Affect-sensitive Virtual Standardized Patient Interface System

Introduction

Traditional approaches to training clinicians in the interpersonal communication skills needed for assessment, diagnosis, and interview performance rely upon a combination of classroom learning and role-playing with human standardized patients. The importance of interpersonal communication is reflected in recent requirements for communication evaluation in medical schools. The Accreditation Council for Graduate Medical Education (ACGME; 2007) has emphasized the importance of interpersonal and communication skills in training clinicians. Residents are expected to: (1) create and sustain a therapeutic and ethically sound relationship with the patient; (2) use effective listening skills, eliciting and providing information using effective nonverbal, explanatory, questioning, and writing skills; and (3) work in an efficient manner with others. However, evaluation studies have revealed methodological deficiencies in many cases (Chant et al., 2002) and limited positive training effects (Hulsman et al., 1999). In an effort to increase interpersonal communication assessment, standardized patients (paid human actors) have been recruited and trained to exhibit the characteristics of an actual patient, thereby affording novice clinicians a realistic opportunity to practice and to be evaluated in a mock clinical environment. Although a valuable training approach, there are limitations with the use of human standardized patients that can be mitigated through simulation technology. For example, human standardized patients are expensive and cost several thousand dollars per student. Further, given the fact that there are only a handful of sites (for over 130 medical schools in the U.S.) providing standardized patient assessments of the clinician in training’s communication ability as part of the U.S. Medical Licensing Examination (USMLE), the current model provides limited availability. Another concern is the issue of standardization. Despite the expense of standardized patient programs, the standardized patients themselves are typically unskilled actors. As a result of common turnover, administrators face considerable challenges for offering psychometrically reliable and valid interactions with the training clinicians. A related issue is the limited scope that the actors are able to portray. As a result, there tends to be an inadequate array of developmentally, socially, and culturally appropriate scenarios. For example, when a clinician has a pediatric focus and needs access to children, it is difficult for the clinician to pretend that the actor is a child. Finally, many clinical cases (e.g., traumatic brain injury) have associated physical symptoms and behaviors (e.g., dilated pupils, spasms, and uncoordinated movements) that simply cannot be accurately portrayed by human actors.