There are provided a method, system and medium having instructions embedded to determine an attribute of a simulated patient's state resulting from a patient-physician encounter. The method includes receiving a current treatment move and an initial value of the attribute; calculating a maximal expected incremental effect value of the current treatment move over a previous treatment move on the attribute; attenuating the maximal expected incremental effect value based on amount of time between the previous treatment move and the current treatment move; summing the attenuated maximal expected incremental effect value with the initial value to generate an updated attribute of the simulated patient's state; and generating a patient-physician encounter that includes the updated attribute.