Keywords
Standardized patients
Standardized patients Psychology education
Clinical simulation
Student cConfidence Pacientes estandarizados
Inteligencia artificial
Educación en psicología
Simulación clínica
Confianza del estudiante
How to Cite
Abstract
Background: Incorporating artificial intelligence (AI) as standardized patients (SPs) in psychology education may enhance experiential learning and student confidence. The aim of the study was to analyze the effectiveness of using AI-based simulations to develop communication skills and influence psychology students’ affective state. Method: A mixed-methods intervention study was conducted with 31 third-year psychology students. Participants engaged in clinical simulations using ChatGPT as an SP. Quantitative data on affective state, communication attitudes, and perceptions of knowledge and skills were collected pre- and post-intervention via questionnaires. Qualitative data were obtained through open-ended questions and a focus group. Data were analyzed using repeated measures ANOVA and thematic analysis. Results: Significant reductions in negative affect and increases in perceived knowledge and skills were observed post-intervention. No significant changes were found in communication attitudes. Qualitative findings supported the quantitative results, indicating improved confidence and reduced anxiety during simulated patient interactions. Conclusions: Utilizing AI as SPs is an effective pedagogical tool that enhances experiential learning, increases student confidence in professional skills, and positively influences the affective state. This innovative approach offers a valuable supplement to traditional teaching methods in psychology education.
References
Abbott, E. F., Laack, T. A., Licatino, L. K., Wood-Wentz, C. M., Warner, P. A., Torsher, L. C., Newman, J. S., & Rieck, K. M. (2021). Comparison of dyad versus individual simulation-based training on stress, anxiety, cognitive load, and performance: a randomized controlled trial. BMC Medical Education, 21(1), Article 367. https://doi.org/10.1186/s12909-021-02786-6
Alrashidi, N., Pasay An, E., Alrashedi, M. S., Alqarni, A. S., Gonzales, F., Bassuni, E. M., Pangket, P., Estadilla, L., Benjamin, L. S., & Ahmed, K. E. (2023). Effects of simulation in improving the self-confidence of student nurses in clinical practice: a systematic review. BMC Medical Education, 23(1), Article 815. https://doi.org/10.1186/s12909-023-04793-1
Baile, J. I. (2024). Patient with depression created by freely accessible artificial intelligence for the teaching of Psychology. Preliminary study of its validity. Tecnología, Ciencia y Educación, 27, 7-42. https://doi. org/10.51302/tce.2024.19069
Basnet, S., Shrestha, S. P., Shrestha, R., Shrestha, A. P., Shrestha, A., Sahu, S., Mhatre, B., & Silwal, P. (2024). Effect of simulation-based emergency airway management education on the knowledge, skills and perceived confidence of medical interns. Annals of Medicine and Surgery, 86(9), 5191-5198. https://doi.org/10.1097/MS9.0000000000002376
Burrell, S. A., Ross, J. G., D’Annunzio, C., & Heverly, M. (2023). Standardized patient simulation in an oncology symptom management seminar-style course: prelicensure nursing student outcomes. Journal of Cancer Education: the official journal of the American Association for Cancer Education, 38(1), 185-192. https://doi.org/10.1007/s13187- 021-02096-x
Carrero-Planells, A., Pol-Castañeda, S., Alamillos-Guardiola, M. C., Prieto- Alomar, A., Tomás-Sánchez, M., & Moreno-Mulet, C. (2021). Students and teachers’ satisfaction and perspectives on high-fidelity simulation for learning fundamental nursing procedures: A mixed-method study. Nurse Education Today, 104, Article 104981. https://doi.org/10.1016/j. nedt.2021.104981
Clinard, E. S. (2022). Increasing student confidence with medically complex infants through simulation: a mixed methods investigation. American Journal of Speech-language Pathology, 31(2), 942-958. https://doi. org/10.1044/2021_AJSLP-21-00234
Cho, M. K., & Kim, M. Y. (2024). The effect of virtual reality simulation on nursing students’ communication skills: a systematic review and meta-analysis. Frontiers in Psychiatry, 15, Article 1351123. https://doi. org/10.3389/fpsyt.2024.1351123
Curry, L., & Nunez-Smith, M. (2015). Mixed methods in health sciences research. A practical primer. SAGE Publications, Inc.
