By Zahra Aziz and Debra Kiegaldie
Posted Tuesday 1 April, 2025

Cultural responsiveness (i.e., adapting healthcare to respect and meet patients’ cultural needs) is increasingly recognised as a critical element in delivering equitable and effective healthcare across various cultural contexts. However, incorporating it meaningfully into health professions education (HPE) has remained a significant challenge.

While traditional teaching methods, such as lectures and workshops, are commonly employed, their impact is often short-lived. For example, one-time lectures or workshops may introduce concepts of cultural responsiveness, but they frequently fail to leave a lasting impression or meaningfully alter students’ perceptions and behaviours in clinical settings.

One-time lectures or workshops may introduce concepts of cultural responsiveness, but they frequently fail to leave a lasting impression

Simulation-based education (SBE), combined with digital educational technologies (DET), offers a promising way forward, enabling immersive and authentic learning experiences that have the potential to foster self-reflection and empathy.

Recognising this potential, our team embarked on a collaborative initiative to integrate AI-driven simulations into the Collaborative Online International Learning (COIL) program. This initiative brought students and educators from four countries – Australia, Italy, Malawi, and Malaysia, to address the gaps in cultural responsiveness and foster interprofessional collaboration (i.e., healthcare professionals working together to improve patient outcomes) within health professions education.

Introducing Aalia: A transformative AI-driven learning experience

At the heart of our project is “Aalia,” an AI-driven simulated patient designed to immerse students in a multifaceted cultural scenario. Aalia is a 32-year-old Middle Eastern woman navigating the Italian healthcare system. Her narrative challenges students to engage with her cultural and religious needs while addressing her medical concerns. This scenario, delivered through the ATLAS (Authentic Teaching and Learning through Adaptive Simulations) platform, aligns well with the COIL framework, supporting interprofessional and intercultural collaboration.

In October 2024, a synchronous online simulation session, conducted via Zoom, brought together over 140 health professions students and 20 educators from ten disciplines across four countries. Each of the ten breakout rooms was facilitated by two educators who underwent a one-hour training session covering the session’s objectives, the use of the ATLAS platform, interaction strategies with Aalia, and accessing the system-generated feedback report. Students collaborated in small, interprofessional and intercultural groups, engaging with Aalia through the ATLAS platform accessed in Zoom breakout rooms. Using their own devices, students engaged with Aalia using microphones, speakers, and optional webcams. One student shared their screen to navigate the ATLAS platform, while the group collaborated in real-time. The designated speaker interacted directly with Aalia, simulating a clinical encounter as if taking a patient’s history, while others observed, provided input via Zoom chat, and reflected on the exchange, fostering interprofessional collaboration.

The conversations seemed to encourage students to develop empathy towards Aalia, as they engaged with her concerns, cultural background, and healthcare challenges. Additionally, working in interprofessional teams fostered collaboration, as students from different disciplines contributed their unique professional perspectives to address Aalia’s needs. From our perspective, this immersive educational experience seemed to help bridge the gap between technical skills and empathetic care, encouraging students to develop a more culturally sensitive patient centred care approach. Detailed feedback generated from the ATLAS platform further supported students in refining their approach to patient-centred care.

Working in interprofessional teams fostered collaboration, as students from different disciplines contributed their unique professional perspectives to address Aalia’s needs

Key findings and insights

During the 45-minute session, over 350 conversations took place across ten Zoom breakout rooms, showing promising preliminary evaluation results:

• Student Engagement: Over 80% of participants reported being “very satisfied” or “satisfied” with the simulation. The majority indicated that they perceived the experience as realistic (88%) and engaging (90%).
• Skill Development: Over 80% of students expressed feeling more confident in their ability to provide culturally competent care and recognised the importance of interprofessional collaboration.
• Learning from Feedback: The AI-generated feedback was generally well-received, with 79% of students reporting that they found it specific and objective. Additionally, two-thirds of students indicated that they perceived AI-generated feedback as more tolerable compared to traditional instructor-led critiques.
• Educator Perspectives: Educators noted the simulation’s potential for addressing real-world challenges, describing it as scalable, easy to use, and capable of fostering meaningful learning experiences.

