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Lessons Learned from the Usability Evaluation of a Simulated Patient Dialogue System

  • Education & Training
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Abstract

Simulated consultations through virtual patients allow medical students to practice history-taking skills. Ideally, applications should provide interactions in natural language and be multi-case, multi-specialty. Nevertheless, few systems handle or are tested on a large variety of cases. We present a virtual patient dialogue system in which a medical trainer types new cases and these are processed without human intervention. To develop it, we designed a patient record model, a knowledge model for the history-taking task, and a termino-ontological model for term variation and out-of-vocabulary words. We evaluated whether this system provided quality dialogue across medical specialities (n = 18), and with unseen cases (n = 29) compared to the cases used for development (n = 6). Medical evaluators (students, residents, practitioners, and researchers) conducted simulated history-taking with the system and assessed its performance through Likert-scale questionnaires. We analysed interaction logs and evaluated system correctness. The mean user evaluation score for the 29 unseen cases was 4.06 out of 5 (very good). The evaluation of correctness determined that, on average, 74.3% (sd = 9.5) of replies were correct, 14.9% (sd = 6.3) incorrect, and in 10.7% the system behaved cautiously by deferring a reply. In the user evaluation, all aspects scored higher in the 29 unseen cases than in the 6 seen cases. Although such a multi-case system has its limits, the evaluation showed that creating it is feasible; that it performs adequately; and that it is judged usable. We discuss some lessons learned and pivotal design choices affecting its performance and the end-users, who are primarily medical students.

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Data availability

The dialogue data collected during development and evaluation is available at: https://pvdial.limsi.fr/data/PG-logs-eval.zip A demonstration of the dialogue system can be tested at: http://vps-9069f76a.vps.ovh.net

Code availability

Not applicable.

Notes

  1. We refer with this term to virtual standardised patients.

  2. http://vps-9069f76a.vps.ovh.net

  3. http://umvf.cerimes.fr/portail/ecn.php

  4. https://pvdial.limsi.fr

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Acknowledgements

We greatly thank all doctors who evaluated the system and gave valuable remarks, and also Dr. Aurélie Névéol for her helpful comments on the manuscript. We also thank the anonymous reviewers for their constructive suggestions. We developed the dialogue system in a collaborative project led by Interaction Healthcare and having as partners VIDAL, Angers University Hospital, Voxygen and LIMSI.Footnote 4

Funding

This work was funded by BPI (FUI Project PatientGenesys, F1310002-P) and by the Société d’Accélération de Transfert Technologique (SATT) Paris Saclay (PVDial project). The funding bodies did not take part in the design of the study, analysis and interpretation of data and writing the manuscript.

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Author notes

  1. Leonardo Campillos-Llanos

    Present address: ILLA - Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain

Authors and Affiliations

  1. Université Paris-Saclay, CNRS, LISN, Orsay, France

    Leonardo Campillos-Llanos, Éric Bilinski, Sophie Rosset & Pierre Zweigenbaum

  2. SATT Paris-Saclay, Orsay, France

    Catherine Thomas

  3. Assistance Publique-Hôpitaux de Paris, Paris, France

    Antoine Neuraz

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  1. Leonardo Campillos-Llanos
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Contributions

Sophie Rosset (SR), Leonardo Campillos-Llanos (LC) and Catherine Thomas (CT) developed the VP dialogue system, and Pierre Zweigenbaum (PZ) contributed to the medical terminology components and patient record model. Éric Bilinski (EB) implemented the web evaluation tool and the online demonstration of the dialogue system. Antoine Neuraz (AN) helped to engage the evaluation participants and made valuable remarks about the system and article. SR and PZ designed the evaluation protocol, and LC collected and analysed the evaluation data. LC and SR double-checked a subset of the data. LC, SR and PZ wrote the manuscript, and all authors read and approved the final article.

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Correspondence to Leonardo Campillos-Llanos.

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Appendix

Appendix

Fig. 6
figure 6

Procedures and weighting scheme to predict linguistic information for OOV items

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Table 6 Examples of correct, incorrect and deferred replies (I: ‘input’; R: ‘system reply’); we show the English translation of dialogue interactions using the French system
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Table 7 Results of prediction methods of part-of-speech (PoS) category and morphology data for out-of-vocabulary (OOV) words (in percentage); the number of instances per class is shown in brackets; results of morphology data were only computed on OOVs for which the PoS category was predicted correctly
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Table 8 Analysis of incorrect replies with examples (I: ‘user input’; R: ‘system reply’); we show the English translation of dialogue interactions using the French system
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Table 9 Sample clinical record (top) and sample of the output for OOV words in a new VP record (bottom); adj stands for ‘adjective’; fp, for ‘feminine plural’; the format is YAML
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Fig. 7
figure 7

Interface to input data to create a new virtual patient record

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Table 10 Description of the seen cases used in the usability study
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Table 11 Description of the unseen cases used in the usability study
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Table 12 Summary of lessons learned from the development and usability evaluation and implications on design and development
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Fig. 8
figure 8

Overall functioning of the dialogue system and update components; further technical details are provided in [27, 46, 47]

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Fig. 9
figure 9

Graphical abstract

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Campillos-Llanos, L., Thomas, C., Bilinski, É. et al. Lessons Learned from the Usability Evaluation of a Simulated Patient Dialogue System. J Med Syst 45, 69 (2021). https://doi.org/10.1007/s10916-021-01737-4

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