Dawood, E., Alshutwi, S. S., Alshareif, S., & Shereda, H. A. (2024). Evaluation of the effectiveness of standardized patient simulation as a teaching method in psychiatric and mental health nursing. Nursing Reports, 14(2), 1424-1438. https://doi.org/10.3390/nursrep14020107
Duff, J. P., Morse, K. J., Seelandt, J., Gross, I. T., Lydston, M., Sargeant, J., Dieckmann, P., Allen, J. A., Rudolph, J. W., & Kolbe, M. (2024). Debriefing methods for simulation in healthcare: a systematic review. Simulation in Healthcare: Journal of the Society for Simulation in Healthcare, 19(1S), S112-S121. https://doi.org/10.1097/SIH.0000000000000765
Escribano, S., Juliá-Sanchis, R., García-Sanjuán, S., Congost-Maestre, N., & Cabañero-Martínez, M. J. (2021). Psychometric properties of the attitudes towards medical communication scale in nursing students. PeerJ, 9, Article e11034. https://doi.org/10.7717/peerj.11034
Elendu, C., Amaechi, D. C., Okatta, A. U., Amaechi, E. C., Elendu, T. C., Ezeh, C. P., & Elendu, I. D. (2024). The impact of simulation-based training in medical education: A review. Medicine, 103(27), Article e38813. https:// doi.org/10.1097/MD.0000000000038813
Elosua, P., Aguado, D., Fonseca-Pedrero, E., Abad, F. J., & Santamaría, P. (2023). New trends in digital technology-based psychological and educational assessment. Psicothema, 35(1), 50-57. https://doi.org/10.7334/ psicothema2022.241
Farina, C. L., Moreno, J., & Schneidereith, T. (2024). Using simulation to improve communication skills. The Nursing clinics of North America, 59(3), 437-448. https://doi.org/10.1016/j.cnur.2024.02.007
Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175-191. https:// doi.org/10.3758/BF03193146
Fetters, M. D., Curry, L. A., & Creswell, J. W. (2013). Achieving integration in mixed methods designs-principles and practices. Health Services Research, 48(6 Pt 2), 2134-2156. https://doi.org/10.1111/1475-6773.12117 Flanagan, O. L., & Cummings, K. M. (2023). Standardized patients in medical education: a review of the literature. Cureus, 15(7), Article e42027. https://doi.org/10.7759/cureus.42027
García-Carpintero Blas, E., Vélez-Vélez, E., Gómez-Moreno, C., Martínez- Arce, A., Tovar-Reinoso, A., Rodriguez-Gómez, P., Vaquero Velerdas, L., & López-Martín, I. (2024). Simulation with a standardised patient to reduce stigma towards people with schizophrenia spectrum disorder among nursing students: A quasi-experimental study. Archives of Psychiatric Nursing, 52, 24-30. https://doi.org/10.1016/j.apnu.2024.07.015
Gerzina, H. A., & Stovsky, E. (2023). Standardized patient assessment of learners in medical simulation. In StatPearls [Internet]. StatPearls Publishing.
Gutiérrez-Maldonado, J., Alsina-Jurnet, I., Rangel-Gómez, M. V., Aguilar- Alonso, A., Jarne-Esparcia, A. J., Andrés-Pueyo, A., & Talarn-Caparrós, A. (2008). Virtual intelligent agents to train abilities of diagnosis in Psychology and Psychiatry. In G. A. Tsihrintzis, M. Virvou, R. J. Howlett, & L. C. Jain (Eds.), New directions in intelligent interactive multimedia (pp. 497-505). Springer. https://doi.org/10.1007/978-3-540-68127-4_51
Gutierrez-Maldonado, J., Andres-Pueyo, A., Jarne, A., Talarn, A., Ferrer, M., & Achotegui, J. (2017). Virtual reality for training diagnostic skills in Anorexia Nervosa: A usability assessment. In S. Lackey, & J. Chen (Eds.), Virtual, augmented and mixed reality (pp. 239-247). Springer International Publishing. https://doi.org/10.1007/978-3-319-57987-0_19
Hawkins, A., & Tredgett, K. (2016). Use of high-fidelity simulation to improve communication skills regarding death and dying: a qualitative study. BMJ Supportive & Palliative Care, 6(4), 474-478. https://doi.org/10.1136/bmjspcare-2015-001081
Higgins, M., Madan, C., & Patel, R. (2021). Development and decay of procedural skills in surgery: A systematic review of the effectiveness of simulation-based medical education interventions. The Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 19(4), e67-e77. https://doi.org/10.1016/j.surge.2020.07.013
Hillier, M., Williams, T. L., & Chidume, T. (2023). Standardization of standardized patient training in medical simulation. In StatPearls [Internet]. StatPearls Publishing.
