Understanding empathy training with virtual patients
Open accessAbstract
While the use of virtual characters in medical education is becoming more and more commonplace, an understanding of the role they can play in empathetic communication skills training is still lacking. This paper presents a study aimed at building this understanding by determining if students can respond to a virtual patient's statement of concern with an empathetic response. A user study was conducted at the [blinded] College of Medicine in which early stage medical students interacted with virtual patients in one session and real humans trained to portray real patients (i.e., standardized patients) in a separate session about a week apart. During the interactions, the virtual and 'real' patients presented the students with empathetic opportunities which were later rated by outside observers. The results of pairwise comparisons indicate that empathetic responses made to virtual patients were rated as significantly more empathetic than responses made to standardized patients. Even though virtual patients may be perceived as artificial, the educational benefit of employing them for training medical students' empathetic communications skills is that virtual patients offer a low pressure interaction which allows students to reflect on their responses.
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AI-driven virtual patient simulations can boost learner empathy.
“This finding parallels prior work showing that AI-driven virtual patient simulations can boost learner empathy: for example, trainees interacting with virtual patients in low-pressure, interactive settings produce more empathic responses53, and virtual patient encounters that include empathic feedback have yielded higher empathy scores in later standardized‐patient interviews54.”
From A large language model digital patient system enhances ophthalmology history taking skills (2025) · cites this paper as [54]
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Cites
Measuring individual differences in empathy: Evidence for a multidimensional approach.
Davis, M. H. (1983) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.44.1.113 · Cited by 10,272 · see citing works
The Effects of Physician Empathy on Patient Satisfaction and Compliance
Kim, S. S., Kaplowitz, S., & Johnston, M. V. (2004) · Evaluation & the Health Professions · doi:10.1177/0163278704267037 · Cited by 1,063 · see citing works
Do medical students respond empathetically to a virtual patient?
Deladisma, A. M., Cohen, M., Stevens, A., Wagner, P., Lok, B., Bernard, T., Oxendine, C., Schumacher, L., Johnsen, K., Dickerson, R., et al. (2007) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2007.01.021 · Cited by 160 · cited 4× · see citing works
“Deladisma et al. (2007) found that empathy was in fact positively correlated with specific nonverbal communication behaviors (i.e., eye contact, head nod and body lean).”
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Research works printed but not linked: 23
- Babu S Suma E Barnes T Hodges LF Can immersive virtual humans teach social conversational protocols?. Virtual Reality Conference 3 2007 215 218 IEEE
- Basch MF Empathic understanding: A review of the concept and some theoretical considerations. Journal of the American Psychoanalytic Association 1983 31 101 126 6681414
- Bailenson JN Aharoni E Beall AC Guadagno RE Dimov A Blascovich J Comparing behavioral and self-report measures of embodied agents’ social presence in immersive virtual environments. 10 2004 Proceedings of the 7th Annual International Workshop on PRESENCE
- Bonvicini KA Perlin MJ Bylund CL Carroll G Rouse RA Goldstein MG Impact of communication training on physician expression of empathy in patient encounters. Patient Education and Counseling 2009 75 1 3 10 19081704
- Bylund CL Makoul G Examining empathy in medical encounters: an observational study using the empathic communication coding system. Health Communication 2005 18 2 123 140 16083407
- Colliver JA Conlee MJ Verhulst SJ Dorsey JK Reports of the decline of empathy during medical education are greatly exaggerated: a reexamination of the research. Academic Medicine 2010 85 4 588 593 20354372
- Diseker RA Michielutte R An analysis of empathy in medical students before and following clinical experience. Journal of Medical Education 1981 56 1004 1010 7310834
- Easter DW Beach W Competent patient care is dependent upon attending to empathic opportunities presented during interview sessions. Current Surgery 2004 61 3 313 318 15165773
- Haider AH Sexton J Sriram N Cooper LA Efron DT Swoboda S Villegas CV Haut ER Bonds M Pronovost PJ Cornwell EE Association of unconscious race and social class bias with vignette-based clinical assessments by medical students. JAMA 2011 306 9 942 951 21900134 PMC3684149
- Hirsh AT Hollingshead NA Matthias MS Bair MJ Kroenke K The influence of patient sex, provider sex, and sexist attitudes on pain treatment decisions. The Journal of Pain 2014 15 5 551 559 24576430
