By: Lou Clark, PhD, MFA, Andrea Doyle, PGDip, Med Phys, MedEd, BSc, PhD, Melih Elcin, MD, MS, CHSE-A, Nancy McNaughton, PhD, Cate Nicholas, EdD, MS, PA, FSSH, Tamara Owens, PhD, MEd, CHSE, Cathy Smith, PhD, MA, BA Hons, CHSE, Karen Szauter, MD, MACP, FAMEE, Kuan Xing, PhD, Debra Nestel, AM, PhD, FAcadMEd, FSSH
Submitted by: Miranda Powell, AS, CHSE, University of South Alabama

In modern healthcare education, simulated participants (SPs) play an essential role in bridging the gap between theoretical knowledge and clinical practice. These trained individuals portray patients, family members, or other key roles in structured simulations, allowing healthcare learners to refine their communication, clinical reasoning, and procedural skills in a controlled environment. Their contributions are critical to improving patient safety and the overall quality of medical training. However, despite their significance, SPs often face challenges related to recognition, training consistency, and emotional well-being. The article, Call to Action: Honoring Simulated Participants and Collaborating With Simulated Participant Educators, underscores the need for institutions to formally acknowledge and support these vital members of the healthcare education ecosystem. Simulated participants facilitate experiential learning by providing students with realistic patient interactions, enabling them to develop essential competencies before engaging with real patients. Their ability to offer structured, high-quality feedback enhances the learning experience, ensuring that learners gain both technical proficiency and strong interpersonal skills. However, despite their integral role, SPs frequently remain undervalued within the academic and clinical training landscape. Many institutions fail to provide formal recognition or adequately define their roles, treating SPs as ancillary components rather than core contributors to healthcare education. Beyond the issue of recognition, a lack of standardized training presents another significant challenge. Variability in preparation methods can lead to inconsistencies in SP performance and the quality of feedback delivered to learners. Establishing comprehensive training protocols would help ensure uniformity and reliability in simulations, ultimately enhancing educational outcomes. Additionally, the emotional and psychological demands of portraying patients—particularly those with complex or distressing conditions—should not be overlooked. Without appropriate support mechanisms, SPs may experience undue stress or emotional fatigue, which can impact their performance and overall well-being. To address these challenges, institutions must adopt a structured and intentional approach to integrating SPs into healthcare education. First, formal recognition through clearly defined roles and professional titles will help solidify their status as key members of the educational team. Second, the development of standardized training programs will promote consistency and improve the overall quality of simulated encounters. Third, providing emotional and psychological support—such as debriefing sessions, peer support networks, and access to counseling—will help safeguard the well-being of SPs, enabling them to perform their roles effectively. Finally, fostering collaboration by involving SPs in curriculum development and feedback processes will further enhance the educational experience for both learners and educators. Simulated participants are invaluable to the advancement of healthcare training. Their contributions extend beyond simple role-playing; they serve as educators, evaluators, and facilitators of critical learning experiences. Recognizing and supporting SPs is not merely an ethical imperative but a necessary step toward ensuring high-quality, patient-centered medical education. As healthcare training continues to evolve, institutions must prioritize the inclusion and professionalization of SPs, ensuring they receive the respect and resources necessary to excel in their roles.

Lead Author: Adam Kronish, MD
Submitted by: Amy Lorion, NBOME

Kronish, et al. note that, because of an increase in hospitalizations for mental illness, children and adolescents in need of psychiatric care are increasingly being admitted into general pediatric wards until beds in psychiatric wards are available, creating a need for staff outside of psychiatric wards to be trained in how to respond to “escalations due to dysregulated behavior.” Accordingly, they designed a study to train residents in how to deal with an adolescent patient who becomes “acutely agitated with aggressive behaviors.” They opted for “a standardized patient (SP) case as the teaching method to immerse the learner and evoke authentic emotional and physical reactions to this difficult scenario.” Based on results from 22 residents, the authors found that they had “effectively evaluated learner self-efficacy, with residents expressing an aggregate increase in confidence in their own knowledge and abilities.”

Lead Author: Violeth E. Singano
Submitted by: Amy Lorion, NBOME

This article describes a study in Tanzania comparing two approaches to teaching nursing students to perform a mental status evaluation (MSE): one where lecture is paired with practice performing the MSE with patients in a general medical ward who do not have symptoms of mental illness (control group) and one where the lecture is instead paired with performing the MSE with SPs trained to portray mental health symptoms (intervention group). The study involved 311 students from nursing schools across two regions of the country, with 202 students in the control group and 109 in the intervention group. The intervention group demonstrated “a significantly higher level of cognition regarding Mental Status Evaluation (MSE) when compared to the control group” plus “a 25% increase in confidence and cognition about mental health compared to traditional instructional hours.”

Lead Author: Banafsheh Ghorbani
Submitted by: Amy Lorion, NBOME

This article is a striking reminder of cultural differences surrounding SP work as well as the need to engage with SPs about their experiences and their perceptions of their role. Ghorbani et al. interviewed 15 SPs in Tehran, Iran, on their experiences “as SPs in the student education process.” The interviews were semi-structured and each lasted 60-90 minutes. The authors found two themes, with three subthemes each, including the subthemes of “guilty conscience” and “fear of judgment by others” in the “duality of feeling” theme. Among the SPs, they found there was “a prevailing feeling of guilt because participants received payment for their involvement in the educational process. They believed that as educators, they should contribute without monetary compensation. …participants shared concerns about the perception others might have if they found out about receiving payment. They feared being seen as financially needy or from a lower social class, leading to a diminished sense of worth. Consequently, they preferred to keep their involvement and compensation a secret. The worry about how students perceived them consistently occupied their thoughts.”

