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Background Clinical decision-making (CDM) refers to physicians’ ability to gather, evaluate, and interpret relevant diagnostic information. An integral component of CDM is the medical history conversation, traditionally practiced on real or simulated patients. In this study, we explored the potential of using Large Language Models (LLM) to simulate patient-doctor interactions and provide structured feedback. Methods We developed AI prompts to simulate patients with different symptoms, engaging in realistic medical history conversations. In our double-blind randomized design, the control group participated in simulated medical history conversations with AI patients (control group), while the intervention group, in addition to simulated conversations, also received AI-generated feedback on their performances (feedback group). We examined the influence of feedback based on their CDM performance, which was evaluated by two raters (ICC = 0.924) using the Clinical Reasoning Indicator – History Taking Inventory (CRI-HTI). The data was analyzed using an ANOVA for repeated measures. Results Our final sample included 21 medical students (age mean = 22.10 years, semester mean = 4, 14 females). At baseline, the feedback group (mean = 3.28 ± 0.09 [standard deviation]) and the control group (3.21 ± 0.08) achieved similar CRI-HTI scores, indicating successful randomization. After only four training sessions, the feedback group (3.60 ± 0.13) outperformed the control group (3.02 ± 0.12), F (1,18) = 4.44, p  = .049 with a strong effect size, partial η 2  = 0.198. Specifically, the feedback group showed improvements in the subdomains of CDM of creating context ( p  = .046) and securing information ( p  = .018), while their ability to focus questions did not improve significantly ( p  = .265). Conclusion The results suggest that AI-simulated medical history conversations can support CDM training, especially when combined with structured feedback. Such training format may serve as a cost-effective supplement to existing training methods, better preparing students for real medical history conversations.

Background: Simulation-based education has emerged as an effective approach in nursing education worldwide. We aimed to evaluate the effectiveness of a surgical nursing education program based on a simulation using standardized patients and mobile applications among nursing students. Methods: A mixed-methods design with a quasi-experimental longitudinal approach and focus group interviews was employed. The data were collected from 130 third-year nursing students at three different time points who were equally divided into experimental and control groups. This study measured the level of clinical surgical nursing competence, self-efficacy in clinical performance, cultural competence, and satisfaction with simulation experience. Four focus group interviews were conducted using open-ended questions to explore the participants’ perspectives on the course’s efficacy and satisfaction. Results: There were statistically significant differences in clinical surgical nursing competence (F = 8.68, p < 0.001), self-efficacy in clinical performance (F = 13.56, p < 0.001), and cultural competence (F = 10.35, p < 0.001) across time between the intervention and control groups. Student satisfaction with the simulation-based training was high, particularly regarding debriefing and reflection, with an overall mean satisfaction level of 4.25 (0.40). Students’ perspectives regarding integrated hybrid training are categorized into three themes: educational achievement, dynamic learning experiences, and satisfaction and suggestion. Conclusion: Simulation-based learning provides a dynamic and immersive educational experience that enables undergraduate nursing students to develop and refine essential clinical skills while also fostering confidence and cultural competence.

This study investigates the impact of standardized patient simulation-based compassionate care training on nurses' emotional intelligence and empathy. The growing emphasis on compassionate care in healthcare settings highlights the need for nurses to cultivate emotional intelligence and empathy to enhance patient interactions and care quality. Standardized patient simulation has emerged as an effective method for developing these essential skills. A quasi-experimental design was employed. 124 staff nurses were divided into a study group (62 nurses) and a control group (62 nurses). Pre- and post-intervention assessments measured emotional intelligence and empathy using validated scales. Data were collected from December 2024 to February 2025. The study group exhibited substantial improvements in emotional intelligence post-intervention (38.74 ± 8.11) in contrast to the control group (29.5 ± 11.4) with a p-value < 0.001. Empathy scores also significantly increased in the study group (8.15 ± 1.97) versus the control group (6.07 ± 2.52), p < 0.001. The findings underscore the effectiveness of standardized patient simulation in developing emotional intelligence and empathy among nurses. These skills are crucial for improving patient care quality, suggesting healthcare institutions should integrate this training into professional development programs. Ongoing research is required to explore long-term impacts and the role of organizational support in skill development.

Background Good communication between patients and practitioners is essential, especially during dental procedures, as these treatments are often associated with increased nervousness and anxiety. The aim of this study was to investigate, implement and evaluate a concept for communication skills training by using targeted training in combination with simulation patients in dental education. Methods Students ( n  = 34) were assigned to four small groups receiving targeted training consisting of two parts. A lecture about the theoretical basics of communication skills and two practical sessions with simulation patients. During this training, one of the students performed the conversation with the patient. Immediately after self-assessment was obtained, the simulation patient, the remaining students and the lecturer provided feedback. Additionally, anonymous surveys were administered to the students at the beginning of the semester, immediately after the training and at the end of the course. Results The students rated the learning of communication skills as important for later professional life at all times. After targeted training followed by subsequent use in simulated patients, there was a significant improvement in communication skills ( p  < 0.001). The number of open-ended questions asked to patients after attending the course significantly increased ( p  = 0.0245). The communication training was considered useful, especially in small groups. Conclusion The implementation of targeted training with subsequent use in simulated patients significantly contributed to the students’ improvement in communication skills. The concept offers a good opportunity to better prepare students for interaction with patients, both in their studies and in their upcoming professional lives.

