Research shows that dialogue, the interactive process through which participants articulate their thinking, plays a central role in constructing shared understanding, coordinating action, and shaping learning outcomes in teams. Analysing dialogue content has been central to advancing team learning theory and informing the design of computer-supported collaborative learning environments, yet this progress has depended on labour-intensive qualitative coding. LLMs offer new possibilities for automating and enhancing the dialogue layer within emerging multimodal learning analytics approaches, with recent studies showing that they can approximate human coding through few-shot prompting. However, prior work has focused on replicating human coding accuracy for research purposes, rather than addressing a more educationally consequential question: how can we design prompts that allow an LLM to label team dialogue accurately and fast enough to be useful in real settings, such as in-person healthcare simulations, where results must be returned quickly and computational cost and sustainability also matter? This paper investigates how prompt design and batching strategies can be optimised to balance coding accuracy, processing time, and environmental impact in team-based healthcare simulation debriefing. Using a dataset of 11,647 utterances coded across 6 dialogue constructs, we compared 4 prompt designs across varying batch sizes, evaluating coding performance, processing time, and energy consumption, as well as the trade-offs between these metrics. Results indicate that increasing batch size improves speed and reduces energy use, but negatively impacts coding performance. Beyond demonstrating the feasibility of LLM-based qualitative analysis, this study offers practical guidance for scaling dialogue analytics in contexts where timeliness, privacy, and sustainability are critical.
Large Language Models (LLMs) are increasingly deployed in multi-turn dialogue settings where preserving conversational context across turns is essential. A standard serving practice concatenates the full dialogue history at every turn, which reliably maintains coherence but incurs substantial cost in latency, memory, and API expenditure, especially when queries are routed to large proprietary models. Existing approaches often struggle to balance the trade-off between response quality and efficiency. We propose a framework that exploits the early turns of a session to estimate a local response manifold and then adapt a smaller surrogate model to this local region for the remainder of the conversation. Concretely, we learn soft prompts that maximize semantic divergence between the large and surrogate small language models' responses to surface least-aligned local directions, stabilize training with anti-degeneration control, and distill the mined cases into localized LoRA fine-tuning so the surrogate runs without prompts at inference. A simple gate enables a one-time switch with rollback on drift. We further provide a theoretical analysis for key components in SOMA. Extensive experiments show the effectiveness of SOMA. The source code is provided at: https://github.com/LabRAI/SOMA.
Background. The widespread deployment of ambient digital scribes is driving large-scale capture of clinician-patient dialogues. Human coding of clinical communication data remains costly, inconsistent, and difficult to scale, motivating AI-driven communication coding systems. However, evaluating these systems requires real-world dialogues and human-coded labels, both hard to obtain at scale. Methods. We developed SIMAX (Scalable and Interpretable Framework for Multi-Fidelity and Annotated Clinician-Patient Dialogue Simulation), a framework for generating controlled clinical dialogue data with reference behavioral annotations. SIMAX generates clinician-patient dialogues from predefined clinical scenarios, personas and voice conditions, and target communication behaviors. Behaviors are controlled using two codebooks: the Global Codebook for overall communication quality and the WISER Codebook for specific countable behaviors. We evaluated SIMAX using automated and human quality assessments and an example communication coding system. Results. SIMAX generated 3,388 simulated dialogues across three specialties, multiple visit stages, persona characteristics, and accent conditions. Automated assessment showed mean UTMOS and WV-MOS scores of 3.03 and 2.61, WER and CER of 0.07 and 0.05, and CLAP cosine similarity of 0.41, suggesting reasonable speech naturalness, high transcription fidelity, and positive text-audio correspondence. Human evaluation showed a median MOS of 4.67 and a median clinical realism score of 3.00. Downstream evaluation suggests that SIMAX can assess how a communication coding system responds to behavioral targets and reveal insufficient sensitivity in some dimensions. Conclusions. SIMAX generates controlled and reproducible simulated clinician-patient dialogues, providing a data foundation for developing, validating, and refining communication coding systems.
Medical large language models are typically evaluated on idealized patient cases that do not reflect how real patients communicate. We introduce VeriSim, a patient simulation framework that injects controllable noise along six clinically grounded communication dimensions while substantially preserving each patient's medical record. Truth adherence is supported by a verifier that extracts atomic claims from each candidate utterance and judges them against a UMLS-grounded vector index built with BioLORD embeddings, using the retrieved atoms' structured clinical metadata (e.g., drug class, anatomical site, treats-condition relations) rather than surface-text similarity alone. Across seven open-weight LLMs, realistic noise reduces diagnostic accuracy by 15-25 percentage points and increases conversation length by 34-55%; the 7-8B models degrade 1.4x more than 70B+ models. A board-certified physician and a licensed nurse rate VeriSim's conversations highly on truth, realism, clinical utility, and noise fidelity (inter-annotator agreement >= 0.80 across all dimensions), and an LLM-as-judge closely tracks their ratings, enabling scalable evaluation. We release VeriSim as an open-source framework for rigorous stress-testing of clinical AI: https://github.com/mohitmarvania/VeriSim
Sina Mansouri, Mohit Marvania, Vibhavari Ashok Shihorkar +5