Kuangzhe Xu

Virtual patients have been increasingly utilized in medical education to develop empathy in a structured and scalable manner. Compared with traditional methods such as clinical practice and standardized patients, virtual patients can offer reproducible, resource-efficient learning experiences. This scoping review maps the research on virtual patient-based interventions designed to foster empathy in medical students. It seeks to identify existing research gaps, including conceptual definitions of empathy, scenario design, instructional strategies, assessment methods, and outcome measures. The Joanna Briggs Institute's scoping review methodology was followed, and the PRISMA-ScR guidelines for reporting were used. A comprehensive search was conducted in PubMed, CINAHL, ERIC, Web of Science, Scopus, and the Cochrane Library. Two independent reviewers screened all titles, abstracts, and full texts; a third reviewer resolved any discrepancies. Findings were presented narratively and in tabular form to highlight key insights and research gaps. Eighteen studies involving 1,920 medical students were included. The most common study design was single-arm pre-post pilot studies (n = 4, 21.1%), followed by randomized controlled trials (n = 2, 10.5%) and mixed-methods designs (n = 2, 10.5%). Five research gaps were identified: 1) lack of explicit definitions of empathy, 2) limited diversity in clinical scenarios, 3) absence of repeated virtual patient interventions, 4) limitations in assessment methods, and 5) insufficient evidence on the sustained outcomes of empathy. These findings offer important insights into the current state of medical education, where standardized curricula for empathy training remain underdeveloped. Future efforts should address these challenges by integrating virtual patients into instructional designs that effectively foster empathy in medical students. This review provides a foundation for developing and implementing educational programs that meet the needs of students seeking to enhance their empathic abilities and contribute to improved patient outcomes and prevent clinician burnout.

Human cognition is reflected in gaze behavior, which involves eye movements to fixate or shift focus between areas. In natural interactions, gaze behavior serves two functions: signal transmission and information gathering. While expert gaze as a tool for gathering information has been studied, its underlying cognitive processes remain insufficiently explored. This study investigated differences in gaze behavior and cognition between expert physicians and novice medical students during a simulated medical interview with a simulated patient, drawing implications for medical education. This study employed an exploratory sequential mixed methods design. During the simulated medical interview, participants’ gaze behavior was measured across five areas: the patient’s eyes, face, body trunk, medical chart, and medical questionnaire. A hierarchical Bayesian model analyzed differences in gaze behavior between expert physicians and novice medical students. Then, a semi-structured interview was conducted with participants to discern their perceptions during their gaze behavior; their recorded gaze behavior was presented to them, and analyzed using a qualitative descriptive approach. Model analyses indicated that experts looked at the simulated patient’s eyes less frequently compared to novices during the simulated medical interview. Expert physicians stated that because of the potential for discomfort, looking at the patient’s eyes was less frequent, despite its importance for obtaining diagnostic findings. Conversely, novice medical students did not provide narratives for obtaining such findings, but increased the number of times they did so to improve patient satisfaction. This association between different perceptions of gaze behavior may lead to new approaches in medical education. This study highlights the importance of understanding gaze behavior in the context of medical education and suggests that different motivations underlie the gaze behavior of expert physicians and novice medical students. Incorporating training in effective gaze behavior may improve the quality of patient care and medical students’ learning outcomes.

Aim: We aimed to clarify the characteristics of the Kampo specialists' gaze during Kampo abdominal examinations on simulated patients and obtain suggestions for improving medical students' gaze during Kampo medicine abdominal examinations.Methods: We recorded and quantitatively evaluated the gazes of eight Kampo specialists and six medical students using a wearable eye tracker during abdominal examinations of simulated patients.Results: When specific sites were observed during abdominal examinations, the Kampo specialists' gaze toward the simulated patient's face was significantly higher than that of the medical students (mean = 1.019, 95% highest density interval: 0.159–2.050). A significant difference was also observed between the two populations regarding the specific sites observed. The medical students' gaze durations toward the simulated patient's eyes (mean = −2.696; 95% highest density interval: −4.961 to −0.744), face (mean = −1.881; 95% highest density interval: −3.353 to −0.691), upper limbs (mean = −1.707; 95% highest density interval: −2.932 to −0.500), and lower limbs (mean = −2.555; 95% highest density interval: −4.730 to −0.654) were significantly longer than those of Kampo specialists.Conclusions: The medical students' gazes were dispersed; those of Kampo specialists were focused and of short durations. These findings suggest that Kampo specialists quickly collect essential diagnostic information and look away from the patient's face to concentrate on considering the Kampo medicine diagnosis. Teaching Kampo specialists' gaze techniques in Kampo medicine education could lead to improvements in the gaze of medical students during abdominal examinations.

Previous studies have suggested behavioral patterns, such as visual attention and eye movements, relate to individual personality traits. However, these studies mainly focused on free visual tasks, and the impact of visual field restriction remains inadequately understood. The primary objective of this study is to elucidate the patterns of conscious eye movements induced by visual field restriction and to examine how these patterns relate to individual personality traits. Building on previous research, we aim to gain new insights through two behavioral experiments, unraveling the intricate relationship between visual behaviors and individual personality traits. As a result, both Experiment 1 and Experiment 2 revealed differences in eye movements during free observation and visual field restriction. Particularly, simulation results based on the analyzed data showed clear distinctions in eye movements between free observation and visual field restriction conditions. This suggests that eye movements during free observation involve a mixture of conscious and unconscious eye movements. Furthermore, we observed significant correlations between conscious eye movements and personality traits, with more pronounced effects in the visual field restriction condition used in Experiment 2 compared to Experiment 1. These analytical findings provide a novel perspective on human cognitive processes through visual perception.

Previous studies on facial impression inference have focused on the physical features of faces, with only a few considering the effects of the observer. This study explored how participants’ personality traits directly and indirectly affect the impression inference of human faces. Specifically, we examined how observers’ personality traits impact their eye movements, which in turn influence impression inferences. Experiment 1 found relationships between participants’ personality traits and eye movements, but these did not significantly impact impression inferences. In Experiment 2, we manipulated observers’ observational behavior to control for the potential interactive effect between facial features and participants’ eye movements during impression inference. This manipulation suggested that focusing on different areas of faces leads to different impression inferences. It also suggests that the same person might have different impressions of the exact same face by changing their observational behavior. These results deepen our understanding of the impact of facial features and participants’ personality traits on impression inferences, indicating that observers’ personality traits and observational behavior play a significant role in impression formation.

The present study investigated (1) how well humans can recognize facial expressions represented by a small set of landmarks, a commonly used technique in facial recognition in machine learning and (2) differences in conscious observational behaviors to recognized different types of expressions. Our video stimuli consisted of facial expression represented by 68 landmark points. Conscious observational behaviors were measured by movements of the mouse cursor where a small area around it was only visible to participants. We constructed Bayesian models to analyze how personality traits and observational behaviors influenced how participants recognized different facial expressions. We found that humans could recognize positive expressions with high accuracy, similar to machine learning, even when faces were represented by a small set of landmarks. Although humans fared better than machine learning, recognition of negative expressions was not as high as positives. Our results also showed that personality traits and conscious observational behaviors significantly influenced recognizing facial expressions. For example, people with high agreeableness could correctly recognize faces expressing happiness by observing several areas among faces without focusing on any specific part for very long. These results suggest a mechanism whereby personality traits lead to different conscious observational behaviors and recognitions of facial expressions are based on information obtained through those observational behaviors.