Table 1.

Strategies used to ensure 3 modes of fidelity throughout the virtual patient simulation.

Modes of fidelity		Strategies used
Physical fidelity		Giving cues to the VPa simulation team for their design of the VP: Taking a picture of a real nurse’s office for the representation of the virtual nurse’s office Adding objects that represent reality (eg, chart of antiretroviral therapy on the wall)
		Getting charts from real patient records to use the same vocabulary in the VP’s electronic record
		Designing the VP with human features (eg, facial expression and body movements) based on past experiences of the VP simulation team
		Using real voice-overs for both patient and nurse: Preselecting some French- and English-speaking actors, listening to their audio tracks and choosing the ones that best fit the spirit of the simulation Providing descriptive cues in the script besides the nurse’s and patient’s speech, so that the actors can respect the tone of voice and ambiance and vibe in the nurse-patient virtual relationship, consistent with SBN b and MI c
		Getting written approval for each step of the graphical design before undertaking the subsequent one
Conceptual fidelity		Co-designing the clinical content with a nurse having expertise in HIV care and MI to ensure that the simulation reflects the nursing practice and the validity of the theory injected in preprogrammed interactions
		Meeting a clinical nurse specialist who is an expert in HIV care to discuss real-life situations of people living with HIV having difficulty taking their medication to identify nursing actions, in partnership with physicians and pharmacists, in nonadherence situations
		Validating the content with health care professionals
		Working with pedagogical engineering to make sure that good educational practices are met
Emotional and experiential fidelity		Promoting a positive learning experience and relatedness by creating messages that value and respect nurses’ competencies and current practice. In doing so, clinical content inventors must themselves be consistent with the MI values in their way of translating the educational content to the simulation
		Creating opportunities for reflection on action (virtual practice) by incorporating quizzes and feedback that represent what nurses do in their current practice
		Establishing a fiction contract with nurses [44,48]. The following message in the prebriefing video is intended to create such a contract: “The relational aspect of the practice of caring cannot be simulated to perfection. Needless to say, human beings are not preprogrammed to respond to a nurse this way or that. I invite you, then, to immerse yourself in this virtual simulation as if it were real and to pay attention to the interactions between Mr. Wilson and the nurse”.

^aVP: virtual patient.

^bSBN: strengths-based nursing.

^cMI: motivational interviewing.