Using the Virtual Patient to Improve the Primary Care of Traumatized Refugees

Background: Refugees who have experienced traumatic life experiences have entered into the United States’ primary health care system. Primary care providers (PCPs) have limited training in their diagnoses and treatment. Assessing and caring for the health and mental health of refugees in a culturally effective way in a time limited health care environment is challenging. We conducted a study on the role of the Virtual Patient (VP) as a training instrument for improving the diagnoses and treatment of refugee patients. Methods: This was a descriptive and quantitative study of PCPs at a local neighborhood health care center in Massachusetts. A sample of PCPs initially reviewed an alpha Virtual Patient refugee prototype. An improved β-VP prototype was offered in training. The PCPs performance on pre- and post-diagnosis and treatment planning was assessed after studying the β-VP. 10 PCPs studied the alpha VP prototype; an additional 14 PCPs studied the β-VP prototype (N=24). The Karolinska Institutet Virtual Patient Learning Experience Questionnaire (KI-VP-LEQ) assessed feasibility, and motivation to use the VP. A Trauma-BPPS (Trauma -Bio-Psycho-Social- Spiritual scale) scale measured the PCP’s perception of the patient’s trauma history, and medical, psycho-social and spiritual domains. Pre- and post-VP training using refugee paper clinical cases was performed. Concluding telephone interviews were conducted. Analysis included qualitative methods and significance testing. Results: PCPs were receptive and motivated to use the VP in training. Prior to VP training, respondents scored highly on medical diagnosis and treatment planning (Medical domain); followed by the psychological domain. Respondents scored lower on the social domain and lowest on the trauma and spiritual domains. All five domain scores significantly improved for those PCPs who devoted ≥90 minutes studying the VP. Telephone interviews conducted after training revealed PCPs felt they did not have enough time and/or clinical training to properly diagnose or treat refugee patients in the primary health care setting. Conclusions: The PCPs in this pilot study demonstrated the ability to improve their treatment plan for traumatized refugee patients in the medical and psychological domains after VP training. Devotion of time with the VP training instrument was significantly associated with improvement in all domains.