What Counts as ‘Real’ in Healthcare Interaction? Examining Human/Technology Hybrid Simulation Interactions in Communication Skills Training

Simulated interaction is a common healthcare training tool and is increasingly technologically mediated. Although the need for clinical realism or authenticity of simulated interactions is commonly understood, less attention has been paid to their interactional realism. However, research beyond healthcare suggests that participants interact differently in simulated scenarios. This paper examines simulations conducted through the MetaHuman Live platform, where a human tutor is live-linked to an avatar using the tutor's voice and mapping their gaze and facial expressions. We use conversation analysis (CA) to analyse student nurses' interactions with this platform, identifying key areas where they differ from 'real' interactions. These are openings, closings, establishing shared knowledge, interactional progressivity and orientation to simulation platforms as an assessment tool. We suggest that features of a hybrid platform which aim to increase realism can also make interaction more complicated for learners trying to navigate between 'the person' and 'the system'. We conclude that, although our analysis suggests ways forward for the more effective integration of simulation technologies in training communication skills in healthcare, it also points to our continued need for a better sociological understanding of how interaction itself works in practice, to provide an evidential basis for design and evaluation of such simulations.