Objective: Virtual patient cases are a scalable and engaging tool for training medical professionals. Strategies and frameworks for their implementation in teaching and training settings are few, technically complicated and/or expensive. We developed and evaluated open source and free virtual patient cases to test knowledge acquisition during an echocardiography training program for internal medicine trainees in Haiti. The objective of this paper is to describe the technical aspects of the GMENEcho virtual patient cases implementation and motivate similar work by resource-constrained teams. Methods: We used an open source engine for text-based games (Twine) since it provides the necessary interaction mechanics and is usable out-of-the-box. The case code was written in SugarCube 2.30.0 notation and the tweego-generated .html file was hosted on Github Pages for continuous integration and deployment, making iterations by the clinical team seamless. Data from completed tests were reported back via email through a third party integration. Results: The technical work was completed in two weeks by a team member with a clinical background and minimal computer programming experience. The virtual patient cases were deployed for a pretest (November 2023) and a second time unaltered for a post-test (June 2024) after the interim hands-on and theoretical training had been completed. Qualitative feedback was positive or neutral. The System Usability Scale (SUS) score was 74.6 ('Excellent'). Discussion: This proof-of-concept methodology can be applied to create clinical patient cases for use within a class or a clinical training setting, through a friendly graphical user interface. A more complex software stack can allow for remote or larger scale implementations with additional features. Conclusion: The rapid development time and positive qualitative and quantitative feedback highlight the potential of this approach for clinical education in resource-constrained settings. It can serve as a template for more streamlined adaptations of case-based learning in diverse healthcare settings.

The authors have declared no competing interest.

This study did not receive any funding

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The Ethics Committee of the University Hospital of La Paix gave ethical approval for this work. Yale University institutional review board (ID: 2000034601) gave ethical approval for this work. Compliance with both local regulations and international ethical standards was ensured. Informed consent was obtained from all participants, who were assured of their right to withdraw from the study at any time without penalty.

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