ArticleBMC medical education2026
Cost-effectiveness of virtual patient integration in dermatology education: evidence for precision education by learner expertise.
Article in BMC medical education, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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4 authors.
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Abstract
backgroundEducational technology adoption accelerates despite limited evidence of incremental value within already-effective curricula. Pragmatic evaluations examining cost-effectiveness and differential benefits across learner populations with varying expertise remain scarce.
objectivesTo evaluate virtual patient integration into established flipped classroom curriculum, examining incremental educational outcomes, comprehensive cost-effectiveness, and systematic variation by training level.
methodsSequential implementation study at a tertiary teaching hospital in Taiwan (2022-2025). Flipped classroom (FC; 2022-2023, N = 131) was followed by FC with virtual patients (FC + VP; 2024-2025, N = 161). PRIMARY OUTCOMES: knowledge acquisition (Cohen's d, achievement rates ≥ 80%). Incremental cost-effectiveness ratios (ICERs) were calculated by training level.
resultsBoth approaches achieved extremely large learning effects (FC: d = 2.27; FC + VP: d = 2.43; >98% achievement; between-group differences non-significant). FC + VP required 3.08-fold higher per-student investment ($163 vs. $53). Cost-effectiveness varied dramatically: undergraduates showed meaningful gains (Δd = + 0.29, ICER = $383/d), while postgraduates showed minimal benefit (Δd = + 0.02, ICER = $4,670/d)-a 12.2-fold difference. Germane cognitive load was associated with learning progress (r = .196, R² = 8.5%); critical thinking was not independently associated (p = .497).
conclusionsNear-universal competency is attainable through multiple instructional approaches. Virtual patient integration was associated with differential incremental value by learner expertise-meaningful for novices but negligible for advanced learners achieving comparable outcomes more efficiently. Findings support precision education frameworks targeting technology investments based on cost-effectiveness profiles rather than universal deployment.
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