  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.
