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Abstract

Psychology students face limitations in opportunities for supervised practice, constrained by access to clients, the costs of standardized patient programs, and ethical barriers. Novel teaching instruments in the form of multimodal avatars and human simulations have been proposed as innovative solutions, yet their effectiveness remains unclear. This review aimed to answer the question: to what extent do existing systems support skill acquisition in psychology training? A structured search of nine databases (2015–2025) identified seven eligible studies. Solutions from the studies were classified into five categories: basic virtual patient simulations, chatbot-based avatars, mixed reality avatars, virtual reality avatars, and virtual world avatars. Results show that digital simulation solutions are feasible, engaging, and accepted by students. There is evidence of improved training in diagnostic reasoning, questioning strategies, and self-efficacy. However, traditional actor-based simulations are still more effective for developing interpersonal skills. Technological issues, such as limited interactivity and the Uncanny Valley effects, hurt realism and reduce training gains. In conclusion, these technologies have promise as supplements to traditional training. Yet, the field remains underdeveloped and will require further design-focused improvements to reach its full potential.

Keywords

Human simulations multimedia learning artificial intelligence in clinical training artificial intelligence multimodal avatars

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References

Al-Ansi

A. M.

Jaboob

Garad

Al-Ansi

(2023). Analyzing augmented reality (AR) and virtual reality (VR) recent development in education. Social Sciences & Humanities Open, 8(1), 100532. https://doi.org/10.1016/j.ssaho.2023.100532

American Psychological Association. (2018). JARS–Qual | qualitative meta-analysis article reporting standards information recommended for inclusion in manuscripts reporting qualitative meta-analyses. American Psychological Association. https://apastyle.apa.org/jars/qualitative

Bassett

(2019). The computational therapeutic: Exploring Weizenbaum’s ELIZA as a history of the present. AI & Society, 34(4), 803–812. https://doi.org/10.1007/s00146-018-0825-9

Bearman

Palermo

Allen

L. M.

Williams

(2015). Learning empathy through simulation: A systematic literature review. Simulation in Healthcare, 10(5), 308–319. https://doi.org/10.1097/SIH.0000000000000113

Bell

D. J.

Self

M. M.

Davis III

Conway

Washburn

J. J.

Crepeau-Hobson

(2020). Health service psychology education and training in the time of COVID-19: Challenges and opportunities. American Psychologist, 75(7), 919. https://doi.org/10.1037/amp0000673

Bennett

Williams

Thames

Scheutz

(2017). Differences in interaction patterns and perception for teleoperated and autonomous humanoid robots. 2017 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS) (pp. 6589–6594). https://ieeexplore.ieee.org/abstract/document/8206571/

Bjork

E. L.

Bjork

R. A.

(2011). Making things hard on yourself, but in a good way: Creating desirable difficulties to enhance learning. Psychology and the Real World: Essays Illustrating Fundamental Contributions to Society, 2(59–68), 56–64. https://psycnet.apa.org/record/2011-19926-008

Brown

Mann

Ryder

Subbiah

Kaplan

J. D.

Dhariwal

Neelakantan

Shyam

Sastry

Askell

(2020). Language models are few-shot learners. Advances in Neural Information Processing Systems, 33, 1877–1901. https://doi.org/10.48550/arXiv.2005.14165

Brubacher

S. P.

Powell

M. B.

Johnson

M. S.

Cano

M. L.

Hassan

S. Z.

Riegler

M. A.

Halvorsen

Baugerud

G. A.

(2025). Experts’ views on artifical intelligence-based child chatbots to train investigative interviewing skills. Applied Cognitive Psychology, 39(2), e70048. https://doi.org/10.1002/acp.70048

10.

Cerf

(1973). Parry encounters the doctor. https://www.rfc-editor.org/rfc/rfc439.html

11.

Chen

Kong

Wei

(2021). Design and development of psychological virtual simulation experiment teaching system. Computer Applications in Engineering Education, 29(2), 481–490. https://doi.org/10.1002/cae.22293

12.

Ciekanowska

Kiszczak-Gliński

Dziedzic

(2021). Comparative analysis of Unity and Unreal Engine efficiency in creating virtual exhibitions of 3D scanned models. Journal of Computer Sciences Institute, 20, 247–253. https://doi.org/10.35784/jcsi.2698

13.

