AI-Enhanced Social Robotic Versus Computer-Based Virtual Patients for Clinical Reasoning Training in Medical Education: Observational Crossover Cohort Study (Preprint)

<sec> <title>BACKGROUND</title> Virtual patient (VP) simulations can be used to practice clinical reasoning (CR) in controlled learning environments. Traditional computer-based VP platforms often lack the authenticity and interactivity required for effective CR training. Artificial intelligence (AI)–enhanced social robotic VPs can enhance realism and engagement; however, quantitative evidence comparing them with conventional VP platforms remains limited. </sec> <sec> <title>OBJECTIVE</title> We compared medical students’ experience of an AI-enhanced social robotic versus a conventional computer-based VP platform regarding the extent to which the design characteristics of the respective platform facilitate CR skill training. </sec> <sec> <title>METHODS</title> This observational crossover cohort study involved 178 sixth-semester medical students at Karolinska Institutet, Stockholm, Sweden (response rate: 42.3%; 178 of 421 invited students; Spring 2024-Spring 2025), who experienced both a large language model–enhanced social robotic VP platform supporting dialogue (social artificial intelligence–enhanced robotic interface [SARI]) and a conventional computer-based VP platform (virtual interactive case [VIC]) during their clinical rotation within rheumatology. Platform order was determined by clinical rotation scheduling. VP design was evaluated using a validated questionnaire across 5 domains: authenticity, professional approach, coaching quality, learning effects, and overall judgment. Students’ CR training preferences were assessed using categorical responses and a Visual Analogue Scale, where a lower score favored SARI and a score of 5 indicated equal preference between platforms. </sec> <sec> <title>RESULTS</title> SARI outperformed VIC across all 5 VP design domains. Students rated SARI higher for authenticity (median 4.0, IQR 3.5-4.5 vs 3.0, IQR 2.5-3.5; &lt;i&gt;P&lt;/i&gt;&lt;.001), professional approach (median 4.5, IQR 4.0-4.8 vs 4.0, IQR 3.5-4.5; &lt;i&gt;P&lt;/i&gt;&lt;.001), coaching quality (median 4.3, IQR 4.0-4.7 vs 4.0, IQR 3.7-4.7; &lt;i&gt;P&lt;/i&gt;&lt;.001), learning effect (median 4.4, IQR 4.0-5.0 vs 4.0, IQR 3.5-4.5; &lt;i&gt;P&lt;/i&gt;&lt;.001), and overall judgment (median 5.0, 4.0-5.0 vs 4.0, IQR 4.0-5.0; &lt;i&gt;P&lt;/i&gt;&lt;.001). Students strongly preferred SARI for CR training (72% vs 14%; odds ratio [OR] 27.1, 95% CI 14.3-53.7; &lt;i&gt;P&lt;/i&gt;&lt;.001), with Visual Analogue Scale scores confirming this preference (median 3.0, IQR 2.0-5.0; &lt;i&gt;P&lt;/i&gt;&lt;.001). Preferences were consistent across most subgroups (sex, prior VP experience, and platform order); in 2 subgroups, the difference was not significant, that is, students with prior VP experience (62% vs 38%; OR 2.6; 95% CI 0.8-8.9; &lt;i&gt;P&lt;/i&gt;=.11) and students first introduced to VIC (55% vs 45%; OR 1.5; 95% CI 0.7-2.9; &lt;i&gt;P&lt;/i&gt;=.33). </sec> <sec> <title>CONCLUSIONS</title> Our findings provide the first quantitative evidence that AI-enhanced social robotic VPs offer superior design characteristics than conventional computer-based platforms for CR training in medical education. These results support the use of AI-driven social robots for VP simulations to better prepare medical students for real clinical encounters, and warrant future research on objective CR skill outcomes and long-term transfer to clinical practice. Unlike previous qualitative studies examining each platform separately, this study provides the first quantitative comparison of design characteristics between AI-enhanced social robotic and conventional computer-based VPs. </sec>