A Stratified Multi-Rater Evaluation of LLM-Based Virtual Standardized Patients with a Deployed Data-Generation Platform

Abstract

The Objective Structured Clinical Examination (OSCE) is widely used to assess clinical communication skills in medical education, requiring trainees to take histories and reason clinically with standardized patients (SPs). Large language model (LLM)-based virtual standardized patients (VSPs), typically built by persona-injected prompting, offer a practical alternative. However, existing evaluations rely on a single backbone LLM, small human rater panels, or LLM-as-a-judge scoring without an utterance-aligned human-expert reference, and so cannot identify the specific shortcomings of individual models. We evaluated four LLMs (GPT-4o, Claude 3.5 Sonnet, Llama-3.1 70B, and HyperCLOVA X), spanning commercial, open-source and Korean-developed models, against a human-expert reference across three Korean OSCE cases (hematuria, fever in pregnancy, and chronic cough). In a double-blind, fully crossed design, 17 senior medical-student raters scored every model utterance on three sentence-level and six encounter-level Likert metrics, yielding 7,480 data points. We analyzed the scores using a stratified linear mixed-effects model based on an 11-category history-taking and 3-level linguistic-form taxonomy. At the encounter level, three of the four LLMs fell 0.08 to 0.47 Likert points below the human-expert reference on Comprehensibility, Consistency and Hallucination-freeness. The difference was not statistically significant for Hallucination-freeness in Claude 3.5 Sonnet and GPT-4o, Consistency in GPT-4o, and Engagement in HyperCLOVA X. Llama-3.1 70B fell significantly below the reference on all six metrics. We also introduce a web-based OSCE platform that supports virtual practice across diverse clinical cases and continuously collects student-VSP dialogues under research and privacy consent.