Problem: Effective patient-centered communication is a core competency for physicians. However, both seasoned providers and medical trainees report decreased confidence in leading conversations on sensitive topics such as goals of care or end-of-life discussions. The significant administrative burden and the resources required to provide dedicated training in leading difficult conversations has been a long-standing problem in medical education. Approach: In this work, we present a novel educational tool designed to facilitate interactive, real-time simulations of difficult conversations in a video-based format through the use of multimodal generative artificial intelligence (AI). Leveraging recent advances in language modeling, computer vision, and generative audio, this tool creates realistic, interactive scenarios with avatars, or "synthetic patients." These synthetic patients interact with users throughout various stages of medical care using a custom-built video chat application, offering learners the chance to practice conversations with patients from diverse belief systems, personalities, and ethnic backgrounds. Outcomes: While the development of this platform demanded substantial upfront investment in labor, it offers a highly-realistic simulation experience with minimal financial investment. For medical trainees, this educational tool can be implemented within programs to simulate patient-provider conversations and can be incorporated into existing palliative care curriculum to provide a scalable, high-fidelity simulation environment for mastering difficult conversations. Next Steps: Future developments will explore enhancing the authenticity of these encounters by working with patients to incorporate their histories and personalities, as well as employing the use of AI-generated evaluations to offer immediate, constructive feedback to learners post-simulation.

翻译：问题：有效的以患者为中心的沟通是医生的核心能力。然而，无论是经验丰富的医疗从业者还是医学生，都表示在主导关于敏感话题（如治疗目标或临终讨论）的对话时信心下降。提供专门困难对话培训所需的大量行政负担和资源，一直是医学教育中长期存在的问题。方法：在本研究中，我们提出了一种新颖的教育工具，旨在通过使用多模态生成式人工智能（AI），以视频形式促进困难对话的交互式、实时模拟。该工具利用语言建模、计算机视觉和生成式音频领域的最新进展，创建了逼真的、具有交互性的场景，其中包含虚拟化身或“合成患者”。这些合成患者通过定制的视频聊天应用程序，在医疗护理的各个阶段与用户互动，为学习者提供了与来自不同信仰体系、个性和种族背景的患者进行对话练习的机会。成果：尽管该平台的开发需要大量的前期人力投入，但它能以最小的财务投资提供高度逼真的模拟体验。对于医学生而言，该教育工具可在培训项目中实施，以模拟医患对话，并可纳入现有的姑息治疗课程，为掌握困难对话提供一个可扩展、高保真度的模拟环境。后续步骤：未来的开发将探索通过与患者合作，纳入其病史和个性特征，以及利用AI生成的评估在模拟后为学习者提供即时、建设性的反馈，从而增强这些互动体验的真实性。