Colby

K. M.

Hilf

F. D.

Weber

Kraemer

H. C.

(1972). Turing-like indistinguishability tests for the validation of a computer simulation of paranoid processes. Artificial Intelligence, 3, 199–221. https://doi.org/10.1016/0004-3702(72)90049-5

14.

Davitadze

Ooi

C. Y.

Zhou

Thomas

Hanania

Blaggan

Evans

Chen

Melson

Arlt

Kempegowda

(2022). SIMBA: Using Kolb’s learning theory in simulation-based learning to improve participants’ confidence. BMC Medical Education, 22(1), 116. https://doi.org/10.1186/s12909-022-03176-2

15.

Ellawa

R. H.

(2014). Virtual patients as activities: Exploring the research implications of an activity theoretical stance. Perspectives on Medical Education, 3(4), 266–277. https://doi.org/10.1007/S40037-014-0134-Z

16.

Fang

Cai

Wang

(2021). Metahuman creator the starting point of the metaverse. 2021 International Symposium on Computer Technology and Information Science (ISCTIS) (pp. 154–157). https://ieeexplore.ieee.org/abstract/document/9603558/

17.

Fares

O. H.

Aversa

Lee

S. H.

Jacobson

(2024). Virtual reality: A review and a new framework for integrated adoption. International Journal of Consumer Studies, 48(2), e13040. https://doi.org/10.1111/ijcs.13040

18.

Fink

M. C.

Robinson

S. A.

Ertl

(2024). AI-based avatars are changing the way we learn and teach: Benefits and challenges. Frontiers in Education, 9, 1416307. https://www.frontiersin.org/journals/education/articles/10.3389/feduc.2024.1416307/full https://doi.org/10.3389/feduc.2024.1416307

19.

Goghari

V. M.

Hagstrom

Madon

Messer-Engel

(2020). Experiences and learnings from professional psychology training partners during the COVID-19 pandemic: Impacts, challenges, and opportunities. Canadian Psychology/Psychologie Canadienne, 61(3), 167. https://doi.org/10.1037/cap0000250

20.

Graesser

A. C.

Chipman

Haynes

B. C.

Olney

(2005). Autotutor: An intelligent tutoring system with mixed-initiative dialogue. IEEE Transactions on Education, 48(4), 612–618. https://doi.org/10.1109/TE.2005.856149

21.

Gratch

Marsella

(2004). A domain-independent framework for modeling emotion. Cognitive Systems Research, 5(4), 269–306. https://doi.org/10.1016/j.cogsys.2004.02.002

22.

Harless

W. G.

Drennon

G. G.

Marxer

J. J.

Root

J. A.

Miller

G. E.

(1971). CASE: A computer-aided simulation of the clinical encounter. Academic Medicine, 46(5), 443–448. https://doi.org/10.1097/00001888-197105000-00009

23.

Hattie

Timperley

(2007). The power of feedback. Review of Educational Research, 77(1), 81–112. https://doi.org/10.3102/003465430298487

24.

Herrington

Reeves

T. C.

Oliver

(2014). Authentic learning environments. In Spector

J. M.

Merrill

M. D.

Elen

Bishop

M. J.

(Eds.), Handbook of research on educational communications and technology (pp. 401–412). Springer New York. https://doi.org/10.1007/978-1-4614-3185-5_32

25.

Hossain

S. I.

Kelson

Morrison

(2024). The use of virtual patient simulations in psychology: A scoping review. Australasian Journal of Educational Technology, 40(6), 76–91. https://doi.org/10.14742/ajet.9559

26.

Howell

Mikeska

J. N.

(2021). Approximations of practice as a framework for understanding authenticity in simulations of teaching. Journal of Research on Technology in Education, 53(1), 8–20. https://doi.org/10.1080/15391523.2020.1809033

27.

Islam

M. Z.

Wang

(2025). Avatars in the educational metaverse. Visual Computing for Industry, Biomedicine, and Art, 8(1), 15. https://doi.org/10.1186/s42492-025-00196-9

28.

Krizhevsky

Sutskever

Hinton

G. E.

(2012). Imagenet classification with deep convolutional neural networks. Advances in Neural Information Processing Systems, 25, 1–9. https://doi.org/10.1145/3065386

29.