This study employed a bibliometric analysis to examine the existing literature on the use of standardised patient simulation in nursing education. SP simulation offers students the opportunity to directly interact with a range of nursing interventions and practices. It demonstrates that SP simulation can be used as an active learning methodology in nursing education. Bibliometric and content analysis. The data set was obtained from the Web of Science database. The sample comprised 310 publications that fulfilled the a priori defined inclusion criteria. The data were subjected to both descriptive content analysis and bibliometric analysis. A bibliometric analysis was conducted using VOSviewer, a software program designed for the mapping and visualisation of bibliometric data. A total of 198 publications were published in 2002–2024. The publications had 3042 citations. Nurse Education Today has the highest number of publications and citations. In terms of authors, Elcin was the author with the highest number of citations (n = 186). In accordance with the findings of the trend topic analysis, the keywords 'simulation', 'nursing education', 'standardised patient' and 'nursing students' emerged in the field. The number of studies examining the efficacy of using standard patient simulators in nursing education has seen a notable increase in recent years. The findings of this study may offer researchers and nursing faculties new insights into the value of incorporating standardised patient simulation into nursing education, as well as potential applications of such an approach. •The research literature productivity and the quality of that literature are increasing.•Bibliometrics is a new quantitative assessment method.•This study examines the evolution of interest in standardized patient simulation between 2002 and 2024.•The journal published the most standardized patient simulation in the field of nursing education was Nurse Education Today.

Adolescent suicide and mental illness have increased at alarming rates. Healthcare professionals report a lack of skill and confidence in obtaining adolescent histories and managing confidential care due to limited training in residency. Nursing professional development practitioners face challenges of adequately preparing interdisciplinary healthcare providers to assess, identify, and intervene at all points of contact with adolescents. To increase the confidence in clinical communication skills and clinical competency, and to increase the number of social work referrals related to modifiable risk factors for adolescent patients, a Texas pediatric tertiary care center utilized standardized patient (SP) methodology to supplement traditional clinical experiences with communication-focused education based on the Home, Education, Eating, Activities, Drugs, Sexuality, Suicidality, and Safety (HEEADSSS) interviewing. This quality improvement (QI) pilot demonstrated the benefits of utilizing standardized patient methodology in communication-focused education based on the HEEADSSS interviewing. Following the SP simulations, confidence in clinical communication skills increased by 13%, clinical competency in performing comprehensive psychosocial interviews increased by 11%, use of HEEADSSS increased by 64%, and social work referrals increased by 89%. This interdisciplinary SP interviewing simulation pilot was beneficial in improving the 36 physician and nursing residents’ ability to conduct psychosocial assessments for risk factors of suicidality among adolescents.

Lack of experience communicating with patients and families at the end of life are key concerns for nursing students. Palliative care simulation using standardized patients (SPs) focusing on difficult conversations may lead to increased self-confidence in providing palliative and end-of-life care in clinical practice. There is currently a paucity of research on SP palliative care simulations in undergraduate nursing education. The objective of this research was to assess 3rd year undergraduate nursing students' levels of satisfaction and self-confidence with palliative and end-of-life care simulations focusing on difficult conversations, as measured by the Student Satisfaction and Self-Confidence in Learning Scale (SSSCLS) and the Simulation Design Scale (SDS). A descriptive post-intervention study. Four palliative care simulation days, consisting of 2 clinical scenarios, were conducted over 4 weeks. The first simulation was an outpatient palliative care clinic scenario, and the second was an inpatient hospital scenario. Nursing students enrolled in a 3rd year nursing palliative care elective ( = 51) at an Australian university were invited to participate. Students who attended simulation days were eligible to participate ( = 31). Immediately post-simulation, students were invited to complete the SSSCLS and the SDS. Fifty-seven surveys were completed (simulation 1, = 28; simulation 2, = 29). The data were analyzed using descriptive statistics. Results showed that students had high levels of self-confidence in developing palliative care and communication skills after both simulation experiences and high levels of satisfaction with the SP simulations. The lack of published literature on palliative care and end-of-life SP simulation highlights the need to collect further evidence to support this as an innovative approach to teaching palliative care. SP palliative care simulation focusing on difficult conversations assists in developing students' communication skills and improves satisfaction and self-confidence with palliative and end-of-life care.