Isaza-Restrepo, A., Gómez, M. T., Cifuentes, G., & Argüello, A. (2018). The virtual patient as a learning tool: a mixed quantitative qualitative study. BMC Medical Education, 18(1), Article 297. https://doi.org/10.1186/s12909-018-1395-8
Jeon, Y., Choi, H., Lee, U., & Kim, H. (2024). Technology-based interactive communication simulation addressing challenging communication situations for nursing students. Journal of Professional Nursing: Official
Journal of the American Association of Colleges of Nursing, 53, 71-79. https://doi.org/10.1016/j.profnurs.2024.05.002
Johnson S. L. (2019). Impact, growth, capacity-building of mixed methods research in the Health Sciences. American Journal of Pharmaceutical Education, 83(2), Article 7403. https://doi.org/10.5688/ajpe7403
Johnson, K. V., Scott, A. L., & Franks, L. (2020). Impact of standardized patients on first semester nursing students self-confidence, satisfaction, and communication in a simulated clinical case. SAGE Open Nursing, 6, Article 2377960820930153. https://doi.org/10.1177/2377960820930153 Kolb, D. A. (2014). Experiential learning: Experience as the source of
learning and development. FT press.
Kolbe, M., Grande, B., & Spahn, D. R. (2015). Briefing and debriefing during simulation-based training and beyond: Content, structure, attitude and setting. Best Practice & Research. Clinical Anaesthesiology, 29(1), 87-96. https://doi.org/10.1016/j.bpa.2015.01.002
Lakens, D. (2022). Sample size justification. Collabra: Psychology, 8(1), Article 33267. https://doi.org/10.1525/collabra.33267
Lazarus, R. S. & Folkman, S. (1984). Stress, appraisal, and coping (Vol. 464). Springer.
Liu, X., Wu, C., Lai, R., Lin, H., Xu, Y., Lin, Y., & Zhang, W. (2023). ChatGPT: when the artificial intelligence meets standardized patients in clinical training. Journal of Translational Medicine, 21, Article 447. https://doi.org/10.1186/s12967-023-04314-0
López, A.I., & López-Chicheri, I. (July 2024). Entrenamiento en habilidades de comunicación orientadas a la intervención mediante simulación clínica en psicología (SCP) [Intervention-oriented communication skills training through clinical simulation in Psychology (SCP)]. I Congreso Interprofesional de Simulación-OneHealth. https://simulacion-onehealth. org/ponencia/entrenamiento-en-habilidades-de-comunicacion-orientadas- a-la-intervencion-mediante-simulacion-clinica-en-psicologia-scp/
López-Gómez, I., Hervás, G., & Vázquez, C. (2015). Adaptación de las“ Escalas de afecto positivo y negativo“(PANAS) en una muestra general española. [Adaptation of the Positive and Negative Affect Scales (PANAS) in a general Spanish sample]. Psicología Conductual, 23(3), 529-548.
Monahan, L., Eaves, C. L., Watson, J. C., Friese, J., McKenna, L., & Estrada- Ibarra, E. (2024). Improving adolescent psychosocial assessment through standardized patient simulation: an interdisciplinary quality improvement initiative. International Journal of Environmental Research and Public Health, 21(3), Article 283. https://doi.org/10.3390/ijerph21030283
Morcela, O. A. (2022). ChatGPT: la IA está aquí y nos desafía [ChatGPT: AI is here and challenging us]. AACINI-Revista Internacional de Ingeniería Industrial, 6. https://riii.fi.mdp.edu.ar/index.php/AACINI-RIII/article/ view/67
Moser, A., & Korstjens, I. (2018). Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. The European Journal of General Practice, 24(1), 9-18. https://doi.org/10.1080/1381 4788.2017.1375091
Moss, C. R. (2023). Neonatal fragile skin: novel use of simulation to improve knowledge and confidence for neonatal nurse practitioner students. Nurse Educator, 48(4), E122-E125. https://doi.org/10.1097/ NNE.0000000000001354
Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis: striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16(1). https://doi.org/10.1177/1609406917733847
Oliveira, G., Oliveira, F. S. E., Coelho, A. S. G., Cavalcante, A. M. R. Z., Vieira, F. V. M., Fonseca, L. M. M., Campbell, S. H., & Aredes, N. D. A. (2022). Effect of simulation on stress, anxiety, and self-confidence in nursing students: Systematic review with meta-analysis and meta-regression. International Journal of Nursing Studies, 133, Article 104282. https://doi.org/10.1016/j.ijnurstu.2022.104282
OpenAI. (2023). ChatGPT (March 14 version) [Large language model]. https://chat.openai.com
Pedrajas, M. L., Sanz, A., García-Carpintero, E., Martínez, E., Uceda, S. (2024). Training GPT as a standardized patient. In M. D. Díaz-Noguera, C. Hervás-Gómez, & F. Sánchez-Vera (Coords.), Artificial Intelligence and Education (pp.189-204). Octaedro. https://doi.org/10.36006/09643-1-12 Peñaloza-Salazar, C., Gutierrez-Maldonado, J., Ferrer-Garcia, M., Garcia- Palacios, A., Andres-Pueyo, A., & Aguilar-Alonso, A. (2011). Simulated interviews 3.0: virtual humans to train abilities of diagnosis –usability assessment. Studies in Health Technology and Informatics, 167, 165-169.
