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In this paper, we define the Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP) for those working with human role players who interact with learners in a wide range of experiential learning and assessment contexts. These human role players are variously described by such terms as standardized/simulated patients or simulated participants (SP or SPs). ASPE is a global organization whose mission is to share advances in SP-based pedagogy, assessment, research, and scholarship as well as support the professional development of its members. The SOBP are intended to be used in conjunction with the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice: Simulation SM , which address broader simulation practices. We begin by providing a rationale for the creation of the ASPE SOBP, noting that with the increasing use of simulation in healthcare training, it is incumbent on ASPE to establish SOBP that ensure the growth, integrity, and safe application of SP-based educational endeavors. We then describe the three and a half year process through which these standards were developed by a consensus of international experts in the field. Key terms used throughout the document are defined. Five underlying values inform the SOBP: safety, quality, professionalism, accountability, and collaboration. Finally, we describe five domains of best practice: safe work environment; case development; SP training for role portrayal, feedback, and completion of assessment instruments; program management; and professional development. Each domain is divided into principles with accompanying key practices that provide clear and practical guidelines for achieving desired outcomes and creating simulations that are safe for all stakeholders. Failure to follow the ASPE SOBP could compromise the safety of participants and the effectiveness of a simulation session. Care has been taken to make these guidelines precise yet flexible enough to address the diversity of varying contexts of SP practice. As a living document, these SOBP will be reviewed and modified periodically under the direction of the ASPE Standards of Practice Committee as SP methodology grows and adapts to evolving simulation practices.

With the increasing interest in the application of large language models (LLMs) in the medical field, the feasibility of its potential use as a standardized patient in medical assessment is rarely evaluated. Specifically, we delved into the potential of using ChatGPT, a representative LLM, in transforming medical education by serving as a cost-effective alternative to standardized patients, specifically for history-taking tasks. The study aims to explore ChatGPT's viability and performance as a standardized patient, using prompt engineering to refine its accuracy and use in medical assessments. A 2-phase experiment was conducted. The first phase assessed feasibility by simulating conversations about inflammatory bowel disease (IBD) across 3 quality groups (good, medium, and bad). Responses were categorized based on their relevance and accuracy. Each group consisted of 30 runs, with responses scored to determine whether they were related to the inquiries. For the second phase, we evaluated ChatGPT's performance against specific criteria, focusing on its anthropomorphism, clinical accuracy, and adaptability. Adjustments were made to prompts based on ChatGPT's response shortcomings, with a comparative analysis of ChatGPT's performance between original and revised prompts. A total of 300 runs were conducted and compared against standard reference scores. Finally, the generalizability of the revised prompt was tested using other scripts for another 60 runs, together with the exploration of the impact of the used language on the performance of the chatbot. The feasibility test confirmed ChatGPT's ability to simulate a standardized patient effectively, differentiating among poor, medium, and good medical inquiries with varying degrees of accuracy. Score differences between the poor (74.7, SD 5.44) and medium (82.67, SD 5.30) inquiry groups (P<.001), between the poor and good (85, SD 3.27) inquiry groups (P<.001) were significant at a significance level (α) of .05, while the score differences between the medium and good inquiry groups were not statistically significant (P=.16). The revised prompt significantly improved ChatGPT's realism, clinical accuracy, and adaptability, leading to a marked reduction in scoring discrepancies. The score accuracy of ChatGPT improved 4.926 times compared to unrevised prompts. The score difference percentage drops from 29.83% to 6.06%, with a drop in SD from 0.55 to 0.068. The performance of the chatbot on a separate script is acceptable with an average score difference percentage of 3.21%. Moreover, the performance differences between test groups using various language combinations were found to be insignificant. ChatGPT, as a representative LLM, is a viable tool for simulating standardized patients in medical assessments, with the potential to enhance medical training. By incorporating proper prompts, ChatGPT's scoring accuracy and response realism significantly improved, approaching the feasibility of actual clinical use. Also, the influence of the adopted language is nonsignificant on the outcome of the chatbot.