Krüger

Gilbert

Kuhlen

T. W.

Gerrits

(2024). Game engines for immersive visualization: Using unreal engine beyond entertainment. PRESENCE: Virtual and Augmented Reality, 33, 31–55. https://doi.org/10.1162/pres_a_00416

30.

Lavoie

Deschênes

M.-F.

Nolin

Bélisle

Garneau

A. B.

Boyer

Lapierre

Fernandez

(2020). Beyond technology: A scoping review of features that promote fidelity and authenticity in simulation-based health professional education. Clinical Simulation in Nursing, 42, 22–41. https://doi.org/10.1016/j.ecns.2020.02.001

31.

Lester

J. C.

Converse

S. A.

Kahler

S. E.

Barlow

S. T.

Stone

B. A.

Bhogal

R. S.

(1997). The persona effect: Affective impact of animated pedagogical agents. Proceedings of the ACM SIGCHI Conference on Human Factors in Computing Systems (pp. 359–366). https://doi.org/10.1145/258549.258797

32.

Levin

Frei-Landau

Flavian

Miller

E. C.

(2023). Creating authenticity in simulation-based learning scenarios in teacher education. European Journal of Teacher Education, 48(2), 291–312. https://doi.org/10.1080/02619768.2023.2175664

33.

Magill

Mastroleo

N. R.

Martino

(2022). Technology-Based methods for training counseling skills in behavioral health: A scoping review. Journal of Technology in Behavioral Science, 7(3), 325–336. https://doi.org/10.1007/s41347-022-00252-8

34.

Makransky

Petersen

G. B.

(2021). The cognitive affective model of immersive learning (CAMIL): A theoretical research-based model of learning in immersive virtual reality. Educational Psychology Review, 33(3), 937–958. https://doi.org/10.1007/s10648-020-09586-2

35.

Masahiro

MacDorman

K. F.

Kageki

(2012). The uncanny valley. IEEE Robotics & Automation Magazine, 19(2), 98–100. https://doi.org/10.1109/MRA.2012.2192811

36.

Mayer

R. E.

(2010). Learning with technology. In The nature of learning: Using research to inspire practice (pp. 179–198). OECD Publishing.

37.

Mayer

R. E.

(2020). Multimedia learning (3rd ed.). Cambridge University Press.

38.

McKim

(2022). Animation without animators: From motion capture to MetaHumans. Animation Studies 2.0. https://eprints.bbk.ac.uk/id/eprint/50248/

39.

Morrison

B. W.

Kelson

Morrison

N. M. V.

Bennett

(2025). You’re virtually a psychologist: Enhancing professional psychology education through virtual client simulations. Australian Psychologist, 1–8. https://doi.org/10.1080/00050067.2025.2547800

40.

Nagendran

Compton

Follette

W. C.

Golenchenko

Compton

Grizou

(2022). Avatar led interventions in the metaverse reveal that interpersonal effectiveness can be measured, predicted, and improved. Scientific Reports, 12(1), 21892. https://doi.org/10.1038/s41598-022-26326-4

41.

Narciss

(2013). Designing and evaluating tutoring feedback strategies for digital learning. Digital Education Review, 23, 7–26. https://revistes.ub.edu/index.php/der/article/view/11284

42.

Omer

A. T.

Ali

E. M.

Elhassan

M. E.

Ibrahim

S. A.

Ahmed

Y. S.

(2024). Medical education challenges during the war crisis in Sudan: A cross-sectional study, 2023–2024. BMC Medical Education, 24(1), 1354. https://doi.org/10.1186/s12909-024-06358-2

43.

Pomerantz

A. M.

(2016). Clinical psychology: Science, practice, and culture. Sage Publications. https://books.google.com/books?hl=en&lr=&id=fCBuDQAAQBAJ&oi=fnd&pg=PP1&dq=Pomerantz,+A.+M.+(2003).+Clinical+psychology:+Science,+practice,+and+culture.+Thousand+Oaks,+CA:+SAGE.&ots=IJ6kwAFkJ_&sig=bmF5swql-6EP3sF7syrrsNCLq-I

44.

Rickel

Johnson

W. L.

(1999). Animated agents for procedural training in virtual reality: Perception, cognition, and motor control. Applied Artificial Intelligence, 13(4–5), 343–382. https://doi.org/10.1080/088395199117315

45.

