Call to Action

Abstract

We call to action our broader global simulation community to partner with simulated participants (SPs) and to regard the expertise of SP educators. We issue this charge on behalf of SPs and SP educators across borders and cultures including Association of SP Educators (ASPE) members spanning 44 countries. As an international organization founded more than 20 years ago, ASPE serves as the foremost global entity representing SP education, originating and upholding the ASPE Standards of Best Practices (ASPE SOBP),1 and embodying a commitment to excellence in SP methodology. We—SP methodology experts, ASPE leaders, and researchers—call on colleagues to collaborate with us to magnify the hidden, purposeful work of SP educators in preparing SPs to contribute to healthcare learners' education, which ultimately benefits patients. We call the global simulation community to action now because, as leaders, we recognize our responsibility to examine key tenets core to SP methodology in a novel way that explicitly amplifies the hidden work of SP educators in relation to the contributions of SPs. SPS AS EDUCATIONAL CHANGE AGENTS Currently, it is commonplace to read that educational activities and programs use SPs. This call to action necessarily includes the commitment not to use SPs. What does this mean? Not using SPs means joining us in a ubiquitous movement for a needed semantic and cultural shift—specifically, to refer to our work with SPs adopting language that uplifts and highlights SPs' educational contributions. We advocate for this linguistic evolution because SPs are human beings, and the concept of using people inherently carries negative connotations.2 Safer work environments are those in which SPs are not used, because doing so dehumanizes SPs, which may place them in physical and psychological danger.1,3,4 This call to action expands the efforts of some SP educators who have led the way in this arena.2,5,6 For many of us, this begins with an acknowledgement that we, too, have employed the phrase use of SPs in our routine work and publications.7,8 This must stop. While we use SP methodology, we do not use SPs in the process. Rather than mere subjects or tools within educational settings, SPs must be recognized and respected as valued collaborators in the pursuit of excellence in healthcare simulation.3–5,9 SPs are team members who participate in the education of healthcare learners and those in other professions.10 Guided by SP educators, SPs draw on lived experience to contribute to scenario/case development, portray patients, family members, and healthcare professionals interacting with learners, provide patient-centered constructive feedback, and offer valid and reliable ratings for assessments.11,12 SPs also contribute to quality improvement initiatives and related research within health systems, particularly through work as unannounced SPs interacting with and assessing healthcare providers in clinical settings.13 We work with SPs. We partner with SPs. We ally with SPs as educational change agents to implement healthcare simulation training for and with learners. SP EDUCATORS AS EXPERTS IN THE SHADOWS SP educators are individuals with expertise in SP methodology. They advance their expertise by continued professional development,1 an openness to understanding people and patients, and a commitment to best preparing their learners—SPs.1 To excel as a professional SP educator, one must learn and practice a diverse skill set that facilitates patient-centered experiential education via simulation. SP educators diligently prepare and support SPs for their collaborative role in healthcare education, providing often-unseen and underrecognized expertise that underpins the effectiveness and safety of simulation-based learning. Because this critical work by SP educators is frequently performed behind the scenes and in the shadows, the SP educator role is often inadvertently minimized to that of logistician. Despite substantial contributions to healthcare simulation education and important contributions to scholarly literature for over 50 years,1,6,14–18 SP educators' work as experts in SP methodology remains underrepresented. For example, SP training procedures are frequently overlooked and omitted from scholarship. This is problematic because our expertise in coaching SPs and related safety procedures, including psychosocial safety,19 goes unacknowledged. SP methodology directly impacts quality and rigor of resulting education and scholarship, and contributions in this realm should be made explicit and integrated into research methods sections. To promote greater inclusivity for SP educators as collaborators, it is helpful to understand the unique, essential role we perform in healthcare simulation education and training. Multifaceted skills of SP educators include but are not limited to: applying adult and other learning theories to coaching SPs; contributing to health sciences simulation curriculum design and development; debriefing learners with other SMEs; translating clinical learning objectives to lay audiences (e.g., SPs); training SPs to provide behaviorally anchored constructive verbal and written feedback to learners; conducting quality assurance with SPs to ensure that they are accurately rating learners during assessments; calibrating authentic patient role portrayals for topics as wide-ranging as knee pain to end of life; and repeatedly bearing witness to these portrayals to provide SPs with real-time coaching to ensure procedures are consistent across learners.20 Collaborating with SP educators as experts in SP methodology will result in optimized simulation education activities for learners with SPs to benefit health sciences programs and institutions. MOVING FORWARD TOGETHER We propose three recommendations to support the broader global simulation community of practice in joining us to adopt inclusive, collaborative, and supportive practices to advance SP methodology and scholarship. These recommendations are intentionally designed to