  Effective communication is a crucial skill for healthcare providers since it
leads to better patient health, satisfaction and avoids malpractice claims. In
standard medical education, students' communication skills are trained with
role-playing and Standardized Patients (SPs), i.e., actors. However, SPs are
difficult to standardize, and are very resource consuming. Virtual Patients
(VPs) are interactive computer-based systems that represent a valuable
alternative to SPs. VPs are capable of portraying patients in realistic
clinical scenarios and engage learners in realistic conversations. Approaching
medical communication skill training with VPs has been an active research area
in the last ten years. As a result, the number of works in this field has grown
significantly. The objective of this work is to survey the recent literature,
assessing the state of the art of this technology with a specific focus on the
instructional and technical design of VP simulations. After having classified
and analysed the VPs selected for our research, we identified several areas
that require further investigation, and we drafted practical recommendations
for VP developers on design aspects that, based on our findings, are pivotal to
create novel and effective VP simulations or improve existing ones.
