SIC-Agents: Benchmarking and Building an Adaptive Simulator for Pediatric Serious Illness Communication Training

Pediatric serious illness communication (SIC) is critically important, yet scalable communication training for clinicians remains limited. Compared with other dialogue simulation settings, pediatric SIC poses additional challenges, including multi-party interactions, response to parental distress and strong dependence on feedback dynamics. Existing LLM-based simulators optimize generic dialogue quality rather than curriculum-contingent behavior required for effective SIC training. In collaboration with educators and pediatric clinicians, we introduce the first benchmark suite and simulation framework tailored to pediatric SIC training. Our benchmarks, PitfallBench and DialogueBench, evaluate simulators both at the turn-level and across full dialogues. We further propose SIC-Agents, a self-improving framework that generates a clinician-editable skill document to guide simulator behavior. Our experiments show that SIC-Agents outperforms static expert prompting. To support future research, we release our benchmarks for parent simulation in pediatric SIC at https://github.com/Beikewzh/sic-benchmarks

CultureConverse: A Multilingual Multi-turn Simulation Harness for Culturally Grounded Assistance in East and Southeast Asia

Current cultural evaluations for large language models (LLMs) often reduce culture to single-turn factual recall via MCQs, failing to capture a common use case: users seeking practical help over multiple turns in culturally grounded scenarios. We introduce CultureConverse, a scalable, multilingual simulation and evaluation harness for culturally grounded assistant dialogue that covers 10 East and Southeast Asian regions, 58 subgroup identities, and 7 domains. Each simulated and evaluated episode produces a scored interaction where the assistant assists the user and infers cultural constraints from partial information. The resulting CultureConverse-DS dataset contains 14,610 benchmark (evaluation) episodes and 274,295 oracle-guided (gold-mode) dialogues. In our benchmark evaluation of 18 models, GPT-5 mini achieves the highest assistance quality. Human annotation experiments suggest that our evaluation framework is a sufficient proxy for human judgment. Performance gains from fine-tuning on 27,860 high-quality CultureConverse-DS samples improve in-domain assistance and transfer out-of-domain to cultural MCQ and safety classification benchmarks. We release the harness, both splits, and judge prompts to support interactive evaluation of cultural competency.

SIMAX: A Scalable and Interpretable Framework for Multi-Fidelity and Annotated Clinician-Patient Dialogue Simulation

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.