Application of AI-based virtual standardized patients in physician-patient communication training: a study based on the SEGUE framework

Background Developing effective doctor–patient communication skills is a critical component of medical education. The SEGUE framework offers a structured and systematic approach for teaching and assessing communication competence. However, traditional standardized patient (SP) training is resource-intensive, time-consuming, and difficult to scale for large student cohorts. AI-based virtual standardized patients (AI-VSPs) have emerged as a promising alternative, providing repeatable, accessible, and scalable training opportunities. This study aimed to evaluate the effectiveness and feasibility of AI-VSPs within SEGUE-based communication training for medical students, compared with traditional SPs. Methods In a parallel mixed-methods randomized controlled trial, 82 senior clinical medical students were randomized to train with AI-VSPs ( n = 40) or traditional SPs ( n = 42) for 2 h following a 3-week medical ethics course. Communication performance was assessed using SEGUE total scores, Content and Process subscales, training frequency was recorded, and participant feedback was analyzed qualitatively. Results Both groups improved significantly in SEGUE scores after training ( P < 0.05). The AI-VSP group achieved higher total scores (18.53 ± 2.51 vs. 17.33 ± 2.13) and Content scores (12.55 ± 1.91 vs. 11.74 ± 1.38) than the traditional SP group, while Process scores were similar. AI-VSP students completed more training sessions (4.10 vs. 3.79, P = 0.03). Qualitative feedback highlighted AI-VSPs' repeatability, convenience, and realistic interactions, with fewer negative comments than traditional SPs. Conclusion SEGUE-based simulation training effectively enhances medical students' communication skills. AI-VSPs offer scalable, repeatable, and practical advantages, helping learners complete communication tasks thoroughly and providing targeted feedback, but they do not necessarily improve real-world communication competence such as empathy or relational skills.