A French OSCE Dialogue Dataset and Controllable Virtual Patient System for Clinical Training
Authors: Doria Bonzi, Tom Bourgeade, Fabrice Lefèvre, Irina Illina
Abstract
The clinical and communication skills of medical students are commonly assessed through Objective Structured Clinical Examinations (OSCEs), which consist of brief scenario-driven simulations of doctor-patient interactions. However, training is often limited by the low availability of human standardized patients, motivating the development of realistic virtual patients (VPs). To address this gap, we introduce a French OSCE dialogue dataset comprising 240 student-patient training interactions. We build upon it a controllable LLM-based pipeline to generate synthetic OSCE dialogues. The pipeline integrates modular components, such as retrieval-based grounding and a reflection loop, to ensure patient fidelity, coherence, and realism. Additionally, we propose a multi-level evaluation framework assessing patient simulation quality, student performance, and linguistic quality, using an LLM-as-a-Judge approach. Experiments suggest that controllability modules generally improve patient fidelity and student evaluation consistency. Finally, we implement an interactive prototype in which students can practice with a VP and receive automatic feedback.
Clinical education must prepare medical students to conduct safe and coherent patient interviews under conditions of uncertainty. Traditional standardized patient (SP) training is resource-intensive and difficult to scale. We developed a scaffolding-oriented multi-agent Large Language Model (LLM) AI Standardized Patient (AI-SP) training platform1. The system includes a patient agent for simulated dialog, a tutor agent providing Socratic prompts without disclosing diagnostic information, and a turn-level evaluator agent that monitors clinical progress without revealing summative scores. In a randomized controlled study (N = 100 medical students), participants were assigned to either a multi-agent (MA) scaffolding condition or a control condition. All students completed two learning sessions under their assigned condition followed by an examination conducted in a patient only environment. Performance was assessed using a standardized Objective Structured Clinical Examination (OSCE) based rubric. While no significant difference was observed in final diagnostic accuracy between groups, the multi-agent AI standardized patient system improved final examination scores compared to the control group utilizing structured progressive information disclosure; the most substantial and consistent improvements were observed in communication, the expression of empathy, and specific history-taking behaviors. These findings suggest that specialized LLM agents enhance the process quality of simulated clinical interviews without artificially inflating examination outcomes. To support future research, we release a multi-expert annotated dataset comprising transcripts, checklist annotations, turn-level evaluations, and OSCE-aligned scoring outcomes. This resource aims to facilitate the development of pedagogically grounded AI-SP systems and advance research on AI-supported clinical reasoning training.
Simulating realistic patient interactions is a key requirement to testing clinical applications of LLMs at scale without time-consuming and expensive user studies. However, existing approaches often lack realism and controllability, often oversharing information unprompted, and failing to capture the wide variability of patient behavior. Here, we introduce PatientsWithPersonality (PWP), a patient simulation framework that generates realistic yet diverse virtual patient responses through explicit personality parametrization over a latent patient state. Grounded in HEXACO, a six-dimensional personality space used to quantify and parameterize human behavioral traits, our approach enables fine-grained control over conversational style, cooperativeness, and information disclosure within a unified framework. In a clinician evaluation, PWP is judged nearly as realistic as recorded human actors and clearly ahead of prior simulators, while being flagged as "too informative" far less often. Conditioning on HEXACO axes yields personas whose configured traits are recoverable by both clinicians and an autorater, span a substantially wider behavioral footprint than the closest baseline, and prevent oversharing. Altogether, our framework paves the way for more accurate and informative LLM benchmarking through our realistic and steerable patient simulator.
Moritz Schlager, Friederike Jungmann, Samuel Schmidgall +12
Objective Structured Clinical Examinations (OSCEs) are the gold standard for assessing clinical competence, yet scoring remains vulnerable to examiner subjectivity, fatigue, and cognitive bias. Standard examiner validation via inter-rater statistics lacks explanatory power regarding the source of errors, as it neither analyzes examiner reasoning nor verifies examiner claims against actual events. Thus, we introduce Quality Action Assurance (QAA), a multimodal framework that verifies examiner claims in Virtual Reality (VR) pediatric OSCEs by comparing actions claimed by examiners against a reference record of events constructed from video, VR logs, and actor annotations. QAA combines a constrained temporal action alignment model, which performs action localization and actor source attribution, with a large language model that extracts examiner claims and checks them against the record. Across a 5-fold cross-validation, QAA achieves 99.2% ± 0.7% Actor F1 and 93.4% ± 1.9% W@16 for temporal alignment. Overall, QAA detects examiner errors with 69.9% precision and 76.7% recall; in retrospective evaluation, correcting the detected errors raises the share of factually correct transcripts from 39.2% to 79.2%, supporting fairer OSCE quality assessment.