results were then integrated via triangulation and corroborated to give an overall interpretation of the findings.

Results and discussion
NOAC training appears to be an under provided for area with many participants lacking in confidence in conducting NOAC patient counselling. There was a significant average increase in self-reported counselling ability across the respondents pre- to post-VP which suggests a benefit to VP use. The exact nature of the benefits were wide ranging and included changes in knowledge, confidence, contextualisation of content and an opportunity to practice. Some participants also cited effects of VP use on their practice, including using the learning as part of continuing professional development. Well recognised benefits to VP use were also further demonstrated including mobility and safety.
The VP was largely well liked, usable and acceptable as a learning resource, but some improvements could be made prior to wider implementation. This includes changes to the delivery of feedback and increased flexibility in responses within the VP. The study considered how VP use maps to the theory of experiential learning to provide a learning opportunity routed in andragogical theory. There was a discussion around different VP users with no single ideal group identified but rather multiple groups that could all benefit from VP use; pre-registration trainees and newly qualified pharmacists were the most favoured. Implementation of the VP needs to be more well thought-out with a clear strategy and considerations for the required supporting infrastructure. This supporting infrastructure needs to be developed to support sustained and useful use of the VP application.

This research has demonstrated value of the VP, both from an individual user and wider educational perspective. A number of improvements, developments and further considerations have been identified including things to be addressed prior to any further implementation. The VP application is a useful additional resource which should be considered when pharmacy professionals are undertaking education and training around NOACs.


Richardson, C. L. (2020). The use of a virtual patient to simulate a pharmacist-patient anticoagulation consultation: a mixed methods evaluation. (Thesis). Keele University

Thesis Type Thesis
Publicly Available Date May 30, 2023
Award Date 2020-12


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