{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T19:32:07Z","timestamp":1791401527557,"version":"4.3.3"},"reference-count":50,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Med Educ"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Effective communication is fundamental to high-quality health care delivery, influencing patient satisfaction, adherence to treatment plans, and clinical outcomes. However, communication skills training for medical undergraduates often faces challenges in scalability, resource allocation, and personalization. Traditional methods, such as role-playing with standardized patients, are resource intensive and may not provide consistent feedback tailored to individual learners\u2019 needs. Artificial intelligence (AI) offers realistic patient interactions for education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to investigate the application of AI communication training tools in medical undergraduate education within a primary care context. The study evaluates the effectiveness, usability, and impact of AI virtual patients (VPs) on medical students\u2019 experience in communication skills practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study used a mixed methods sequential explanatory design, comprising a quantitative survey followed by qualitative focus group discussions. Eighteen participants, including 15 medical students and 3 practicing doctors, engaged with an AI VP simulating a primary care consultation for prostate cancer risk assessment. The AI VP was designed using a large language model and natural voice synthesis to create realistic patient interactions. The survey assessed 5 domains: fidelity, immersion, intrinsic motivation, debriefing, and system usability. Focus groups were used to explore participants\u2019 experiences, challenges, and perceived educational value of the AI tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Significant positive responses emerged against a neutral baseline, with the following median scores: intrinsic motivation 16.5 of 20.0 (IQR 15.0\u201018.0;\n                      <jats:italic>d<\/jats:italic>\n                      =2.09,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.001), system usability 12.0 of 15.0 (IQR 11.5\u201012.5;\n                      <jats:italic>d<\/jats:italic>\n                      =2.18,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.001), and psychological safety 5.0 of 5.0 (IQR 5.0\u20105.0;\n                      <jats:italic>d<\/jats:italic>\n                      =4.78,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.001). Fidelity (median score 6.0\/10.0, IQR 5.2\u20107.0;\n                      <jats:italic>d<\/jats:italic>\n                      =\u20130.08,\n                      <jats:italic>P<\/jats:italic>\n                      =.02) and immersion (median score 8.5\/15.0, IQR 7.0\u20109.8;\n                      <jats:italic>d<\/jats:italic>\n                      =0.25\n                      <jats:italic>P<\/jats:italic>\n                      =.08) were moderately rated. The overall Immersive Technology Evaluation Measure scores showed a high positive learning experience: median 47.5 of 65.0 (IQR 43.0\u201051.2;\n                      <jats:italic>d<\/jats:italic>\n                      =2.00,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.001). Qualitative analysis identified 3 major themes across 11 subthemes, with participants highlighting both technical limitations and educational value. Participants valued the safe practice environment and the ability to receive immediate feedback.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AI VP technology shows promising potential for communication skills training despite the current realism limitations. While it does not yet match human standardized patient authenticity, the technology has achieved sufficient fidelity to support meaningful educational interactions, and this study identified clear areas for improvement. The integration of AI into medical curricula represents a promising avenue for innovation in medical education, with the potential to improve the quality and effectiveness of training programs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/70766","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T02:00:08Z","timestamp":1757469608000},"page":"e70766-e70766","source":"Crossref","is-referenced-by-count":19,"title":["Application of AI Communication Training Tools in Medical Undergraduate Education: Mixed Methods Feasibility Study Within a Primary Care