The Acceptability of Avatar Patients for Teaching and Assessing Pediatric Residents in Communicating Medical Ambiguity

J Grad Med Educ. 2022 Dec;14(6):696-703. doi: 10.4300/JGME-D-22-00088.1.


Background: Simulation offers a means to assess resident competence in communication, but pediatric standardized patient simulation has limitations. A novel educational technology, avatar patients (APs), holds promise, but its acceptability to residents, educational relevance, and perception of realism have not been determined.

Objective: To determine if APs are acceptable, provide a relevant educational experience, and are realistic for teaching and assessment of a complex communication topic.

Methods: Pediatric residents at one academic institution participated in an AP experience from 2019 to 2021 consisting of 2 scenarios representing issues of medical ambiguity. After the experience, residents completed a survey on the emotional relevance, realism, and acceptability of the technology for assessment of their communication competence.

Results: AP actor training required approximately 3 hours. Software and training was provided free of charge. Actors were paid $30/hour; the total estimated curricular cost is $50,000. Sixty-five of 89 (73%) pediatric residents participated in the AP experience; 61 (93.8%) completed the survey. Forty-eight (78.7%) were emotionally invested in the scenarios. The most cited emotions evoked were anxiety, uncertainty, concern, and empathy. The conversations were rated by 49 (80.3%) as realistic. APs were rated as beneficial for learning to communicate about medical ambiguity by 40 (65.5%), and 41 (66.7%) felt comfortable having APs used to assess their competence in this area.

Conclusions: Pediatric residents were emotionally invested in the AP experience and found it to be realistic. The experience was rated as beneficial for learning and acceptable to be used for assessment of how to communicate medical ambiguity.

MeSH terms

  • Child
  • Clinical Competence
  • Communication
  • Education, Medical, Graduate
  • Humans
  • Internship and Residency*
  • Learning
  • Patient Simulation
  • Teaching

Grants and funding

Funding: This study was funded by a Massachusetts General Hospital Department of Medicine Center for Education and Innovation Scholarship Grant. Mursion Inc and Massachusetts General Hospital entered into a research donation agreement; Mursion supplied the avatar patient technology and platform free of charge in exchange for the rights to use the simulation scenarios created for this study with their other clients. No money was exchanged between Mursion and the study team or institution. Mursion supplied the avatar patient actors who were paid by the study team using the grant funding received from Massachusetts General Hospital. The PI for this grant was Ariel Frey-Vogel, MD, MAT. The funder and Mursion had no role in study design, data analysis, collection, or interpretation, in the writing of the manuscript, or in the decision to submit the manuscript for publication.