Background Patient simulation has been used in medical education to provide a safe and supportive learning environment for learners to practice clinical and interpersonal skills. However, simulation involving pediatric populations, particularly in child and adolescent psychiatry, is rare and generally does not reflect the child-caregiver dyad or the longitudinal aspects of this care, nor does it provide learners with an opportunity to engage with and reflect on these dynamics. Methods We organized as an educational opportunity a series of seven observed patient simulation sessions with a cohort of a dozen child and adolescent psychiatrists (eight fellows approaching graduation and four senior educators). In these sessions, we utilized the co-constructive patient simulation model to create the simulation cases. We included the use of at least two patient actors in most sessions, and two of the case narratives were longitudinally followed across multiple simulation sessions. We approached the data collected during the simulations and their respective debriefings by using thematic analysis informed by a symbolic interactionist approach. Results Based on data from the debriefing sessions and longitudinal narratives, we identified four overarching themes: (1) Reflecting on dyadic challenges: role reversal and individuation; (2) Centering the child, allying with the parent, and treating the family system; (3) Ambivalence in and about the parent-child dyad; and (4) Longitudinal narratives and ambivalence over time. Conclusion The emotional experience of the simulations, for interviewers and observers alike, provided an opportunity to reflect on personal and professional experiences and triggered meaningful insights and connections between participants. These simulated cases called for emotional labor , particularly in the form of creating holding environments ; in this way, the simulated encounters and the debriefing sessions became dialogic experiences, in which the patient and provider, parent and child, and learner and instructor could co-construct meaning and foster professional development as reflective practitioners.

Clinical reasoning is increasingly recognized as an important skill in the diagnosis of common and serious conditions. eCREST (electronic Clinical Reasoning Educational Simulation Tool), a clinical reasoning learning resource, was developed to support medical students to learn clinical reasoning. However, primary care teams now encompass a wider range of professional groups, such as physician assistants (PAs), who also need to develop clinical reasoning during their training. Understanding PAs' clinical reasoning processes is key to judging the transferability of learning resources initially targeted to medical students. This exploratory study aimed to measure the processes of clinical reasoning undertaken on eCREST by PA students and compare PAs' reasoning processes with previous data collected on medical students. Between 2017 and 2021, PA students and medical students used eCREST to learn clinical reasoning skills in an experimental or learning context. Students undertook 2 simulated cases of patients presenting with lung symptoms. They could ask questions, order bedside tests, and select physical exams during the case to help them form, reflect on, and reconsider diagnostic ideas and management strategies while completing a case. Exploratory analysis was undertaken by comparing students' data gathering, flexibility in diagnosis, and diagnostic ideas between medical and PA students. In total, 159 medical students and 54 PA students completed the cases. PAs were older (mean 27, SD 7 y vs mean 24, SD 4 y; P<.001) and more likely to be female (43/54, 80% vs 84/159, 53%; P<.001). Medical and PA students were similar in the proportion of essential questions asked (Case 1: mean 70.1 vs mean 73.2; P=.33; Case 2: mean 74.6 vs mean 70.9; P=.27), physical examinations requested (Case 1: mean 54.7 vs mean 54.0; P=.59; Case 2: mean 69.3 vs mean 67.5; P=.59), bedside tests selected (Case 1: mean 74.4 vs mean 83.3; P=.05; Case 2: mean 47.9 vs mean 50.0; P=.69), and number of times they changed their diagnoses (Case 1: mean 2.8 vs mean 2.8; P=.99; Case 2: mean 2.8 vs mean 2.5; P=.81). Both student groups improved in their diagnostic accuracy during the cases. These results provide suggestive evidence that medical and PA students had similar clinical reasoning styles when using an online training tool to support their diagnostic decision-making.

Background Communication skills are an essential part of clinical competence that need to be acquired during health professions education. Simulations are extensively used for learning communication skills and have long been integral to medical degree programmes. In this research we use qualitative methodology to explore fourth-year medical students’ experiences in simulations aimed at improving versatile doctor-patient communication, focusing on their learning with trained actors. Methods The data comprises reflective writings from 208 fourth-year medical students, gathered after a communication skills course. These students provided informed consent for their writings to be included in the research. We performed an inductive qualitative content analysis on the textual data, with findings presented as themes, supported by categories, codes, and excerpts from raw data to enhance the trustworthiness of the analysis. Results We identified eight key themes capturing students’ learning experiences through simulations: practising in a safe learning environment, valuing feedback, gaining new perspectives, finding simulations valuable and enjoyable, boosting confidence and self-knowledge, and viewing simulations as authentic and engaging learning opportunities. Some students offered critical perspectives on simulations. Throughout the course, students learned diverse aspects of patient care, emotional and behavioural communication dynamics, and lessons from medical errors. Some students offered critical perspectives on simulations, and a few indicated they did not learn anything new. Conclusions A safe learning environment is vital for encouraging learners to explore, make errors, and absorb feedback to improve their communication with patients. Students predominantly valued the communication skills training with actors and the constructive feedback received and given in the debriefing discussions. However, some students expressed critical views toward simulations. Simulations are not static; they evolve and require continual improvements. Hence, we advocate for the ongoing exploration and enhancement of communication skills learning methods, including simulations, with careful consideration for students’ vulnerability and the importance of psychological safety. Additionally, it is critical to address students’ perceptions that certain clinical teachers prioritise biomedical knowledge over communication skills. Providing tailored training for teachers regarding the learning methods and the desired outcomes of communication courses is essential.