Simulated participants (SPs) are often viewed through the lens of realism, role portrayal, and standardization. Those elements are essential, but I have been thinking more about what happens after the simulation ends. How do we support SPs as members of the educational team? How do we evaluate their performance in a way that promotes growth rather than simply checking a box? And how do we prepare SPs to provide meaningful feedback to learners without placing them in the role of clinical evaluator?
In our program, we have been working to create a more intentional SP feedback and evaluation process. For employee evaluation, SPs are observed during simulation to assess role portrayal, standardization, communication, professionalism, and alignment with the simulation objectives. New SPs are evaluated on their first shift with the program and again in the next long semester, while returning SPs are evaluated at least once per academic year. When feedback is needed, it is provided by SP program leadership within a defined timeframe and may occur through email, Teams, phone, or an in-person conversation.
The goal is quality assurance, coaching, and role support. SPs are asked to portray cases consistently across learner groups, but they also need clear expectations, timely feedback, and opportunities to ask questions or recalibrate their portrayal. When concerns are identified, follow-up evaluation and additional support can help determine whether the issue is related to preparation, role clarity, comfort, standardization, or fit with the program.
A second layer of feedback involves SPs providing feedback to learners. This can be incredibly valuable, but it also requires structure. We ask SPs to provide feedback from the patient’s perspective, especially related to communication, professionalism, comfort, consent, and whether the learner addressed the patient’s questions or concerns. We are careful to separate this from clinical instruction. SPs are not asked to evaluate whether a learner made the correct clinical decision. Instead, they share how the encounter felt from the perspective of the person they portrayed.
For example, a standardized learner feedback tool may ask whether the learner introduced themselves, verified the patient’s identity, used language the patient could understand, listened to concerns, explained actions before performing assessments or interventions, and involved the patient’s preferences in care decisions. This keeps the feedback grounded in the patient experience while also reinforcing communication behaviors that matter across healthcare settings.
One important boundary we have emphasized is that SP feedback should not occur informally in front of learners unless it is designed into the simulation. If learner feedback is part of the activity, SPs are oriented to the process before the lab begins and use a structured format. This protects the learner, supports the SP, maintains confidentiality, and helps ensure feedback is aligned with the objectives of the simulation.
I am including our draft SP Evaluation Form here for anyone who may be developing or revising a similar process:
https://forms.cloud.microsoft/Pages/ShareFormPage.aspx?id=Q1vcXL7XqkyBc3KeOwpi2TYo3HZxSstLqj6CNtKSlapUM1dTV1RJRDRTQ1oxOVhBUjMzWEJRUU9LOS4u&sharetoken=EQTZwauRlUdMNYIquXjD
I am also including our general SP Feedback Tool for learners: https://docs.google.com/document/d/1rT5P8_61ZasvtYjF0QQiiLzPZgTeWmGg/edit?usp=sharing&ouid=116420855517614677350&rtpof=true&sd=true. It is designed to be editable to align with simulation objectives, learner level, and the intended role of the SP within the scenario.
I would love to hear how others are approaching this.
How does your program evaluate SP performance?
Do your SPs provide feedback directly to learners, through a written tool, during debriefing, or only to faculty?
What strategies have helped your SPs feel confident providing feedback while staying within the scope of the role?
Best,
Lucas