amplify the often-hidden yet purposeful scholarly contributions of SP educators. RECOMMENDATION 1: RECOGNIZE, RESPECT, AND COLLABORATE WITH SP EDUCATORS AS SUBJECT MATTER EXPERTS An inclusive approach is critically important when working with SP educators and conducting research related to SP methodology. Related research must adhere to and acknowledge the ASPE SOBP,1 which begin with Domain 1–safe work environment. For future research meetings and conferences, we recommend that organizers invite the ASPE Board of Directors to propose SP educators to serve as subject matter experts (SMEs) and core planning team members on all topics related to SPs and SP methodology. It is important that, at minimum, some SMEs be ASPE-designated representatives, because ASPE leaders are most knowledgeable about which educators and researchers are experts in SP methodology21 that aligns with the ASPE SOBP. ASPE leaders are also attuned to the evolution of language as it influences SP methodology. For example, terms that are problematic and have been discussed within the ASPE community include confederate22 and stakeholder.23 Engaging and including ASPE-designated SP educators as SMEs at the start of the planning process and throughout will benefit the quality and relevance of publications—including scholarly reviews related to SP methodology—and enable true peer review of scholarly work.10,11 RECOMMENDATION 2: ADOPT INCLUSIVE RESEARCH DESIGN PRACTICES TO CREATE MEANINGFUL, COMPREHENSIVE, SYSTEMATIC LITERATURE REVIEWS AND RESEARCH The use of simulated participant methodology in healthcare education, particularly for developing communication skills, has been widely studied.19,24–27 However, the prevailing positivist paradigm often frames research questions in a binary manner, potentially limiting the depth of understanding about the effectiveness and nuances of simulation-based communication skills training.28–31 Important data in this space exist outside of electronic research databases. These include peer-reviewed books,18,32–34 book chapters,6,10,14,17 essays,1,2 SP case scenarios, and curricula, in addition to peer-reviewed articles rooted in qualitative methodology.19 Without considering other sources of data, relevant evidence-based work with SPs will be excluded from systematic reviews, rendering them meaningless in the scope of this literature. In addition, it is imperative to recognize SP educators as authors and include SP educators as co-authors on scholarship to which they have contributed as SMEs. SP educators advance research initiatives by collaboratively writing SP case scenarios, developing assessment materials, coaching and safeguarding SPs, collecting data, participating in research design discussions, and performing other hidden labor. We encourage simulation colleagues to consider these and other professional duties carried out by SP educators that make simulation possible, and to invite SP educators to participate as authors on research teams proactively rather than as an afterthought. It is vital that SP educators be included as co-authors on research articles that come to exist through their often-hidden labor, because this upholds research ethics and this is how, in part, SP Education will advance as a profession. The advancement of SP Education as a profession and the SP educator as a professional occupation is critical, given the many contributions to healthcare education and training that come as a result. This includes the amplification of diverse patient voices and stories, which should be reflected in related and resulting scholarship. To guide future research and review teams on their journey, we highly recommend beginning with the recently updated (2024) comprehensive bibliography of articles on SP methodology by Dr. Karen Szauter that is freely available on the ASPE website at https://www.aspeducators.org/ for anyone to download. RECOMMENDATION 3: INCLUDE A DIVERSITY OF SP EDUCATOR SME REPRESENTATIVES IN EDITORIAL PROCESSES We advocate for a broader inclusion of SMEs in SP Education, including those identified by the ASPE Grants & Research Committee,21 to participate in the editorial processes of this and other journals publishing simulation scholarship. SP educators around the world possess relevant qualifications and experience, including advanced degrees, and a growing number hold faculty positions within their institutions. Participating in editorial processes as reviewers and editorial board members would enable SP educators to provide needed professional expertise and feedback to authors and editors. In this way, SP educator SMEs would support editorial boards in providing accurate, meaningful, and timely feedback to authors submitting scholarship involving SP methodology. This would also enable SP educators to obtain institutional backing for further access to professional associations and networks through conferences and organizational memberships. In addition, participating in editorial processes holds potential for SP educators to obtain protected time for research. This would further support us in joining scholarly conversations as equal partners in the global simulation community. While our call to action specifically focuses on collaborating with SP educators to partner with and ally with SPs, we encourage our global simulation community to join us in a continual examination of language that has both ethical and practical consequences. As SP educators, we champion elevating training for healthcare learners with SPs. We collaborate with other simulation professionals in this work, and most research on innovations with SPs would not exist without the often-hidden labor of SP educators. So now, we call our broader global simulation community to action by providing recommendations for how to more intentionally and inclusively partner with SPs and regard the expertise of SP educators to improve and diversify our impact on the quality and effectiveness of simulation-based healthcare education—together.

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