SIMAX: A Scalable and Interpretable Framework for Multi-Fidelity and Annotated Clinician-Patient Dialogue Simulation
Abstract
Background. The widespread deployment of ambient digital scribes is driving large-scale capture of clinician-patient dialogues. Human coding of clinical communication data remains costly, inconsistent, and difficult to scale, motivating AI-driven communication coding systems. However, evaluating these systems requires real-world dialogues and human-coded labels, both hard to obtain at scale. Methods. We developed SIMAX (Scalable and Interpretable Framework for Multi-Fidelity and Annotated Clinician-Patient Dialogue Simulation), a framework for generating controlled clinical dialogue data with reference behavioral annotations. SIMAX generates clinician-patient dialogues from predefined clinical scenarios, personas and voice conditions, and target communication behaviors. Behaviors are controlled using two codebooks: the Global Codebook for overall communication quality and the WISER Codebook for specific countable behaviors. We evaluated SIMAX using automated and human quality assessments and an example communication coding system. Results. SIMAX generated 3,388 simulated dialogues across three specialties, multiple visit stages, persona characteristics, and accent conditions. Automated assessment showed mean UTMOS and WV-MOS scores of 3.03 and 2.61, WER and CER of 0.07 and 0.05, and CLAP cosine similarity of 0.41, suggesting reasonable speech naturalness, high transcription fidelity, and positive text-audio correspondence. Human evaluation showed a median MOS of 4.67 and a median clinical realism score of 3.00. Downstream evaluation suggests that SIMAX can assess how a communication coding system responds to behavioral targets and reveal insufficient sensitivity in some dimensions. Conclusions. SIMAX generates controlled and reproducible simulated clinician-patient dialogues, providing a data foundation for developing, validating, and refining communication coding systems.
Authors 19
-
Affiliation as printed
Department of Biostatistics and Bioinformatics , Duke University School of Medicine , Durham , NC , USA
-
Affiliation as printed
Centre for Biomedical Data Science , Duke-NUS Medical School , Singapore , Singapore
Duke-NUS AI + Medical Sciences Initiative , Duke-NUS Medical School , Singapore , Singapore
-
Affiliation as printed
Department of Statistical Science , Duke University , Durham , NC , USA
-
Affiliation as printed
Department of Biostatistics and Bioinformatics , Duke University School of Medicine , Durham , NC , USA
-
Affiliation as printed
Department of Biostatistics and Bioinformatics , Duke University School of Medicine , Durham , NC , USA
-
Ruio Heerschap Aachen
Leiden University · Duke University · Leiden University Medical Center
Affiliation as printed
Department of Biostatistics and Bioinformatics , Duke University School of Medicine , Durham , NC , USA
Leiden University Medical Centre , Leiden , The Netherlands
-
The University of Texas at Austin
Affiliation as printed
Department of Mathematics , University of Texas at Austin , Austin , USA
-
Affiliation as printed
Department of Internal Medicine , Yale School of Medicine , New Haven , CT , USA
-
Affiliation as printed
Department of Biostatistics and Bioinformatics , Duke University School of Medicine , Durham , NC , USA
-
University of the Sciences · University of the Arts · University of Pennsylvania
Affiliation as printed
Department of Biostatistics, Epidemiology and Informatics , Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA
The Graduate Group in Applied Mathematics and Computational Science , School of Arts and Sciences , University of Pennsylvania , Philadelphia , PA , USA
-
Affiliation as printed
Department of Biostatistics and Bioinformatics , Duke University School of Medicine , Durham , NC , USA
-
Affiliation as printed
Medstar Health National Center for Human Factors in Healthcare , Washington , DC , USA
-
Affiliation as printed
Department of Biomedical Informatics , Columbia University , New York , NY , USA
-
Duke University · Pulmonary and Allergy Associates
Affiliation as printed
Division of Pulmonary, Allergy and Critical Care Medicine , Duke University School of Medicine , Durham , NC , USA
-
Affiliation as printed
Division of Rheumatology and Immunology , Duke University School of Medicine , Durham , NC , USA
-
Duke University · Duke Medical Center
Affiliation as printed
Cancer Prevention and Control , Duke Cancer Institute , Durham , NC , USA
Department of Population Health Sciences , Duke University School of Medicine , Durham , NC , USA
-
Duke University · Duke Institute for Health Innovation · Duke University Health System
Affiliation as printed
Duke Center for Health Informatics , Duke University , Durham , NC , USA
-
Affiliation as printed
Department of Biostatistics and Bioinformatics , Duke University School of Medicine , Durham , NC , USA
Duke Clinical Research Institute , Durham , NC , USA
Cited by 0 stored of 0
No patents citing this paper on Lens.org (checked 2026-10-11).