Also, during the interaction, students received instant feedback regarding their ability to elicit report of symptoms of major depression (discoveries) as defined by the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV-TR) (18). Table 2 shows the distribution of the various discovery items by group-year as well as the results of the chi-square tests. Only two items showed statistically increased discovery by the students in the 2009–2010 group, as compared with the 2008–2009 group: decreased concentration/indecisiveness, and worthlessness or guilt. The most difficult symptom to identify was psychomotor retardation. During the first study, the interaction was purely text-based, with no visual cues regarding the patient, and, thus, students were unable to observe patient movements during the interview. To address the absence of a visual representation of the character in the first rendering of the scenario, for the second study, an animated image of “Ms. Young” was added to the chat interface (Figure 1), which allows her facial expression to change on the basis of questions asked. Nonetheless, the visual cues added did little to improve the ability to discern psychomotor retardation. Students' difficulty in eliciting this symptom points to the fact that naturalistic virtual human body movement is not a realistic goal for web-based VPs because of limitations of current technology. Furthermore, although the current technology causes errors in question recognition to diminish with increased use of the scenario, they will continue to exist. We are exploring adding additional animations and voice-recordings to mirror the VP's current text-based responses in order to further refine this type of scenario and provide more psychomotor indications. Also, emphasis can be placed on psychomotor retardation as a symptom of depression during classroom-based teaching or in a study guide that can accompany the VP assignment. Overall, our studies indicated that students appeared receptive to using this novel tool. An obvious limitation was the modest number of students who interacted with the VP scenario. Potential causes for the limited student participation could include offering no incentive to complete our study and a certain amount of “survey fatigue,” given the competing demands of research participation of students by various other sources. A recruitment bias may have also been present, with students more familiar with or friendly to issues of mental health and chat interfaces completing the interaction. A limitation identified in the student feedback about the VP addressed the lack of or inappropriate response of the VP to empathetic statements. Previous research has shown that medical students do respond empathetically to a VP (9). Further development of our depression scenario could involve qualitative analysis of the empathetic statements made by the users and building script responses to these statements. Despite their limitations, interactive VPs are potentially versatile tools for psychiatry educators, who can create scenarios based on their own course objectives. Although medical students in preclinical years can use VPs as self-study materials, to practice interviewing on their personal time and augment classroom learning, during clinical years, interactive VPs with complex disease scenarios can potentially be used to consolidate or fill gaps in live clinical exposure in certain areas.