Røed

R. K.

Powell

M. B.

Riegler

M. A.

Baugerud

G. A.

(2023). A field assessment of child abuse investigators’ engagement with a child-avatar to develop interviewing skills. Child Abuse & Neglect, 143, 106324. https://doi.org/10.1016/j.chiabu.2023.106324

46.

Rogers

S. L.

Hollett

Y. R.

Speelman

C. P.

(2022). An evaluation of virtual reality role-play experiences for helping-profession courses. Teaching of Psychology, 49(1), 78–84. https://doi.org/10.1177/0098628320983231

47.

Russell-Stamp

Norman

J. R.

Parker

(2025). Avatars vs. Actors: Comparison shows little difference in role-play simulations for psychology students. International Journal for the Scholarship of Teaching and Learning, 19(1), 7. https://doi.org/10.20429/ijsotl.2025.190107

48.

Schraw

Lehman

(2001). Situational interest: A review of the literature and directions for future research. Educational Psychology Review, 13(1), 23–52. https://doi.org/10.1023/A:1009004801455

49.

Shieber

S. M.

(1994). Lessons from a Restricted Turing Test (No. arXiv:cmp-lg/9404002). arXiv. https://doi.org/10.48550/arXiv.cmp-lg/9404002

50.

Swartout

Artstein

Forbell

Foutz

Lane

H. C.

Lange

Morie

J. F.

Rizzo

A. S.

Traum

(2013). Virtual humans for learning. AI Magazine, 34(4), 13–30. https://doi.org/10.1609/aimag.v34i4.2487

51.

Triola

Feldman

Kalet

A. L.

Zabar

Kachur

E. K.

Gillespie

Anderson

Griesser

Lipkin

(2006). A randomized trial of teaching clinical skills using virtual and live standardized patients. Journal of General Internal Medicine, 21(5), 424–429. https://doi.org/10.1111/j.1525-1497.2006.00421.x

52.

Uwamahoro

(2015). The effect of virtual simulation on the development of basic counseling skills , self-reported immersion experience, self-reported counselor self-efficacy, and self-reported anxiety of counselors-in-training. https://stars.library.ucf.edu/etd/1255/

53.

Vaswani

Shazeer

Parmar

Uszkoreit

Jones

Gomez

A. N.

Kaiser

Ł.

Polosukhin

(2017). Attention is all you need. Advances in Neural Information Processing Systems, 30, 1–11. https://doi.org/10.48550/arXiv.1706.03762

54.

Walkiewicz

Zalewski

Guziak

(2022). Affect and cognitive closure in students—A step to personalised education of clinical assessment in psychology with the use of simulated and virtual patients. Healthcare, 10(6), 1076. https://www.mdpi.com/2227-9032/10/6/1076 https://doi.org/10.3390/healthcare10061076

55.

Washburn

Parrish

D. E.

Bordnick

P. S.

(2020). Virtual patient simulations for brief assessment of mental health disorders in integrated care settings. Social Work in Mental Health, 18(2), 121–148. https://doi.org/10.1080/15332985.2017.1336743

56.

Weiss

Wurhofer

Lankes

Tscheligi

(2009). Autonomous vs. Tele-operated: How people perceive human-robot collaboration with hrp-2. Proceedings of the 4th ACM/IEEE International Conference on Human Robot Interaction (pp. 257–258). https://doi.org/10.1145/1514095.1514164

57.

Weizenbaum

(1966). ELIZA—A computer program for the study of natural language communication between man and machine. Communications of the ACM, 9(1), 36–45. https://doi.org/10.1145/365153.365168

58.

Zgheib

N. K.

Sabra

(2025). How a sudden war affected our medical school: Reflections and lessons learned on adaptability and equity while preserving academic standards. BMC Medical Education, 25(1), 808. https://doi.org/10.1186/s12909-025-07415-0

59.

Zook

S. S.

Hulton

L. J.

Dudding

C. C.

Stewart

A. L.

Graham

A. C.

(2018). Scaffolding interprofessional education: Unfolding case studies, virtual world simulations, and patient-centered care. Nurse Educator, 43(2), 87–91. https://doi.org/10.1097/NNE.0000000000000430

Multimodal Avatars and Human Simulations in Teaching Practical Skills and Training of Clinical Psychology,Psychotherapy,and Related Mental Health Specialists

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