The intervention group were presented with a short case overview introducing four cardiopulmonary VP cases as well as the final diagnosis and had to complete the history, physical findings, and lab results, i.e. constructing VP cases.

The participants were presented with a short case overview introducing four cardiopulmonary VP cases to be solved, i.e. solving VP cases.

The participants were presented with a short case overview. The control group solved the cases, whereas the intervention group also received the final diagnosis and had to complete the history, physical findings, and lab results. After a week, participants completed a transfer test involving two standardized patients presenting a respiratory case and a cardiology case, respectively. Performances were video-recorded and subsequently assessed by two blinded raters using the Reporter-Interpreter- Manager-Educator (RIME) framework. Knowledge gains were assessed using a pre- and post-test of a 95-item Multiple-Response-Questionnaire (MRQ).

The scoring form includes assessment on the roles Reporter, Interpreter, Manager and Educators and has been validated for patient encounters like described below. The requirements for the RIME elements have been defined in with a cardiology professor and a consultant respiratory physician.

The medical students are exposed to two encounters with simulated patients after working with the virtual patients on their own. The students will obtain history and perform physical examination from the simulated patient for 15 minutes. The will be provided a journal form that can be quickly filled in, the patient encounter is video recorded. After this they have 20 minutes to write the journal in an electronic format.

The video recorded patient encounter and the journal will be assessed by two physicians who have experience in rating medical students performance with the scoring form, the raters are blinded for if the students belong to the intervention arm of the study or not.

A delta value for the medical students' knowledge of respiratory medicine and cardiology after working with the virtual patients will be obtained. The students have been taught respiratory medicine, but not cardiology. Half the virtual patient cases the students have been working with are on respiratory medicine and the other half are on cardiology.

The questionnaire has been checked by a cardiology professor and a consultant respiratory physician to ensure validity.