Context"],"prefix":"10.2196","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3638-5454","authenticated-orcid":false,"given":"Chris","family":"Jacobs","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2001-4544","authenticated-orcid":false,"given":"Hans","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8772-3268","authenticated-orcid":false,"given":"Nina","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1442-0412","authenticated-orcid":false,"given":"Kirsty","family":"Brownlie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9252-1940","authenticated-orcid":false,"given":"Richard","family":"Joiner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9880-782X","authenticated-orcid":false,"given":"Trevor","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"issue":"1","key":"R1","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1177\/1062860614545124","article-title":"Creating a patient-centered health care delivery system: a systematic review of health care quality from the patient perspective","volume":"31","author":"Mohammed","journal-title":"Am J Med Qual"},{"issue":"2","key":"R2","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1097\/SIH.0000000000000412","article-title":"Peer role-play for training communication skills in medical students: a systematic review","volume":"15","author":"Gelis","journal-title":"Simul Healthc"},{"issue":"7","key":"R3","doi-asserted-by":"publisher","first-page":"1247","DOI":"10.1016\/j.pec.2017.02.016","article-title":"Promoting patient participation in healthcare interactions through communication skills training: a systematic review","volume":"100","author":"D\u2019Agostino","journal-title":"Patient Educ Couns"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.2196\/50945","article-title":"The role of large language models in medical education: applications and implications","volume":"9","author":"Safranek","journal-title":"JMIR Med Educ"},{"issue":"2","key":"R5","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1002\/ca.24244","article-title":"Using large language models (ChatGPT, Copilot, PaLM, Bard, and Gemini) in Gross Anatomy course: comparative analysis","volume":"38","author":"Mavrych","journal-title":"Clin Anat"},{"issue":"2","key":"R6","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1152\/advan.00093.2024","article-title":"Claude, ChatGPT, Copilot, and Gemini performance versus students in different topics of neuroscience","volume":"49","author":"Mavrych","journal-title":"Adv Physiol Educ"},{"issue":"11","key":"R7","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.73763","article-title":"Human-computer interaction: a literature review of artificial intelligence and communication in healthcare","volume":"16","author":"Clay","journal-title":"Cureus"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.2196\/43311","article-title":"Artificial intelligence supporting the training of communication skills in the education of health care professions: scoping review","volume":"25","author":"Stamer","journal-title":"J Med Internet Res"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.2196\/58623","article-title":"Integrating GPT-based AI into virtual patients to facilitate communication training among medical first responders: usability study of mixed reality simulation","volume":"8","author":"Guti\u00e9rrez Maquil\u00f3n","journal-title":"JMIR Form Res"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.2196\/50705","article-title":"Increasing realism and variety of virtual patient dialogues for prenatal counseling education through a novel application of ChatGPT: exploratory observational study","volume":"10","author":"Gray","journal-title":"JMIR Med Educ"},{"issue":"3","key":"R11","doi-asserted-by":"publisher","first-page":"39","DOI":"10.14742\/ajet.9307","article-title":"Artificial intelligence-driven virtual patients for communication skill development in healthcare students","volume":"40","author":"Bowers","journal-title":"Australas J Educ Technol"},{"issue":"1","key":"R12","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-024-05760-0","article-title":"Artificial intelligence in medical education - perception among medical students","volume":"24","author":"Jackson","journal-title":"BMC Med Educ"},{"issue":"3","key":"R13","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1080\/14739879.2023.2210097","article-title":"Communication skills in primary care settings: aligning student and patient voices","volume":"34","author":"Thuraisingham","journal-title":"Educ Prim Care"},{"issue":"27","key":"R14","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000038813","article-title":"The impact of simulation-based training in medical education: a review","volume":"103","author":"Elendu","journal-title":"Medicine (Baltimore)"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.2196\/58753","article-title":"Enhancing medical interview skills through AI-simulated patient interactions: nonrandomized controlled trial","volume":"10","author":"Yamamoto","journal-title":"JMIR Med Educ"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.2196\/68486","article-title":"Virtual patients using large language models: scalable, contextualized simulation of clinician-patient dialogue with feedback","volume":"27","author":"Cook","journal-title":"J