Evaluating real-time voice AI–based virtual patients for authentic communication training

Effective communication is essential in clinical training, yet opportunities for realistic and interactionally authentic practice remain limited. Standardized patients (SPs) provide realism but are resource-intensive, whereas virtual patients (VPs) offer scalability but have limited capacity to reproduce responsive, interactionally authentic dialogue. Recent advances in generative artificial intelligence (AI), particularly real-time voice models, have opened new possibilities for natural and synchronous dialogue in virtual simulations.
To evaluate whether a real-time voice–based virtual patient (RT-VP) can achieve communication performance, perceived realism, and self-efficacy outcomes comparable to SP training, thereby addressing the global challenge of scalable, authentic communication training.
The RT-VP was developed on the Doubao real-time voice generative AI platform, which supports synchronous, bidirectional spoken interaction. In a randomized controlled study, 134 residents were assigned to RT-VP, standardized-patient (SP), or peer role-play (PR) groups. All groups received identical SPIKES-based instruction and practiced in their assigned simulation modality. Outcomes included communication performance, self-efficacy, and perceived realism.
Post-training SPIKES scores were highest for SP (26.6 ± 3.0), followed by RT-VP (24.9 ± 2.9) and PR (20.4 ± 4.3) (p < .001). Both SP and RT-VP outperformed PR (p < .001), and the difference between SP and RT-VP did not reach statistical significance (p = .06). Perceived realism generally followed an SP > RT-VP > PR pattern, with RT-VP demonstrating comparable linguistic realism to SP, while SP remained superior in contextual, emotional, and engagement realism.
This study represents, to our knowledge, the first controlled comparison of real-time voice generative AI–based VPs and SP encounters in communication training. RT-VP simulation approximated SP-level communication performance and perceived authenticity while offering scalability and consistency. Real-time voice simulation offers a scalable means to expand access to emotionally authentic communication training worldwide.