Neurological Assessment Using a Physical-Virtual Patient (PVP)

Laura Gonzalez, Salam Daher, Greg Welch

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background. Simulation has revolutionized teaching and learning. However, traditional manikins are limited in their ability to exhibit emotions, movements, and interactive eye gaze. As a result, students struggle with immersion and may be unable to authentically relate to the patient. Intervention. We developed a new type of patient simulator called the Physical-Virtual Patients (PVP) which combines the physicality of manikins with the richness of dynamic visuals. The PVP uses spatial Augmented Reality to rear project dynamic imagery (e.g., facial expressions, ptosis, pupil reactions) on a semi-transparent physical shell. The shell occupies space and matches the dimensions of a human head. Methods. We compared two groups of third semester nursing students (N=59) from a baccalaureate program using a between-participant design, one group interacting with a traditional high-fidelity manikin versus a more realistic PVP head. The learners had to perform a neurological assessment. We measured authenticity, urgency, and learning. Results. Learners had a more realistic encounter with the PVP patient (p=0.046), they were more engaged with the PVP condition compared to the manikin in terms of authenticity of encounter and cognitive strategies. The PVP provoked a higher sense of urgency (p=0.002). There was increased learning for the PVP group compared to the manikin group on the pre and post-simulation scores (p=0.027). Conclusion. The realism of the visuals in the PVP increases authenticity and engagement which results in a greater sense of urgency and overall learning.

Original languageEnglish (US)
Pages (from-to)802-818
Number of pages17
JournalSimulation and Gaming
Issue number6
StatePublished - Dec 1 2020

All Science Journal Classification (ASJC) codes

  • General Social Sciences
  • Computer Science Applications


  • authentic learning
  • dynamic visual
  • engagement
  • knowledge retention
  • simulation/gaming
  • virtual reality


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