Megan Zichen Ye

Background: Generative artificial intelligence (GenAI) is enhancing virtual patient simulations in health care education by enabling dynamic, adaptive interactions, reshaping how clinical skills are taught. A synthesis of the current evidence is needed to guide implementation and future research, given the pace of technological advancement. Objective: This systematic review aims to synthesize empirical research on the design, implementation, and educational impact of GenAI-supported virtual patients in health care education. Methods: A systematic search was conducted across 5 databases (CINAHL, Medline, Embase, Scopus, and Web of Science) from their inception to March 19, 2026. Reference lists of included studies and relevant systematic reviews were also screened. Peer-reviewed studies in English that evaluated GenAI-supported virtual patients using quantitative or mixed methods were included. Two reviewers independently screened studies and extracted data. Study quality and risk of bias were assessed critically using JBI (Joanna Briggs Institute) checklists, with disagreements resolved by consensus. Results: A total of 15 studies met the inclusion criteria (total participants N=645), spanning health care disciplines, including nursing, medicine, pharmacy, radiography, and medical first-responder training. The virtual patients varied in design; input modalities included text (9 studies), voice (5 studies), or hybrid (1 study); output was text (9 studies), speech (5 studies), or both (1 study); 6 studies used 3D-embodied avatars, while 9 used nonembodied interfaces. A total of 13 studies used OpenAI GPT models (eg, ChatGPT), 1 used a fine-tuned model from a different provider, and 1 evaluated multiple model families (Claude, GPT, and open-source). Further, 6 studies used controlled experimental designs, including 3 randomized controlled trials (RCTs); the remainder were cross-sectional or prepost evaluations. Primary outcomes included user perceptions (14 studies), communication skills (4 studies), clinical reasoning (3 studies), and performance (7 studies). In controlled comparisons, GenAI-supported virtual patients consistently improved outcomes relative to control conditions: for example, enhanced clinical decision-making (RCT, n=21), ophthalmology history-taking skills (RCT, n=26), and medical history-taking performance (crossover RCT, n=20). The evidence base is characterized by brief intervention durations, a predominant reliance on single-session interactions, and a general lack of underpinning educational theory. No meta-analysis was performed due to the limited number of studies and significant heterogeneity in designs, interventions, and outcome measures. Conclusions: The evidence supports the feasibility and acceptability of GenAI-supported virtual patients, with positive learner perceptions and promising outcomes for skills development. However, critical limitations remain in emotional-behavioral complexity, simulation adaptability, and research design rigor (eg, limited use of control groups and validated instruments). The review offers educators, instructional designers, and policymakers actionable insights for integrating dynamic, artificial intelligence–driven simulations while identifying crucial gaps—such as the need for theoretical grounding, longitudinal studies, and standardized design protocols—that must be addressed for safe and effective implementation.

Promoting regular physical exercise is crucial for healthy ageing, yet many older adults remain physically inactive. Artificial intelligence (AI), evolving

