Improving doctor–patient communication competency in residents through a virtual standardized patient-based training and assessment program: a mixed-methods pilot study

Abstract

Doctor–patient communication is a core competency for resident physicians, yet residency training in China relies heavily on traditional standardized patients (SPs), constrained by high costs, limited scalability, and subjective scoring. Virtual standardized patients (VSPs) combined with the SEGUE (Set the Stage, Elicit Information, Give Information, Understand the Patient’s Perspective, End the Encounter) framework offer a promising alternative, but empirical evidence among residents remains scarce. This study aimed to evaluate a VSP-based training and assessment program for improving residents’ communication competency and pedagogical acceptability. A single-center, pre-test–post-test, convergent mixed-methods pilot study was conducted at a residency training hospital in China. Forty residents across different postgraduate years and specialties were enrolled. Communication performance was assessed using the 25-item SEGUE framework before and after a 4-week VSP training intervention, scored independently by two blinded raters. Training frequency was automatically recorded. Qualitative data were collected through open-ended questionnaires and semi-structured interviews. Paired t-tests or Wilcoxon signed-rank tests were used for pre-post comparisons, with effect sizes reported as Cohen’s dz. Thirty-seven residents (92.5%) completed all assessments. SEGUE total scores improved significantly from 11.84 ± 3.21 to 16.97 ± 3.46 ( P  < 0.001, dz = 1.70). Content subscale scores showed substantial improvement (dz = 1.84), while Process subscale improvement was more modest (dz = 0.63). Training frequency correlated positively with score improvement ( r  = 0.41, P  = 0.012). Qualitative feedback highlighted repeatable practice convenience (82.9%) and targeted feedback (71.4%), while insufficient emotional realism was the most cited limitation (60.0%). Participation in the overall educational program (theoretical instruction combined with VSP-based training) was associated with significant improvement in residents’ SEGUE scores, particularly in communication task completeness. These preliminary findings suggest that VSP-based training is feasible as a scalable complement to traditional SP training. Future multi-center trials with long-term follow-up are warranted. Not applicable. This was a medical education and simulation-based pilot study involving resident physicians as learners; no patient participants, clinical interventions, or patient health/biological outcomes were involved.