Using the voice of artificial intelligence for physiotherapy student clinical simulation: a mixed methods study

Background Generative artificial intelligence (GenAI) has the potential to enhance the quality of simulation-based learning activities. The aim of this study is to evaluate whether GenAI could provide appropriate feedback on student performance, and to explore students’ perceptions of two simulation tasks.Methods First-year physiotherapy students completed two GenAI-delivered clinical simulation tasks, using ChatGPT (GPT-4o or GPT-5) Advanced Voice Mode, designed to develop communication skills: a clinical handover (Task A) and a patient interview (Task B). GenAI feedback transcripts were assessed against the Clinical Handover Assessment Tool (CHAT; Task A) and a purpose-built rubric (Task B) to determine whether GenAI identified performance deficits. Thirteen students were subsequently interviewed about their perceptions of the tasks.Results Seventy-four students participated across both activities. Task A produced 95 handovers (mean CHAT score 15.3 ± 1.2 SD), with 121 occasions of unsatisfied CHAT domains; ChatGPT identified and gave feedback on 55 (45%) of these. In Task B, 53 interviews were rated using the rubric, with 36 (68%) rated completely appropriate and 17 (32%) mostly appropriate. Inductive analysis of interviews revealed four themes: realism of AI interactions, teaching and learning insights, diverse positive and negative views on AI feedback, and technology perceptions.Conclusion With appropriate task design and attention to the physical environment, voice-based GenAI can be pedagogically tuned to support communication-based simulation activities. The tasks were well received, and GenAI feedback was mostly appropriate but often failed to identify performance deficits.Practice pointsVoice-based generative AI can deliver realistic, engaging clinical simulation tasks for physiotherapy students.Human oversight remains necessary as deficit detection by GenAI was often inaccurate.Students found GenAI a non-judgmental, always-available practice partner, particularly valuable for repetitive and independent practice.Careful task design and a quiet physical environment are important for successful voice-based GenAI simulation delivery.