Med Internet Res"},{"issue":"4","key":"R17","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1001\/jamainternmed.2023.7965","article-title":"Using artificial intelligence to improve primary care for patients and clinicians","volume":"184","author":"Sarkar","journal-title":"JAMA Intern Med"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.2196\/48785","article-title":"Opportunities, challenges, and future directions of generative artificial intelligence in medical education: scoping review","volume":"9","author":"Preiksaitis","journal-title":"JMIR Med Educ"},{"issue":"1","key":"R19","doi-asserted-by":"publisher","DOI":"10.2196\/51344","article-title":"Evaluation of ChatGPT\u2019s real-life implementation in undergraduate dental education: mixed methods study","volume":"10","author":"Kavadella","journal-title":"JMIR Med Educ"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.1016\/j.cexr.2023.100027","article-title":"Cognitive interviewing as a method to inform questionnaire design and validity - Immersive Technology Evaluation Measure (ITEM) for healthcare education","volume":"2","author":"Jacobs","journal-title":"Comput Educ X Real"},{"issue":"5","key":"R21","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.84381","article-title":"Beyond traditional simulation: an exploratory study on the effectiveness and acceptability of ChatGPT\u20114o advanced voice mode for communication skills practice among medical students","volume":"17","author":"Mukadam","journal-title":"Cureus"},{"issue":"4","key":"R22","doi-asserted-by":"publisher","first-page":"430","DOI":"10.4300\/JGME-D-16-00500.1","article-title":"Reflection as a learning tool in graduate medical education: a systematic review","volume":"9","author":"Winkel","journal-title":"J Grad Med Educ"},{"key":"R23","doi-asserted-by":"crossref","unstructured":"Calhoun AW Hui J Scerbo MW . Quantitative research in healthcare simulation: an introduction and discussion of common pitfalls. In: Nestel D Hui J Kunkler K Scerbo MW Calhoun AW , editors. Healthcare Simulation Research: A Practical Guide. Springer International Publishing; 2019:153-160. [doi: 10.1007\/978-3-030-26837-4_21]","DOI":"10.1007\/978-3-030-26837-4_21"},{"issue":"3","key":"R24","doi-asserted-by":"publisher","first-page":"163","DOI":"10.30476\/JAMP.2022.95226.1632","article-title":"Developing measures of immersion and motivation for learning technologies in healthcare simulation: a pilot study","volume":"10","author":"Jacobs","journal-title":"J Adv Med Educ Prof"},{"issue":"8","key":"R25","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0275766","article-title":"Evaluating user experience with immersive technology in simulation-based education: a modified Delphi study with qualitative analysis","volume":"18","author":"Jacobs","journal-title":"PLoS One"},{"key":"R26","doi-asserted-by":"crossref","unstructured":"Ryan RM Deci EL . Self-Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness. The Guilford Press; 2017. [doi: 10.1521\/978.14625\/28806]","DOI":"10.1521\/978.14625\/28806"},{"key":"R27","doi-asserted-by":"crossref","unstructured":"Sch\u00f6n DA . The Reflective Practitioner: How Professionals Think in Action. Routledge; 2017. [doi: 10.4324\/9781315237473]","DOI":"10.4324\/9781315237473"},{"issue":"4","key":"R28","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0061562","article-title":"A plea for neutral comparison studies in computational sciences","volume":"8","author":"Boulesteix","journal-title":"PLoS One"},{"key":"R29","unstructured":"Conover WJ . Practical Nonparametric Statistics. 3rd ed. Wiley; 1999."},{"issue":"2","key":"R30","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","journal-title":"Qual Res Psychol"},{"issue":"6","key":"R31","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1080\/13645579.2020.1805550","article-title":"The online survey as a qualitative research tool","volume":"24","author":"Braun","journal-title":"Int J Soc Res Methodol"},{"issue":"1","key":"R32","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-024-05365-7","article-title":"Artificial intelligence and medical education: application in classroom instruction and student assessment using a pharmacology & therapeutics case study","volume":"24","author":"Sridharan","journal-title":"BMC Med Educ"},{"key":"R33","doi-asserted-by":"publisher","DOI":"10.2196\/54507","article-title":"Evidence-based learning strategies in medicine using AI","volume":"10","author":"Arango-Ibanez","journal-title":"JMIR Med Educ"},{"issue":"sup1","key":"R34","doi-asserted-by":"publisher","first-page":"S14","DOI":"10.1080\/15391523.2021.1891998","article-title":"Applying the self-determination theory (SDT) to explain student engagement in online learning during the COVID-19 pandemic","volume":"54","author":"Chiu","journal-title":"J Res Technol Educ"},{"key":"R35","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2020.564294","article-title":"Technology