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In the past decade, many medical schools have begun developing or implementing virtual, computer-based exercises. This paper reports findings regarding an experiment to design and implement virtual patient simulations (VPS) for first year osteopathic medical students. In this study, students collaborated in teams to complete a series of in-class virtual patient cases. Clinical reasoning was measured by a diagnostic competency task, pre- and post-tests, and an electronic exit survey. Triangulated findings indicated that VPS are effective in terms of supporting clinical decision-making. Following a design-based methodology, we describe the process of improving the technology-enhanced simulations for first year medical students through iterative testing.