To develop clinical reasoning skills, medical students are often tasked with interacting with trained standardized patients (SPs). Human SPs enable real conversations that can resemble authentic clinical scenarios. However, human SPs require extensive training and are often limited in their accessibility and continual availability to medical students or residents. Virtual SPs offer the ability for medical students to practice clinical interviews in a lower-stakes setting across a broader set of clinical cases. This paper introduces a virtual SP (VSP) that leverages Amazon’s Nova Sonic, a speech-to-speech foundation model designed for human-like conversation. We investigated the ability of Nova Sonic to portray four distinct clinical cases in virtual doctor-patient encounters with 20 third-year medical students. The system’s realism, its perceived learning value, and user experience were all assessed via a survey administered to the students. Students were also asked to compare this experience to interactions with a human SP. Survey results and conversations were analyzed to derive insights for improving the Nova Sonic-based VSP system.

This study examines the classification of AI-generated clinical multiple-choice questions drafts as “helpful” or “non-helpful” starting points. Expert judgments were analyzed, and multiple classifiers were evaluated—including feature-based models, fine-tuned transformers, and few-shot prompting with GPT-4. Our findings highlight the challenges and considerations for evaluation methods of AI-generated items in clinical test development.

Standardized patients (SPs) are essential for clinical reasoning assessments in medical education. This paper introduces evaluation metrics that apply to both human and simulated SP systems. The metrics are computed using two LLM-as-a-judge approaches that align with human evaluators on SP performance, enabling scalable formative clinical reasoning assessments.

This study aims to model the discourse structure of spontaneous spoken responses within the context of an assessment of English speaking proficiency for non-native speakers. Rhetorical Structure Theory (RST) has been commonly used in the analysis of discourse organization of written texts; however, limited research has been conducted to date on RST annotation and parsing of spoken language, in particular, non-native spontaneous speech. Due to the fact that the measurement of discourse coherence is typically a key metric in human scoring rubrics for assessments of spoken language, we conducted research to obtain RST annotations on non-native spoken responses from a standardized assessment of academic English proficiency. Subsequently, automatic parsers were trained on these annotations to process non-native spontaneous speech. Finally, a set of features were extracted from automatically generated RST trees to evaluate the discourse structure of non-native spontaneous speech, which were then employed to further improve the validity of an automated speech scoring system.

This study aims to build an automatic system for the detection of plagiarized spoken responses in the context of an assessment of English speaking proficiency for non-native speakers. Classification models were trained to distinguish between plagiarized and non-plagiarized responses with two different types of features: text-to-text content similarity measures, which are commonly used in the task of plagiarism detection for written documents, and speaking proficiency measures, which were specifically designed for spontaneous speech and extracted using an automated speech scoring system. The experiments were first conducted on a large data set drawn from an operational English proficiency assessment across multiple years, and the best classifier on this heavily imbalanced data set resulted in an F1-score of 0.761 on the plagiarized class. This system was then validated on operational responses collected from a single administration of the assessment and achieved a recall of 0.897. The results indicate that the proposed system can potentially be used to improve the validity of both human and automated assessment of non-native spoken English.

The availability of the Rhetorical Structure Theory (RST) Discourse Treebank has spurred substantial research into discourse analysis of written texts; however, limited research has been conducted to date on RST annotation and parsing of spoken language, in particular, non-native spontaneous speech. Considering that the measurement of discourse coherence is typically a key metric in human scoring rubrics for assessments of spoken language, we initiated a research effort to obtain RST annotations of a large number of non-native spoken responses from a standardized assessment of academic English proficiency. The resulting inter-annotator kappa agreements on the three different levels of Span, Nuclearity, and Relation are 0.848, 0.766, and 0.653, respectively. Furthermore, a set of features was explored to evaluate the discourse structure of non-native spontaneous speech based on these annotations; the highest performing feature resulted in a correlation of 0.612 with scores of discourse coherence provided by expert human raters.

Native Language Identification (NLI) is the task of automatically identifying the native language (L1) of an individual based on their language production in a learned language. It is typically framed as a classification task where the set of L1s is known a priori. Two previous shared tasks on NLI have been organized where the aim was to identify the L1 of learners of English based on essays (2013) and spoken responses (2016) they provided during a standardized assessment of academic English proficiency. The 2017 shared task combines the inputs from the two prior tasks for the first time. There are three tracks: NLI on the essay only, NLI on the spoken response only (based on a transcription of the response and i-vector acoustic features), and NLI using both responses. We believe this makes for a more interesting shared task while building on the methods and results from the previous two shared tasks. In this paper, we report the results of the shared task. A total of 19 teams competed across the three different sub-tasks. The fusion track showed that combining the written and spoken responses provides a large boost in prediction accuracy. Multiple classifier systems (e.g. ensembles and meta-classifiers) were the most effective in all tasks, with most based on traditional classifiers (e.g. SVMs) with lexical/syntactic features.