acceptance, technological self-efficacy, and attitude toward technology-based self-directed learning: learning motivation as a mediator","volume":"11","author":"Pan","journal-title":"Front Psychol"},{"issue":"4","key":"R36","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1207\/S15327965PLI1104_01","article-title":"The \u201cwhat\u201d and \u201cwhy\u201d of goal pursuits: human needs and the self-determination of behavior","volume":"11","author":"Deci","journal-title":"Psychol Inq"},{"issue":"4","key":"R37","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1080\/17453054.2022.2097059","article-title":"Learning from 360-degree film in healthcare simulation: a mixed methods pilot","volume":"45","author":"Jacobs","journal-title":"J Vis Commun Med"},{"issue":"3","key":"R38","doi-asserted-by":"publisher","first-page":"319","DOI":"10.2307\/249008","article-title":"Perceived usefulness, perceived ease of use, and user acceptance of information technology","volume":"13","author":"Davis","journal-title":"MIS Q"},{"issue":"2","key":"R39","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1080\/01587910802154947","article-title":"University students\u2019 approaches to learning: rethinking the place of technology","volume":"29","author":"Goodyear","journal-title":"Distance Educ"},{"issue":"Suppl 1","key":"R40","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1007\/s11606-007-0283-4","article-title":"Simulation technology for skills training and competency assessment in medical education","volume":"23 Suppl 1","author":"Scalese","journal-title":"J Gen Intern Med"},{"issue":"1","key":"R41","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-019-1464-7","article-title":"High-fidelity is not superior to low-fidelity simulation but leads to overconfidence in medical students","volume":"19","author":"Massoth","journal-title":"BMC Med Educ"},{"issue":"3","key":"R42","doi-asserted-by":"publisher","first-page":"133","DOI":"10.30476\/JAMP.2023.98655.1803","article-title":"Application of artificial intelligence in medical education: current scenario and future perspectives","volume":"11","author":"Mir","journal-title":"J Adv Med Educ Prof"},{"issue":"6","key":"R43","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1001\/jamainternmed.2023.1838","article-title":"Comparing physician and artificial intelligence chatbot responses to patient questions posted to a public social media forum","volume":"183","author":"Ayers","journal-title":"JAMA Intern Med"},{"issue":"5","key":"R44","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1097\/SIH.0000000000000113","article-title":"Learning empathy through simulation: a systematic literature review","volume":"10","author":"Bearman","journal-title":"Simul Healthc"},{"key":"R45","doi-asserted-by":"publisher","DOI":"10.2196\/53961","article-title":"A generative pretrained transformer (GPT)-powered chatbot as a simulated patient to practice history taking: prospective, mixed methods study","volume":"10","author":"Holderried","journal-title":"JMIR Med Educ"},{"key":"R46","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecns.2023.101487","article-title":"Enhancing healthcare education: leveraging ChatGPT for innovative simulation scenarios","volume":"87","author":"Vaughn","journal-title":"Clin Simul Nurs"},{"issue":"6","key":"R47","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1097\/SIH.0000000000000747","article-title":"Artificial intelligence and the simulationists","volume":"18","author":"Rodgers","journal-title":"Simul Healthc"},{"key":"R48","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1279707","article-title":"Integrating AI in medical education: embracing ethical usage and critical understanding","volume":"10","author":"Alam","journal-title":"Front Med (Lausanne)"},{"issue":"1","key":"R49","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1108\/JRIT-06-2022-0036","article-title":"Asynchronous learning: a general review of best practices for the 21st century","volume":"16","author":"Varkey","journal-title":"J Res Innov Teach Learn"},{"key":"R50","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2015.00736","article-title":"Perceived synchrony for realistic and dynamic audiovisual events","volume":"6","author":"Eg","journal-title":"Front Psychol"}],"container-title":["JMIR Medical Education"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/mededu.jmir.org\/2025\/1\/e70766","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:59:41Z","timestamp":1782842381000},"score":1,"resource":{"primary":{"URL":"https:\/\/mededu.jmir.org\/2025\/1\/e70766"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,24]]},"references-count":50,"URL":"https:\/\/doi.org\/10.2196\/70766","relation":{},"ISSN":["2369-3762"],"issn-type":[{"value":"2369-3762","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,24]]},"article-number":"v11i1e70766"}}