Adaptive Real-Time Voice Virtual Patients for Clinical Communication Training

Summary

This study evaluated whether an emotionally and interactionally adaptive real-time voice virtual patient can improve clinical communication training for resident physicians. Communication with patients in emotionally challenging situations, such as breaking bad news, requires clinicians to deliver information clearly, recognize emotional cues, respond empathically, and maintain a coherent interaction. Standardized patient training can support these skills but is resource intensive and difficult to provide repeatedly. Real-time voice virtual patients may offer scalable practice opportunities, but simple spoken interaction alone may not provide patient responses that change meaningfully according to the learner's communication.

The adaptive virtual patient used in this study was designed to update the patient's emotional tone, openness, defensiveness, and interactional style during the conversation based on the learner's communication behavior. The study compared this adaptive virtual patient training with a non-adaptive real-time voice virtual patient and with standardized patient training.

Resident physicians were randomly assigned in a 1:1:1 ratio to one of three groups: emotionally and interactionally adaptive virtual patient training, non-adaptive virtual patient training, or standardized patient training. Participants completed two communication training sessions focused on breaking bad news. After training, participants completed learner-reported measures of perceived response contingency and patient realism. Approximately four weeks later, participants completed a mini-objective structured clinical examination using a human standardized patient to assess communication performance in a delayed near-transfer setting.

The primary outcome was the total mini-OSCE communication score at four weeks. Secondary outcomes included mini-OSCE domain scores for structured delivery, emotional responsiveness, and interactional process; learner-reported response contingency and patient realism; and expert-rated behavioral consistency and clinical credibility of virtual patient interactions.

Conditions

• Medical Education
• Clinical Communication
• Breaking Bad News Skills

Interventions

BEHAVIORAL

Adaptive Real-Time Voice Virtual Patient Training

Participants completed two breaking-bad-news communication training sessions with an emotionally and interactionally adaptive real-time voice virtual patient. The virtual patient interacted with participants through continuous spoken dialogue and dynamically updated its emotional tone, openness, defensiveness, and interactional style based on the participant's communication behavior. The adaptive mechanism was designed to provide behavior-contingent patient responses during the encounter.

BEHAVIORAL

Non-Adaptive Real-Time Voice Virtual Patient Training

Participants completed two breaking-bad-news communication training sessions with a non-adaptive real-time voice virtual patient. The platform, case structure, spoken interaction format, training exposure, and communication tasks were matched to the adaptive virtual patient condition. Unlike the adaptive condition, the virtual patient did not dynamically update its emotional or interactional state based on the participant's communication behavior.

BEHAVIORAL

Standardized Patient Training

Participants completed two breaking-bad-news communication training sessions with trained human standardized patients. The cases, training objectives, session duration, and communication tasks were structurally matched to the virtual patient training conditions. Standardized patients were trained to portray the assigned clinical communication scenarios using standardized case scripts and interactional guidance.

Sponsors & Collaborators

• Wang Shalong

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

OTHER

Masking

SINGLE

Model

PARALLEL

Eligibility

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2025-12-01

Primary Completion

2026-03-20

Completion

2026-03-20

Countries

• China

Study Locations