https://doi.org/10.3233/978-1-60750-766-6-165
Perugini, M., Gallucci, M., & Costantini, G. (2018). A practical primer to power analysis for simple experimental designs. Revue Internationale de Psychologie Sociale, 31(1), 1-23. https://dx.doi.org/10.5334/IRSP.181
Rizzo, A., Lange, B., Buckwalter, J. G., Forbell, E., Kim, J., Sagae, K., Williams, J., Difede, J., Rothbaum, B. O., Reger, G., Parsons, T., & Kenny,
P. (2011). SimCoach: An intelligent virtual human system for providing healthcare information and support. International Journal on Disability and Human Development, 10(4), 277-281. https://doi.org/10.1515/ IJDHD.2011.046
Rodríguez, S., Condés, E., & Arriaga, A. (2021). Irrupción de la simulación clínica online en tiempos de COVID-19. Una experiencia ilustrativa de asignatura en el Grado de Psicología. Revista de la Fundación de Educación Médica, 24(2), 101-104. https://dx.doi.org/10.33588/ fem.242.1118
Rouder, J. N., Morey, R. D., Speckman, P. L., & Province, J. M. (2012). Default Bayes factors for ANOVA designs. Journal of Mathematical Psychology, 56(5), 356-374. https://doi.org/10.1016/j.jmp.2012.08.001
Rouder, J. N., Speckman, P. L., Sun, D., Morey, R. D., & Iverson, G. (2009). Bayesian t tests for accepting and rejecting the null hypothesis. Psychonomic Bulletin & Review, 16, 225-237. https://doi.org/10.3758/ PBR.16.2.225
Ruiz-Rodríguez, J., Bados López, A., Fusté Escolano, A., García-Grau, E., Saldaña García, C., & Lluch Canut, T. (2016). Aprendizaje experiencial de habilidades terapéuticas y análisis de su utilidad en función de la personalidad. Behavioral Psychology, 24, 405-422. http://hdl.handle. net/2445/155366
Scherr, R., Halaseh, F. F., Spina, A., Andalib, S., & Rivera, R. (2023). ChatGPT interactive medical simulations for early clinical education: case study. JMIR Medical Education, 9, Article e49877. https://doi.org/10.2196/49877
Sezer, B., Sezer, T. A., Teker, G. T., & Elcin, M. (2023). Developing a virtual patient: design, usability, and learning effect in communication skills training. BMC Medical Education, 23(1), Article 891. https://doi.org/10.1186/s12909-023-04860-7
Sezgin, M. G., & Bektas, H. (2023). Effectiveness of interprofessional simulation-based education programs to improve teamwork and communication for students in the healthcare profession: A systematic review and meta-analysis of randomized controlled trials. Nurse Education Today, 120, Article 105619. https://doi.org/10.1016/j.nedt.2022.105619
Talbot, T., & Rizzo, A. “Skip”. (2019). Virtual human standardized patients for clinical training. In A. “Skip” Rizzo & S. Bouchard (Eds.), Virtual reality for psychological and neurocognitive interventions (pp. 387-405). Springer New York. https://doi.org/10.1007/978-1-4939-9482-3_17
Ton, D. N. M., Duong, T. T. K., Tran, H. T., Nguyen, T. T. T., Mai, H. B., Nguyen, P. T. A., Ho, B. D., & Ho, T. T. T. (2024). Effects of standardized patient simulation and mobile applications on nursing students’ clinical competence, self-efficacy, and cultural competence: A quasi-experimental study. International Journal of Environmental Research and Public Health, 21(4), Article 515. https://doi.org/10.3390/ijerph21040515
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care: Journal of the International Society for Quality in Health Care, 19(6), 349-357. https://doi.org/10.1093/intqhc/mzm042
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: the PANAS scales. Journal of personality and social psychology, 54(6), 1063-1070. https://doi.org/10.1037/0022-3514.54.6.1063
Weizenbaum, J. (1966). ELIZA—a computer program for the study of natural language communication between man and machine. Commun. ACM, 9(1), 36-45. https://doi.org/10.1145/365153.365168
Yu, J. H., Chang, H. J., Kim, S. S., Park, J. E., Chung, W. Y., Lee, S. K., Kim, M., Lee, J. H., & Jung, Y. J. (2021). Effects of high-fidelity simulation education on medical students’ anxiety and confidence. PloS one, 16(5), Article e0251078. https://doi.org/10.1371/journal.pone.0251078