Aalia’s narrative provided a structured yet immersive virtual environment, allowing students to practice culturally responsive and collaborative care in a realistic context.

This AI-driven simulation was perceived as an engaging  learning experience that  emphasised teamwork as a core aspect of professional practice. This was reflected in the evaluation data, with the majority of students reporting increased motivation to collaborate with their peers during the simulation.

This immersive learning experience also provided students with opportunities to practice competencies such as cultural sensitivity, empathetic communication, and patient-centered decision-making. Through active listening and adaptive responses, students navigated complex clinical interactions and expressed an increased awareness of diverse cultural perspectives. This is illustrated in various conversations with Aalia, where students engaged in a simulated yet realistic patient encounter. The dialogue image below shows a sample of a conversation between Aalia and one of the student groups.

Educators found this learning experience effective and easy to implement, recognising its potential for broader integration across units and courses.

Challenges and considerations in implementing AI-driven simulations in teaching and learning

While AI-driven simulations offer significant potential in health professions education, their implementation comes with challenges. Strong institutional support is crucial, particularly in simulation-based and interprofessional education. At Monash University, the Faculty of Medicine, Nursing, and Health Sciences (FMNHS) has been instrumental in supporting the adoption of this approach, helping to facilitate its development and integration into the COIL curriculum more effectively.

Additionally, the development of this case scenario was a collaborative effort across multiple international institutions, requiring careful planning to ensure that diverse cultural perspectives were appropriately incorporated. Crafting Aalia’s scenario involved extensive consultations and iterative refinements to ensure that the case was both pedagogically sound and culturally nuanced. Striking a balance between authenticity and applicability across different healthcare contexts required sustained dialogue and collaboration among partners, highlighting the complexities of creating culturally responsive educational content.

Another emerging priority in health professions education is the involvement of consumers and community members in the development of learning materials to ensure authenticity and representation. While Aalia’s case was carefully curated, future iterations could benefit from direct input from individuals with lived experience, strengthening its real-world relevance.

The logistical challenges of delivering this activity via Zoom with international partners further underscored the barriers to implementing technology-enhanced learning at a global scale. Some of our international partner students experienced frequent internet connectivity issues, limiting their ability to engage fully in the sessions. This points to broader concerns about digital equity in global health professions education, where a lack of access to a stable internet connection can significantly impact participation and learning outcomes. This calls for incorporating complementary learning activities that can be undertaken offline to ensure that all students achieve the desired learning outcomes.

What’s next?

AI-driven simulations have the potential to enhance cultural competence and interprofessional collaborative practice skills in health professions education, particularly when supported by well-designed scenarios, faculty training, strong collaborations among partners and institutional backing, with the added benefit of being shareable across international contexts for broader impact. Building on the success of this pilot, we are committed to expanding our work. Our next steps include the following:

• Developing additional AI-driven scenarios to address a broader range of cultural and clinical contexts.
• Creating a comprehensive suite of resources to support educators in implementing these simulations.
• Exploring opportunities for integrating AI simulations into diverse healthcare curricula globally.

How to collaborate

We invite educators and researchers to help us shape the future of culturally responsive education by building a robust framework for fostering empathy, equity, and collaboration in healthcare.

If you’re passionate about enhancing cultural competence and interprofessional collaboration in health professions education, we would love to hear from you. Whether you’re interested in integrating AI simulations into your curriculum, co-designing new scenarios, or contributing to research and development, there are numerous ways to get involved. Please email zahra.aziz@monash.edu

References

Gulati, S., & Weir, D. (2022). Cultural competence in healthcare leadership education and development. Journal of Healthcare Leadership, 14(3), 123-135.

Licen, S., & Prosen, M. (2023). Acquisition of cultural competencies in nursing education. International Journal of Nursing Education Scholarship, 20(1), 45-60.

This work is presented on behalf of the Monash COIL Project Team and our international partners, including the University of Padua, Italy. We sincerely acknowledge the exceptional support of the Monash ATLAS Team in developing this teaching tool and appreciate their commitment to enhancing educational innovations.