Transformative learning through virtual patient simulations: Predicting critical student reflections

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.