Background: Older adults may experience chronic pain as they age, which can affect their physical and psychological well-being. Virtual reality (VR) is emerging as a novel and nonpharmacological intervention that offers pain relief and mood enhancement through immersive experiences. However, the feasibility and effectiveness of using nonlocalized and commercial VR applications for chronic pain relief and mood enhancement among community-dwelling older adults remain underexplored. Objective: The main objectives of this study were to (1) evaluate the feasibility of using commercial-off-the-shelf VR applications for managing chronic pain among older adults, (2) assess the efficacy of VR in alleviating chronic pain, and (3) examine its impact on the well-being of older adults in a community setting. Methods: The study was a single-arm mixed methods pilot study. It was divided into two stages, including preparation and implementation. A total of 13 older adults (8 with chronic pain and 5 without) were recruited to participate in a 3-week VR intervention. Participants engaged in VR sessions that followed a step-by-step adaptation process. Each session included 360-degree relaxation videos and VR-based boxing exercises via Les Mills BODYCOMBAT, lasting 15 minutes. Pain intensity, pain self-efficacy, well-being, and mood were measured pre- and post-intervention using the Numeric Pain Rating Scale (NPRS), a pain self-efficacy question, the World Health Organization–Five Well-Being Index (WHO-5), and the Mood Assessment Scale (Mood). VR feasibility was evaluated based on completion rates, adverse outcomes, and qualitative feedback from semistructured interviews. Results: Of the 13 participants recruited, 11 completed the intervention (84.6% completion rate). The mean age was 79.2 (SD 9.2) years. The study found a statistically significant 16.32% improvement in the mean mood score, with a mean increase of 2.64 (SD 1.45) points and a large effect size (P<.001; Cohen d=1.82). The median pain self-efficacy score decreased from 3.0 (IQR 1.5-3.0) to 1.0 (IQR 1.0-2.0) (z=−2.236; P=.03). However, no significant changes were observed in pain intensity or overall well-being. The study demonstrated the high feasibility of commercial-off-the-shelf VR technology for older adults. Minor adverse effects were reported, including back pain and headset discomfort. In addition, 90.9% of participants enjoyed the VR experience, and all were willing to join future sessions. Conclusions: The pilot study demonstrated that commercial-off-the-shelf VR applications can effectively enhance mood and pain self-efficacy. Additional procedures, such as prebriefing, real-time interpretation, and a gradual adaptation process, were essential to overcoming barriers such as language, cultural nuances, and the digital literacy of older adults. Despite the lack of significant changes in pain intensity or overall well-being, the psychological benefits suggest that VR could be a valuable adjunct tool in chronic pain management. Future research should focus on larger sample sizes, longer intervention durations, randomized controlled trials, and the development of localized commercial VR applications to further explore their efficacy.

BACKGROUND Older adults may experience chronic pain as they age, which can affect their physical and psychological well-being. Virtual reality (VR) becomes a novel and non-pharmacological intervention that offers pain relief and mood enhancement through immersive experiences. However, the feasibility and effectiveness of using non-localized and commercial VR applications for chronic pain relief and mood enhancement among community older adults remain underexplored. OBJECTIVE The main objectives of this study were to: (1) evaluate the feasibility of using commercial-off-the-shelf VR applications for managing chronic pain among older adults; (2) assess the efficacy of VR in alleviating chronic pain; and (3) examine its impact on the well-being of older adults in a community setting. METHODS The study was a single-armed mixed-methods pilot study. It was divided into two stages, including preparation and implementation. A total of 13 older adults (8 with chronic pain and 5 without) were recruited to participate in a 3-week VR intervention. Participants engaged in VR sessions followed a step-by-step adaptation process. Each session included 360-degree relaxation videos and interactive boxing exercises via Les Mills BodyCombat, lasting 15 minutes. Pain intensity, pain self-efficacy, well-being, and mood were measured pre- and post-intervention using the Numeric Pain Rating Scale (NPRS), a pain self-efficacy questionnaire, the World Health Organization-Five Well-Being Index (WHO-5), and the Mood Assessment Scale. VR feasibility was evaluated based on completion rates, adverse outcomes, and qualitative feedback from semi-structured interviews. RESULTS Of the 13 participants recruited, 11 completed the intervention (84.6% completion rate). The mean age was 79.2 years (SD 9.2). The study found a significant 16.32% improvement in the mean mood score, with a large effect size (p < .001, Cohen's d = 1.82). The pain self-efficacy median score decreased significantly by 2.0 (Z = -2.236, p = .025). However, we observed no significant changes in pain intensity or overall well-being. The study demonstrated the high feasibility of commercial-off-the-shelf VR technology for older adults. Minor adverse effects were reported, including back pain and headset discomfort. Additionally, 90.9% of participants enjoyed the VR experience, and all were willing to join future sessions. CONCLUSIONS The pilot study demonstrated that commercial-off-the-shelf VR applications could effectively enhance mood and pain self-efficacy. Additional procedures, such as pre-briefing, real-time interpretation, and a gradual adaptation process, were essential to overcoming barriers like language, cultural nuances, and the digital literacy of older adults. Despite the lack of significant changes in pain intensity or overall well-being, the psychological benefits suggest that VR could be a valuable adjunct tool in chronic pain management. Future research should focus on larger sample sizes, longer intervention duration, randomized controlled trials, and the development of localized commercial VR to further explore its efficacy.