Development of a GPT-4-Powered Virtual Simulated Patient and Communication Training Platform for Medical Students to...

Standardized patients (SPs) prepare medical students for difficult conversations with patients. Despite their value, SP-based simulation training is constrained by available resources and competing clinical demands. Researchers are turning to artificial intelligence and large language models, such as generative pretrained transformers, to create communication training that incorporates virtual simulated patients (VSPs). GPT-4 is a large language model advance allowing developers to design virtual simulation scenarios using text-based prompts instead of relying on branching path simulations with prescripted dialogue. These nascent developmental practices have not taken root in the literature to guide other researchers in developing their own simulations.

This study aims to describe our developmental process and lessons learned for creating a GPT-4-driven VSP. We designed the VSP to help medical student learners rehearse discussing abnormal mammography results with a patient as a primary care physician (PCP). We aimed to assess GPT-4's ability to generate appropriate VSP responses to learners during spoken conversations and provide appropriate feedback on learner performance.

A research team comprised of physicians, a medical student, an educator, an SP program director, a learning experience designer, and a health care researcher conducted the study. A formative phase with in-depth knowledge user interviews informed development, followed by a development phase to create the virtual training module. The team conducted interviews with 5 medical students, 5 PCPs, and 5 breast cancer survivors. They then developed a VSP using simulation authoring software and provided the GPT-4-enabled VSP with an initial prompt consisting of a scenario description, emotional state, and expectations for learner dialogue. It was iteratively refined through an agile design process involving repeated cycles of testing, documenting issues, and revising the prompt. As an exploratory feature, the simulation used GPT-4 to provide written feedback to learners about their performance communicating with the VSP and their adherence to guidelines for difficult conversations.

In-depth interviews helped establish the appropriate timing, mode of communication, and protocol for conversations between PCPs and patients during the breast cancer screening process. The scenario simulated a telephone call between a physician and patient to discuss the abnormal results of a diagnostic mammogram that that indicated a need for a biopsy. Preliminary testing was promising. The VSP asked sensible questions about their mammography results and responded to learner inquiries using a voice replete with appropriate emotional inflections. GPT-4 generated performance feedback that successfully identified strengths and areas for improvement using relevant quotes from the learner-VSP conversation, but it occasionally misidentified learner adherence to communication protocols.

GPT-4 streamlined development and facilitated more dynamic, humanlike interactions between learners and the VSP compared to branching path simulations. For the next steps, we will pilot-test the VSP with medical students to evaluate its feasibility and acceptability.