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Currently submitted to: Journal of Medical Internet Research

Date Submitted: Sep 14, 2020
Open Peer Review Period: Sep 14, 2020 - Nov 9, 2020
(currently open for review)

Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

Implementing remote collaboration in a virtual patient platform – enabling students and physicians to learn collaborative clinical reasoning



Learning with virtual patients is highly popular for fostering clinical reasoning in medical education. However, little learning with virtual patients is done collaboratively, despite the potential learning benefits of collaborative vs. individual learning.


In this article, we describe the rationale behind the implementation of student collaboration in the CASUS virtual patient platform.


The SimpleWebRTC library of andYet was used to implement the collaborative tool. It provided a basis for the conferencing platform and could be adapted to include features such as video communication and screensharing. An additional text chat was created based on the message protocol of the SimpleWebRTC library. We implemented a user interface for educators to set up and configure the collaboration. Educators can configure video, audio, and text-based chat communication, which are known to promote effective learning.


We tested the tool in a sample of 137 students working on virtual patients. The study results indicate that students successfully diagnosed 53% (SD = 26%) of the patients when working alone and 71% (SD= 20%) when collaborating using the tool (p < .05, eta2=.12). A usability questionnaire for the study sample shows a usability score of 82.16 (SD = 1.31), a B+ grade.


The approach provides a technical framework for collaboration that can be used with the CASUS virtual patient system. Additionally, the application programming interface is generic, so that the setup can also be used with other learning management systems. The collaborative tool helps students diagnose virtual patients and results in a good overall usability of CASUS. Using learning analytics, we are able to track students’ progress in content knowledge and collaborative knowledge and guide them through a virtual patient curriculum designed to teach both. More broadly, the collaborative tool provides an array of new possibilities for researchers and educators alike to design courses, collaborative homework assignments, and research questions for collaborative learning.


Please cite as:

Implementing remote collaboration in a virtual patient platform – enabling students and physicians to learn collaborative clinical reasoning

JMIR Preprints. 14/09/2020:24306

DOI: 10.2196/preprints.24306


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