{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T14:47:02Z","timestamp":1785941222931,"version":"3.56.0"},"reference-count":24,"publisher":"Ubiquity Press, Ltd.","issue":"1","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Perspect Med Educ"],"abstract":"<jats:p>Background: Virtual Patient (VP) systems are widely used in medical education, yet evidence on how they support near and far transfer remains limited. This study investigates integrating VPs with role modelling, varied case practices, and \u201cwhat-if\u201d discussions. It aims to measure the students\u2019 overall experience with the intervention, improvement in performance scores on near- and far-transfer cases, and to explore how and why the intervention is perceived to enhance transfer.\nMethods: An exploratory mixed-methods study was conducted with 21 second-year undergraduate medical students enrolled in the course \u201cPersonalised Medicine in Cancer Treatment and Care\u201d. Students engaged in role modelling performed by an oncologist, worked through authentic cases with varying patient characteristics, and participated in structured \u201cwhat-if\u201d discussions. Perceptions about the overall experience were gathered through a 19-item survey (n = 21). Performance scores were evaluated using pre- and post-assessments involving VPs and paper-based cases designed to measure near transfer (Case D) and far transfer (Case E) (n = 21). Group interviews (n = 8) provided deeper insights into enhancing transfer.\nResults: Survey results revealed positive student perceptions of role modelling (M = 4.44), varied case practices (M = 4.35), and \u201cwhat-if\u201d discussions (M = 3.76). Significant improvements were observed in tumour-stage reasoning for both near and far transfer (p &lt; .001), in initial patient impressions (p = .007) for far transfer, and in the total score (p = .018) for far transfer. Thematic analysis indicated that students benefited from a stepwise build-up in case complexity, recognition of similar reasoning steps across cases, reflective \u201cwhat-if\u201d discussions that highlighted underlying principles, and peer dialogue around VP feedback that supported concept abstraction.\nConclusions: Students evaluated the VP session positively and performance data indicated significant improvements, suggesting that the intervention enhanced near and far transfer. Reflection through \u201cwhat-if\u201d discussions was perceived to deepen understanding of the underlying principles enabling transfer.<\/jats:p>","DOI":"10.5334\/pme.2363","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T13:45:27Z","timestamp":1785937527000},"page":"633-643","source":"Crossref","is-referenced-by-count":0,"title":["Ensuring Knowledge Transfer: The Critical Role of \u201cWhat-If\u201d Discussions in Virtual Patient Simulation"],"prefix":"10.5334","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2223-8940","authenticated-orcid":false,"given":"Zhien","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6044-6790","authenticated-orcid":false,"given":"Maryam","family":"Asoodar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5648-2203","authenticated-orcid":false,"given":"Tom","family":"Keulers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6161-7117","authenticated-orcid":false,"given":"Desir\u00e9e","family":"Joosten-ten Brinke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4802-1156","authenticated-orcid":false,"given":"Diana","family":"Dolmans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3285","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"issue":"9","key":"key20260805134520_B1","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1111\/j.1365-2929.2006.02544.x","article-title":"A conceptual framework for developing teaching cases: a review and synthesis of the literature across disciplines","volume":"40","year":"2006","journal-title":"Medical education"},{"issue":"9","key":"key20260805134520_B2","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1046\/j.1365-2923.2001.00999.x","article-title":"Random comparison of \u2018virtual patient\u2019 models in the context of teaching clinical communication skills","volume":"35","year":"2001","journal-title":"Medical education"},{"key":"key20260805134520_B3","first-page":"33","article-title":"The effect of constructing versus solving virtual patient cases on transfer of learning: a randomized trial","year":"2016","journal-title":"Perspectives on medical education"},{"key":"key20260805134520_B4","volume-title":"Ten steps to complex learning: A systematic approach to four-component instructional design","year":"2017"},{"key":"key20260805134520_B5","first-page":"90","article-title":"Transfer of learning from simulated setting to the clinical setting: identifying instructional design features","volume":"35","year":"2021","journal-title":"Medical Journal of the Islamic Republic of Iran"},{"issue":"8","key":"key20260805134520_B6","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1111\/medu.14137","article-title":"The student is key: a realist review of educational interventions to develop analytical and non-analytical clinical reasoning ability","volume":"54","year":"2020","journal-title":"Medical education"},{"key":"key20260805134520_B7","first-page":"6452","article-title":"Transfer of learning","volume":"2","year":"1992","journal-title":"International encyclopedia of education"},{"issue":"1","key":"key20260805134520_B8","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1111\/j.1365-2929.2004.01972.x","article-title":"What every teacher needs to know about clinical reasoning","volume":"39","year":"2005","journal-title":"Medical education"},{"issue":"2","key":"key20260805134520_B9","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1037\/bul0000180","article-title":"A meta-analysis of the experimental evidence on the near-and far-transfer effects among children\u2019s executive function skills","volume":"145","year":"2019","journal-title":"Psychological Bulletin"},{"issue":"2","key":"key20260805134520_B10","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1037\/a0028228","article-title":"Is working memory training effective? 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