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What are the primary mechanisms of action for ACE inhibitors in treating hypertension?
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ACE inhibitors work by blocking the conversion of angiotensin I to angiotensin II, leading to vasodilation and reduced aldosterone secretion. This results in decreased blood pressure and reduced cardiac workload.
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Master clinical scenarios with neural voice synthesis
Practice realistic patient interactions powered by Sesame's Conversational Speech Model—advanced transformer architecture that generates contextually-aware, emotionally intelligent speech for clinical training
The Limitations of Traditional Clinical Assessment
Current State
Traditional OSCE assessments rely on standardized patients (SPs) with inherent limitations: limited demographic diversity, scripted responses, inconsistent performance across examinations, and prohibitive costs for frequent practice sessions.
Medical students typically receive fewer than 20 hours of SP interaction before high-stakes clinical exams, with minimal exposure to diverse communication styles, accents, emotional states, or rare clinical presentations.
The Innovation Gap
Previous AI patient simulators have struggled with the "uncanny valley" effect—synthetic voices that sound robotic, lack emotional depth, and fail to respond naturally to conversational cues. This undermines learning effectiveness and fails to prepare students for real clinical interactions.
The challenge: creating AI patients that cross the uncanny valley with natural prosody, emotional intelligence, and contextual awareness indistinguishable from human communication.
Sesame Conversational Speech Model: Technical Architecture
Transformer-Based Architecture
Sesame's CSM uses a novel transformer architecture optimized for conversational speech generation. Unlike traditional TTS systems that operate on isolated utterances, CSM maintains conversational context across multi-turn dialogues, enabling natural flow and coherent responses.
The model employs a hierarchical attention mechanism that captures both local (phoneme-level) and global (discourse-level) features, allowing for contextually appropriate prosody, timing, and emotional expression.
- 24-layer transformer with 512M parameters optimized for speech synthesis
- Multi-head attention mechanisms for prosodic feature extraction
- Contextual embedding layer for emotional state tracking
- Adversarial training for natural speech rhythm and timing
Amortized Training & Inference
The CSM uses an amortized inference approach that dramatically reduces latency while maintaining high-fidelity output. Traditional diffusion-based speech models require hundreds of denoising steps; Sesame's approach achieves comparable quality in a single forward pass.
This breakthrough enables real-time conversational AI with latency under 200ms—critical for natural clinical dialogue where delayed responses break immersion and reduce training effectiveness.
- Single-step inference with 180ms average latency
- Consistency distillation for quality-preserving compression
- GPU-optimized inference pipeline for scalability
- Dynamic batching for efficient resource utilization

Figure 1: CSM Architecture with hierarchical attention and prosodic feature extraction

Figure 2: Amortized training pipeline with consistency distillation
Paralinguistic Modeling
Advanced prosodic feature extraction captures subtle emotional cues: pitch modulation, speech rate variation, pause duration, and voice quality changes that convey patient emotional state.
Contextual Awareness
The model maintains dialogue state across turns, adapting emotional expression and communication style based on conversational context, clinical urgency, and patient history.
Multilingual Support
Native pronunciation of medical terminology and foreign words across 40+ languages, enabling diverse patient demographic simulation without acoustic artifacts.
Technical Specifications
Clinical Voice Technology Demonstrations
These samples demonstrate the three critical dimensions of conversational speech synthesis: paralinguistic expression, accurate pronunciation of complex terminology, and contextual emotional adaptation.
Paralinguistics
Emotional expression and non-verbal communication captured through prosodic features
Patient expressing pain
00:07
Empathetic response
00:03
Foreign Words & Terminology
Accurate pronunciation of medical terminology and multilingual patient names
Complex medical terminology
00:09
International patient names
00:06
Contextual Expressivity
Dynamic emotional adaptation based on clinical context and patient state
Breaking difficult news
00:22
Reassuring anxious patient
00:22
"Voice is our most intimate medium as humans, carrying layers of meaning through countless variations in tone, pitch, rhythm, and emotion. Creating truly conversational AI requires modeling not just what is said, but how it's said—the prosodic features that make speech feel human."— Sesame Research Team
Realistic Patient Interactions
Practice with AI patients powered by neural voice synthesis that responds naturally to clinical communication
Immediate Detailed Feedback
Receive instant AI-powered assessment of clinical reasoning, communication skills, and diagnostic approach
Comprehensive Clinical Coverage
Access evidence-based scenarios across all medical specialties with graduated difficulty levels
Clinical Excellence
Master OSCE Assessments
Experience our comprehensive OSCE training platform with real-time vital signs monitoring, task tracking, and performance analytics.
OSCE Training Platform
Advanced clinical assessment and performance monitoring
Total Cases
24
Completed
18
Average Score
87%
Study Hours
32.5h
Available Cases
Sarah Johnson
Cardiology
Chest pain with radiating discomfort
Michael Chen
Emergency
Acute respiratory distress
Emma Williams
Internal Medicine
Persistent fever and fatigue
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