- Hojat M Gonnella JS Nasca TJ Mangione S Vergare M Magee M Physician empathy: definition, components, measurement, and relationship to gender and specialty CRMEHC Faculty Papers 2002 4 12202278
- Hojat M Vergare MJ Maxwell K Brainard G Herrine SK Isenberg GA Veloski J Gonnella JS The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Academic Medicine 2009 84 9 1182 1191 19707055
- Jensen N The empathic physician (letter). Archives of Internal Medicine 1994 154 108 8267482
- Kenny P Parsons TD Gratch J Leuski A Rizzo AA Virtual patients for clinical therapist skills training. Intelligent Virtual Agents 1 2007 197 210 Springer Berlin Heidelberg
- Levinson W Gorawara-Bhat R Lamb J A study of patient clues and physician responses in primary care and surgical settings. JAMA 2000 284 8 1021 1027 10944650
- Neumann M Edelhäuser F Tauschel D Fischer MR Wirtz M Woopen C Haramati A Scheffer C Empathy decline and its reasons: a systematic review of studies with medical students and residents. Academic Medicine 2011 86 8 996 1009 21670661
- Nightingale SD Yarnold PR Greenberg MS Sympathy, empathy, and physician resource utilization. Journal of General Internal Medicine 1991 6 420 423 1744756
- Pan X Gillies M Barker C Clark DM Slater M Socially anxious and confident men interact with a forward virtual woman: an experimental study. PloS One 2012 7 4 e32931 22509251 PMC3324473
- Raij A Johnsen K Dickerson R Lok B Cohen M Bernard T Wagner P Lind DS Interpersonal Scenarios: Virtual approx Real?. Virtual Reality Conference 3 2006 59 66
- Rivera-Gutierrez DJ Kopper R Kleinsmith A Cendan J Finney G Lok B Exploring Gender Biases with Virtual Patients for High Stakes Interpersonal Skills Training. Intelligent Virtual Agents 1 2014 385 396 Springer International Publishing
- Rossen B Lind D Lok B Human-centered Distributed Conversational Modeling: Efficient Modeling of Robust Virtual Human Conversations International Conference on Intelligent Virtual Agents 2009 474 481 Springer International Publishing
- Slater M Pertaub DP Barker C Clark DM An experimental study on fear of public speaking using a virtual environment. CyberPsychology & Behavior 2006 9 5 627 633 17034333
- Tulsky JA Interventions to enhance communication among patients, providers, and families. Journal of Palliative Medicine 2005 8 supplement 1 s 95 16499474
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Effective virtual patient simulators for medical communication training: A systematic review
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“The results were derived from retrospectively rating the responses and were attributed to the lowerpressure environment, and the extra time users could have when formulating responses.(17) Whilst this study provided important evidence for the positive benefit of training with virtual patients, the use of retrospective…”
MethodA large language model digital patient system enhances ophthalmology history taking skills
Luo, M.-J., Bi, S., Pang, J., Liu, L., Tsui, C.-K., Lai, Y., Chen, W., Yang, Y., Xu, K., Zhao, L., et al. (2025) · npj Digital Medicine · doi:10.1038/s41746-025-01841-6 · Cited by 39 · see citing works
“…can boost learner empathy: for example, trainees interactingwithvirtualpatientsinlow-pressure,interactivesettingsproduce moreempathicresponses 53 , and virtual patient encounters that include empathic feedback have yielded higher empathy scores in later standardized ‐ patientinterviews 54 .”
Aware Intelligent Virtual Agent's Effect on Social Presence and Empathy of Caregivers
Ahmmed, A., Butts, E., Naeiji, K., Thiamwong, L., Ancis, J., & Daher, S. (2024) · Proceedings of the ACM International Conference on Intelligent Virtual Agents · doi:10.1145/3652988.3673951 · Cited by 8 · see citing works
- Authors
- Kleinsmith, A., Rivera-Gutierrez, D., Finney, G., Cendan, J., & Lok, B.
- Affiliations
- University of Florida (US)
- University of Central Florida (US)
- Corresponding author
- Kleinsmith, Andrea
- Venue
- Computers in Human Behavior
- Publisher
- Elsevier BV
- Published
- 2015-11
- Volume
- 52
- Pages
- 151-158
- ISSN
- 0747-5632 (ISSN-L)
- PMC
- PMC4493762
- OpenAlex
- W638508087
- Cited by
- 141
- References
- 3
- Citations by year
- 2026: 5 · 2025: 18 · 2024: 18 · 2023: 14 · 2022: 6 · 2021: 14 · 2020: 21 · 2019: 17 · 2018: 11 · 2017: 9 · 2016: 8
- FWCI
- 7.58
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Computers in Human Behavior (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Maryland Shared Open Access Repository (USMAI Consortium) (submittedVersion, cc-by-nc-nd)
- Digital Repository at the University of Maryland (University of Maryland College Park)
- Funders
- National Institutes of Health
- U.S. National Library of Medicine (R01LM010813)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
- Health Sciences › Medicine › Physiology › Simulation-Based Education in Healthcare
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Keywords
- empathy training, virtual patients, empathic communication, medical students, standardized patients, patient-physician interaction
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