By: Kimberly A. Conway and Robert L. Scoloveno
Submitted by: Renee Wadsworth, Simclusive

By: Lauren Woods et al
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

This study aimed to examine how occupational therapy (OT) students incorporate real-time Simulated Patient (SP) feedback, numerical feedback (i.e. scores), and instructor-written feedback to enhance their learning from the simulation experience. This mixed methods study collected learner assessment numerical data and qualitative data (SP feedback and instructor written feedback) in first-year OT students’ simulation learning sessions. The students answered six debrief questions reflecting on the simulation process, explaining how they plan to incorporate the feedback in future OT practice. Quantitative results of student performance data were reported. Seven themes emerged from the thematic analysis of the debrief reflections. These themes provided information on students’ perceptions of the experience and illustrated how they plan to use the feedback. The findings of this study provide instructors strategies that can be used to enhance student learning when designing simulations. This study found that numerical and written feedback from the instructor was more meaningful when combined with real-time SP feedback.

Lead Author: Katharine Cardiff
Submitted by: Amy Lorion, NBOME

According to Cardiff et al., “Psychiatric genetic counseling (pGC) has been demonstrated to have meaningful positive outcomes for people with psychiatric conditions and their families. However, it is not widely accessed, and clinical genetics services tend to receive few referrals for these indications.” To gain insight into how to breach this gap, the authors undertook a study “to understand the perceptions of and reactions to a simulated pGC session among psychiatrists.” The study involved recording a 65-minute simulated pGC session with an SP.

Journal Article: Challenges facing standardised patients representing equity-deserving groups: Insights from health care educators

By: Matt Sibbald et al

Article 1: The Contribution of Simulated Patients to Meaningful Student Learning
Article 2: How Simulated Patients Contribute to Student Learning in an Authentic Way, an Interview Study
Lead Author: Annelies Lovink
Submitted by: Amy Lorion, NBOME

Annelies Lovink et al. published two articles looking at the same phenomenon from two perspectives: that of the student and that of the SP. The articles stand on their own but can also be read in conversation with one another.

LGBTQ+ Microaggressions in Health Care: Piloting an Observation Framework in a Standardized Patient Assessment
Lead Author: Hallie Decker
Submitted by: Kerensa Peterson, UCR School of Medicine

“Microaggressions are subtle derogatory behaviors that unintentionally communicate hostility toward marginalized social groups. This article describes the preliminary validation of a framework for observing LGBTQ+ microaggressions in healthcare, which can lead to distrust and disengagement from the healthcare system. Coders used the framework to observe microaggressions in video-recorded clinical-skills assessments with medical students who elicited health histories from standardized patients.

Student empathy in standardized patient experiences: Applying concepts from a critical thinking emulation model
Lead Author: Lance Brendan Young PhD, MBA
Submitted by: Amy Lorion, NBOME

According to Young et al., research has shown that dental students’ empathy for patients declines over the course of their education and this “empathy-reducing influence of training” can have a real and negative impact on the students’ future patients. In order to address this concern, the authors aspired to “(1) Develop a learning guide for observable behaviors communicating emotional and cognitive empathy and (2) determine whether the learning guide can be used as a rubric for assessing empathy in a standardized patient experience.” The authors created a learning guide/evaluation rubric using an emulation model that focused on, “the communication of empathy,” a guide that SPs then used to score student performance in simulated encounters. According to the authors, the study’s results show that their model, “is viable as both a learning guide and evaluation rubric in a standardized patient format.”

Simulating Inclusive Dialogues: Encouraging Faculty-led Conversations Surrounding Bias and Microaggression
Lead Author: Vikasni Mohan, et al.
Submitted by: Amanda Fernandez-Acosta, University of Miami

Within the University of Miami, medical students and residents noted a lack of dialogue surrounding bias and microaggressions, and uncertainty on how to handle these types of situations. To assist, the authors designed a course for faculty to better understand the harmful impact of bias/microaggressions and provide them with the proper tools to engage in meaningful dialogue surrounding the subject. The authors adapted the PAAIL framework and added the Bridge-the-Gap component to better support conversations surrounding bias/microaggressions in healthcare education. The course followed self-selected participants who indicated first-hand personal experiences with bias and microaggressions and offered clinical faculty a framework to intervene in such cases. Next steps include evaluating whether practicing these difficult conversations promotes psychological safety among faculty and normalizing these conversations to foster inclusivity and engagement among faculty, staff and learners.

Standardized Patients in Medical Education: A Review of the Literature
Authors: Flanagan O L, Cummings K M
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

The research questions posed for this review were as follows: do medical students in their first two years of education who have practiced skills using SPs have more self-confidence in their ability to perform skills on real patients than those students who did not use SPs? Do medical students in their third and fourth years of medical school have higher clinical competency with sensitive patient examinations after using SPs in their first two years of medical education than those students who did not use SPs? And finally, do medical students who have used SPs for discussing sensitive issues have better interpersonal skills when they encounter real patients in the clinical setting than those who have not used SPs? I’m going to take a leap and say yes.

Using Simulation-Based Learning with Standardized Patients (SP) in an Implicit Bias Mitigation Clinician Training Program
By: Jennifer Tjia et al
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

This article describes the design, implementation, and response to a simulation-based training program on implicit bias awareness and mitigation skills. Two aspects of this undertaking really stood out to me. First, the SPs were recruited from the local community and were involved in case development to ensure that the scenarios were realistic and relevant to the community's needs.  Second, the program creators revised the structure of the program based on participant responses to create a more safe environment and a more robust learning experience.