It Is Not Just the Script that Matters: Overlooked Elements in Standardized Patient Methodology : Simulation in Healthcare

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Letter to the Editor

It Is Not Just the Script that Matters: Overlooked Elements in Standardized Patient Methodology

Jaramillo-Rincón, Sandra MD, MHPE; Potes, Juan Manuel MD

Author Information
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare 17(2):p 140, April 2022. | DOI: 10.1097/SIH.0000000000000624
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To the Editor:

Within the context of the increasingly common use of standardized patients (SPs) in the education of medical professionals, and given the many advantages in their use at every level of health professional's education, a conversation about how to improve this experience will always be useful and pertinent.

In their latest article, Davies et al1 focus on the implementation of templates and protocols to orient instructors in the construction of scripts to improve the validity and consistency of scenarios with the aim of meeting the objectives established within the learning activity.

As the authors report, there is a great deal of information in the literature concerning the utility, advantages, and disadvantages in the use of SPs in the teaching/learning process,1–3 and there is little reported in the literature about structuring scenarios, writing scripts, and especially the instruction and training of the SPs themselves.4

Talwaker et al4 frame the use of SPs in fulfilling curricular learning objectives through 12 helpful tips. However, neither they nor Davies et al1 take into account the role of the actor in the construction of the script as being a key factor in the successful implementation of the scenario.

In addition to the use of templates and protocols for constructing scenarios, our group has identified other factors and built a structural framework that may have an important influence on the consistency and validity of the scenario, beyond that of just the information being presented.

One of the elements that clearly modifies the development and implementation of scenarios is the instruction of the actors that become SPs. Based on our experience in the Clinical Skills and Simulation Center of the Universidad de Los Andes in Bogotá, Colombia, we propose a training model to develop 4 core skills of the SP:

  • Acting skills: knowledge and skills focused on the creation and appropriate interpretation of a role and its usage within a pedagogic space. That is, the construction and interpretation of “the person behind the patient.” This process includes the construction of a psychological, biological, and social profile and its interpretation, permitting both the student and the instructor to become immersed in the scenario and thus ensure an authentic interaction with the SP.
  • Thematic skills: focused on the “assertive improvisation” of a scenario, taking into account and understanding the possible variations that may occur during its implementation, as well as pertinent and timely responses to questions that the student might ask which if answered incorrectly would change the course of the scenario and defeat its intended purpose. This requires a broad knowledge of the pathology and semiology to accurately portray the scenario.
  • Pedagogic skills: “the SP as a teacher.” Depending on the scenario, the level of the student, and the type of activity being realized (the objective structured clinical examination, workshops, simulation, etc.), the SP is able to tailor their performance to reach the objectives of the specific situation with the rational use of pedagogic skills and feedback.
  • Planning and leadership skills: These skills are focused on the SP recognizing their role in the learning environment, thereby developing as a rational and responsible “coplanner” of the scenario. Some of the task are optimizing the learning theater, their use of the allotted time and space, as well as undergoing self-evaluation and giving proactive feedback of the scenarios in the planning and implementation stages, and identifying opportunities to improve the learning scenario in the short and long term.

Although a good script may promote the successful use of SPs as a teaching/learning strategy for education of health professionals, the standardization of other elements such as the instruction and training of SP actors in the previously mentioned skills can lead to a much higher level of consistency and validity in the deployment of this methodology. It is well worth the effort for our field to begin to work on these elements to enhance SP scripts and protocols.

Sandra Jaramillo-Rincón, MD, MHPE
Universidad de Los Andes
School of Medicine
Clínica de Marly
[email protected]
Juan Manuel Potes, MD
Universidad de Los Andes
School of Medicine


1. Davies EL, Pelentsov LJ, Montagu A, Gordon AL, Hooper KJ, Esterman AJ. “Who am I and why am I here?” a scoping review exploring the templates and protocols that direct actors in their roles as simulated (standardized) patients. Simul Healthc 2021;16(3):190–198. doi:10.1097/SIH.0000000000000470.
2. Plaksin J, Nicholson J, Kundrod S, Zabar S, Kalet A, Altshuler L. The benefits and risks of being a standardized patient: a narrative review of the literature. Patient 2016;9(1):15–25. doi:10.1007/s40271-015-0127-y.
3. Wilbur K, Elmubark A, Shabana S. Systematic review of standardized patient use in continuing medical education. J Contin Educ Health Prof 2018;38(1):3–10. doi:10.1097/CEH.0000000000000190.
4. Talwalkar JS, Cyrus KD, Fortin AH. Twelve tips for running an effective session with standardized patients. Med Teach 2020;42(6):622–627. doi:10.1080/0142159X.2019.16079695.
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