Randy Rhodes, a 54-year-old truck driver with a southern Illinois twang, appears impatient and cantankerous after his wife forced him to visit a doctor to get a rash on his arm checked out.
He tells the doctor that he wants to “get this over with quickly.” But after some prodding, he admits feeling tired more than usual, urinating frequently and consuming “mostly sodas and fast food.”
As the doctor talks with him more, Randy eventually will admit to encountering some problems with erectile dysfunction, though earlier in the interview, he says sexual issues are none of the doctor’s business.
The computer-generated image of Randy – a fictitious patient on a screen – looks realistic enough, but his ability to engage in fairly free-flowing conversations with those studying to become doctors at Southern Illinois University School of Medicine is what sets him apart from what medical students have encountered in the past.
The Springfield-based institution, founded in 1970 and known around the world for its innovation in medical education, is infusing artificial intelligence into its curriculum in ways SIU officials describe as groundbreaking.
Medical students and a variety of professionals at SIU’s Carbondale campus are using and refining what’s known as “autonomous AI” to create and interact with avatars, or virtual versions of practice patients.
The avatars have their own personalities, personal histories and emotional traumas and triumphs. They can respond independently to medical students’ questions and comments based on those back-stories, providing what is a more engaging and potentially more effective environment for students as they learn how to hone skills in diagnosing and treating illnesses and gaining patients’ trust.
“It’s a huge breakthrough,” said Richard Selinfreund, a doctorate-level pathologist at SIU’s Springfield medical school campus who has spearheaded the $250,000-a-year effort.
“It’s going to change how we teach medicine,” he said. “It already has. Four of the biggest medical schools in the country already have asked to collaborate with us. … Right now, SIU is leading. Everyone is catching up fast, though.”
Jake Schmid, 25, a third-year medical student from Marion, said the AI-infused curriculum, which will be expanded from a few courses to an entire class of SIU students in the 2025-2026 academic year, served as a consultant in developing the program and now speaks at medical conferences around the country about the effort.
The Marion native believes autonomous AI will help SIU turn out more competent doctors in the long run. And armed with good bedside manners that are refined early in their careers, those doctors will be able to gain patients’ trust quicker and thus be more likely to get patients to take charge of their own health, Schmid said.
“How do we make more compassionate and competent physicians?” he asked. “I think this is a first step toward that. … This is the foundation of it. This is level one. This is state-of-the-art. This is revolutionary.”
A new way to learn
With a U.S. patent pending on this particular use of AI, Selinfreund and his colleagues have built on the “problem-based learning” curriculum that the late Dr. Howard Barrows refined at SIU in the mid-1980s.
Barrows’ method veered from the traditional lectures and Socratic methods in classrooms that were common in medical schools for a century. In that method, medical students often paid a designated note-taker so they could listen intently to the lecturer.
In this new curriculum, medical students gathered in groups of eight or 10, supervised by a faculty member, to study sample cases of patients listed in spiral-bound notebooks and research illnesses and treatments, learning as they go.
The sample cases later were part of a computer program, without avatars but with detailed medical case histories of fictional patients, in which students queried patient symptoms and lifestyle factors to diagnose and treat illnesses. Each patient was part of an ePBLM, or electronic problem-based learning module.
Most medical schools across the country have adopted problem-based learning as part of their core curriculum. Despite being a relatively young and small medical school, SIU is considered “the Yale of medical education,” Selinfreund said.
But by the 2020s, the ePBLM software had become dated, and SIU students were eager for an update.
When Schmid was a first-year medical student in SIU’s Carbondale campus, where most SIU medical students spend the first of their four years, he began to work with Pinckney Benedict, 60, a creative-writing professor at the campus, on a computer game originally intended to replace the clunky ePBLM system.
Benedict had become a mentor to Schmid when Schmid, then working on his bachelor’s degree in physiology at SIU, took creative writing as an elective course before being admitted to medical school.
When the computer-game concept didn’t work out, Schmid, by then a first-year med student, served as a go-between for Selinfreund, 67, a scientist trained at Yale, Vanderbilt and New Mexico State universities who had recently arrived at SIU, and Benedict, a fiction writer with a master’s degree from the Iowa Writer’s Workshop at the University of Iowa.
With some help from others, they all pivoted to what would become autonomous, AI-powered avatars.
The project is based on what Selinfreund described as a “three-legged stool.” One leg is based on the “20 years of a gold mine” of sample patient cases and ways of measuring student responses to determine how well they are developing clinical competency.
The second leg is the background information baked into the avatars. That info, known as “human factors,” is typed into word processors as prose by the undergraduate and graduate students at SIU’s Center for Virtual Expression in Carbondale.
The third leg of the stool are software engineers – graduate students earning their doctorate degrees at SIU – who are loading in all the information into AI software that generates the extemporaneous verbal exchanges that avatars are capable of in ways that even computer scientists don’t fully understand.
Virtual patients, real problems
Randy Rhodes and about a half-dozen other avatar patients have been developed so far. The avatars are based on SIU’s decades-old patient cases but fleshed out with their own unique personalities, emotions and hangups.Â
The characters include Florabell Reynolds, a woman with a systemic infection known as sepsis; Terrance Nichols, a heart-attack patient with potentially minutes to live; and Charity Smith, a preadolescent girl with leukemia.
