Virtual patient scores rose after emergency internship in 86-intern single-group study

Medical interns’ performance improved substantially on screen-based virtual-patient assessments after an eight-week emergency medicine internship, according to a prospective, single-group cohort study conducted at one medical center. Among 86 sixth-year medical interns, the average overall case-management score rose from 69.2 ± 9.4 before the internship to 83.4 ± 5.4 afterward, a mean increase of 14.2 points (95% confidence interval, 12.4–15.9; p < 0.001). The correct final-diagnosis rate increased from 85.7% to 98.4%, while the correct-disposition rate rose from 70.5% to 93.0%; both changes had p-values below 0.001.

Time to disposition also fell from 399 to 336 seconds (p < 0.001). These results show temporal improvement in simulation-based performance, but the study was not designed to prove that the internship itself caused the gains or that they transferred directly to clinical practice. Each intern completed the same type of screen-based virtual-patient assessment before and after the internship, managing six randomly assigned cases.

One case came from each of six categories: cardiac, pulmonary, abdominal, central nervous system, internal medicine and other emergencies. The assessment platform generated an overall case-management score, stage-specific scores, time to disposition and binary indicators for the correctness of the final diagnosis and disposition. Because the research compared each participant with their own earlier performance, the analysis focused on changes within the same group of 86 interns.

The study was prospective and used a pre–post design, but it included no separate group of interns who did not undertake the emergency medicine internship. Five of the six stage scores improved significantly, with the largest gains reported for intervention and stabilization. Intervention increased by 17.9 points, while stabilization rose by 9.6 points.

Review of systems was the exception: its score increased by 2.7 points, but the change did not reach statistical significance (p = 0.087). The authors also noted that intervention and stabilization scores remained comparatively lower than those of the other assessed domains. All six emergency categories improved, although the size of the gains varied.

Cardiac emergencies showed the largest increase, at 18.5 points, while central nervous system emergencies had the smallest, at 8.8 points. Secondary comparisons across stages and presentation categories were exploratory and adjusted using the Holm procedure. Continuous outcomes, including the overall and stage-specific scores and time to disposition, were analyzed at the participant level with paired-samples t-tests or Wilcoxon signed-rank tests.

Binary outcomes—correct or incorrect final diagnosis and disposition—were evaluated with generalized estimating equations that accounted for cases clustered within participants. This approach avoided treating the six cases completed by each intern as independent observations from unrelated trainees. The analysis therefore accommodated both the paired before-and-after structure and the clustering of multiple virtual cases within each participant.

The findings indicate that the interns managed simulated emergencies more accurately and reached disposition decisions faster after the internship. The improvement was evident in the overall score, diagnosis accuracy, disposition accuracy, most assessed stages and every presentation category. Nevertheless, the study’s single-center, single-group design and use of identical cases at both time points limit causal interpretation.

The authors specifically describe the results as evidence of improvement over time in simulation-based performance, not definitive proof of internship effectiveness or transfer of learning to clinical practice.

Subject of Research: Before-and-after changes in 86 medical interns’ screen-based virtual-patient performance following an eight-week emergency medicine internship

Article Title: Medical interns’ performance on screen-based virtual patient assessments before and after an emergency medicine internship

Article References: Karaman, T., Yılmaz, M., Günaydın, İ., Akıl, S. C., Dilaver, E., Ayar, Ş., Şahin, A. S., İmamoğlu, M., & Paslı, S. (2026). Medical interns’ performance on screen-based virtual patient assessments before and after an emergency medicine internship. BMC Medical Education. https://doi.org/10.1186/s12909-026-10679-9

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10679-9

Keywords: medical education, emergency medicine, virtual patients, medical interns, simulation assessment, diagnostic accuracy, clinical decision-making, pre-post cohort study, Medical, interns, performance, screen-based