One version of Randy Rhodes is available online for anyone to interview at https://bit.ly/SIUMEDavatar.
Benedict’s creative writing students and other SIU Carbondale staff members and consultants come up with a personal history for each avatar, but the medical history doesn’t vary from what has been listed in SIU’s problem-based learning curriculum for decades.
Each personal history is about 50,000 words – the length of a short novel such as The Great Gatsby, and similar to a Wikipedia article – that details the avatar’s childhood, family relationships and work history.
Randy Rhodes, for example, has a “deep backstory, strong opinions and the ability to project a real dynamic personality, and he will respond much better to some lines of inquiry than others,” Benedict said.
“There’s no scripting involved,” Benedict said. “He responds according to the ‘bible’ we’ve created for him, which is tens of thousands of words in length.
“You’re basically conversing with a novella written by extremely talented creative writers in Carbondale, and it’s compelling stuff. There are obviously implications for this use of tech far beyond a simple patient interview, for medicine and also for the arts and for the humanities generally, and we’re exploring all of them.”
Though the avatars don’t show much facial expression, at least not yet in this early version, improvements are expected. The avatars’ responses are given on video and in text on a computer screen.
One of the key benefits of avatars is the “safe learning environment” that they create, Selinfreund said. Medical students can access the avatars online anytime and practice interviewing them after class and at home, on a laptop, tablet or smartphone.
Students often are surprised by the answers and reactions from the avatars. That anxiety actually is helpful as students prepare and become more comfortable before a faculty member is observing them and before they encounter real patients in their clinical training, Schmid said.
The students learn that the longer they talk with the avatars in each session, the more the avatars are willing to reveal about their backgrounds and symptoms.
Such is the case with Randy Rhodes, who initially will tell an interviewer that certain details of his private life are no one else’s business but is more open as the interview goes on.
“He starts out with a pretty high level of distrust,” Benedict said.
This virtual development of trust is an amazing part of AI technology, Schmid said.
Improving medical training
The problem-based learning curriculum that Dr. Howard Barrows developed makes use of paid actors who portray standardized patients, also known as simulated patients. They pretend to have certain conditions and personalities. Medical students examine and interact with standardized patients while SIU staff members watch, evaluate the students and later offer feedback.
The avatars don’t replace this part of the curriculum but enhance the whole training process, according to Shelley Tischkau, chairperson of SIU’s Department of Pharmacology, Medical Microbiology, Immunology and Cell Biology.
“It’s a great step forward in training medical students,” she said. “It’s very low-risk for the students.”
Medical students who have been exposed to the avatars love using them, Selinfreund said.
SIU soon will evaluate “code words” developed by the medical faculty and used by medical students as part of “sentiment analysis” to measure how well students are employing techniques to help patients trust doctors, he said.
Selinfreund, who teaches medical students as part of his duties on the faculty, said he began funding the avatar project with money out of his own pocket and from internal SIU funding obtained by Dr. Jerry Kruse, the medical school dean and provost.
Annual funding now comes from federal grants, private foundations and individual donors, Selinfreund said.
The funding pays for software licensing, stipends for SIU computer programmers, a “human factors” engineering consultant and faculty time on the project, and travel expenses to share SIU’s innovations with the world, he said.
Medical students and SIU undergraduates aren’t paid but obtain experience and can use that experience to land jobs. Medical students’ participation in SIU research on AI can result in them being cited as coauthors in medical journals.
Related
The avatars aren’t perfect. Improvements are expected in the months and years to come, and they will never replace real patients in the training process, Benedict said.
However, avatars will become even more lifelike, be able to display parts of their bodies for examination and may be able to react to the tone of voice, facial reactions and eye movements of the people interviewing them, he said.
Tischkau said avatars also could be used to portray patients with certain diseases and conditions so real patients with those conditions could ask for and receive advice and support.
A replacement will be hired for Benedict to supervise Carbondale’s Center for Virtual Expression because he has joined the medical school’s Springfield-based surgery department to start a similar center here and is moving to Springfield. He will continue to assist in development of the avatars for patient interviews.
“As far as we can tell, we are absolutely cutting-edge,” Benedict said. “This is a very forward-thinking place.”
For the surgery department, one of the first uses of AI could be to give medical students, medical residents and practicing surgeons “an immersive, augmented-reality view of an abdominal examination,” he said.
Avatars also are being developed for young doctors going through emergency-medicine training residencies in Springfield as they prepare to work in hospital emergency rooms.
The focus with those avatars will be to help trainees become skilled at quickly interviewing patients, assessing what is wrong and figuring out what to do next to save lives with little time to spare.
Selinfreund, who attended medical school as part of his education but didn’t become a practicing physician, said AI is ideal for today’s young people as they prepare for careers as health professionals.
“I learned from a book,” he said. “They grew up in a whole different environment. Young people learn in a visual world. We’re asking them to learn more and faster than when I went to medical school, and AI delivers that.”
Dean Olsen is a senior staff writer for Illinois Times. He can be reached at dolsen@illinoistimes.com, 217-679-7810 or x.com/DeanOlsenIT.
This article appears in Jan 30 – Feb 5, 2025.