Standardized patients (SPs) have been one of the popular assessment methods in clinical teaching for decades, although they are resource intensive. Nowadays, simulated virtual patients (VPs) are increasingly used because they are permanently available and fully scalable to a large audience. However, empirical studies comparing the differential effects of these assessment methods are lacking. Similarly, the relationships between key variables associated with diagnostic competences (ie, diagnostic accuracy and evidence generation) in these assessment methods still require further research. The aim of this study is to compare perceived authenticity, cognitive load, and diagnostic competences in performance-based assessment using SPs and VPs. This study also aims to examine the relationships of perceived authenticity, cognitive load, and quality of evidence generation with diagnostic accuracy. We conducted an experimental study with 86 medical students (mean 26.03 years, SD 4.71) focusing on history taking in dyspnea cases. Participants solved three cases with SPs and three cases with VPs in this repeated measures study. After each case, students provided a diagnosis and rated perceived authenticity and cognitive load. The provided diagnosis was scored in terms of diagnostic accuracy; the questions asked by the medical students were rated with respect to their quality of evidence generation. In addition to regular null hypothesis testing, this study used equivalence testing to investigate the absence of meaningful effects. Perceived authenticity (1-tailed t =11.12; P<.001) was higher for SPs than for VPs. The correlation between diagnostic accuracy and perceived authenticity was very small (r=0.05) and neither equivalent (P=.09) nor statistically significant (P=.32). Cognitive load was equivalent in both assessment methods (t =2.81; P=.003). Intrinsic cognitive load (1-tailed r=-0.30; P=.003) and extraneous load (1-tailed r=-0.29; P=.003) correlated negatively with the combined score for diagnostic accuracy. The quality of evidence generation was positively related to diagnostic accuracy for VPs (1-tailed r=0.38; P<.001); this finding did not hold for SPs (1-tailed r=0.05; P=.32). Comparing both assessment methods with each other, diagnostic accuracy was higher for SPs than for VPs (2-tailed t =2.49; P=.01). The results on perceived authenticity demonstrate that learners experience SPs as more authentic than VPs. As higher amounts of intrinsic and extraneous cognitive loads are detrimental to performance, both types of cognitive load must be monitored and manipulated systematically in the assessment. Diagnostic accuracy was higher for SPs than for VPs, which could potentially negatively affect students' grades with VPs. We identify and discuss possible reasons for this performance difference between both assessment methods.

Background History-taking is an essential clinical competency for qualified doctors. The limitations of the standardized patient (SP) in taking history can be addressed by the virtual standardized patient (VSP). This paper investigates the accuracy of virtual standardized patient simulators and evaluates the applicability of the improved system’s accuracy for diagnostic teaching support and performance assessment. Methods Data from the application of VSP to medical residents and students were gathered for this prospective study. In a human–machine collaboration mode, students completed exams involving taking SP histories while VSP provided real-time scoring. Every participant had VSP and SP scores. Lastly, using the voice and text records as a guide, the technicians will adjust the system’s intention recognition accuracy and speech recognition accuracy. Results The research revealed significant differences in scoring across several iterations of VSP and SP ( p  < 0.001). Across various clinical cases, there were differences in application accuracy for different versions of VSP ( p  < 0.001). Among training groups, the diarrhea case showed significant differences in speech recognition accuracy ( Z  = -2.719, p  = 0.007) and intent recognition accuracy ( Z  = -2.406, p  = 0.016). Scoring and intent recognition accuracy improved significantly after system upgrades. Conclusion VSP has a comprehensive and detailed scoring system and demonstrates good scoring accuracy, which can be a valuable tool for history-taking training.

This study employed a bibliometric analysis to examine the existing literature on the use of standardised patient simulation in nursing education. SP simulation offers students the opportunity to directly interact with a range of nursing interventions and practices. It demonstrates that SP simulation can be used as an active learning methodology in nursing education. Bibliometric and content analysis. The data set was obtained from the Web of Science database. The sample comprised 310 publications that fulfilled the a priori defined inclusion criteria. The data were subjected to both descriptive content analysis and bibliometric analysis. A bibliometric analysis was conducted using VOSviewer, a software program designed for the mapping and visualisation of bibliometric data. A total of 198 publications were published in 2002–2024. The publications had 3042 citations. Nurse Education Today has the highest number of publications and citations. In terms of authors, Elcin was the author with the highest number of citations (n = 186). In accordance with the findings of the trend topic analysis, the keywords 'simulation', 'nursing education', 'standardised patient' and 'nursing students' emerged in the field. The number of studies examining the efficacy of using standard patient simulators in nursing education has seen a notable increase in recent years. The findings of this study may offer researchers and nursing faculties new insights into the value of incorporating standardised patient simulation into nursing education, as well as potential applications of such an approach. •The research literature productivity and the quality of that literature are increasing.•Bibliometrics is a new quantitative assessment method.•This study examines the evolution of interest in standardized patient simulation between 2002 and 2024.•The journal published the most standardized patient simulation in the field of nursing education was Nurse Education Today.

The practical training course of internal medicine of traditional Chinese medicine (PTC-IMTCM) is primarily based on traditional case teaching, which can be stressful for teachers. The use of virtual standardized patient (VSP) applications could be an alternative; however, there is limited evidence regarding their feasibility and effectiveness. This study aimed to build a VSP-TCM application according to the characteristics of PTC-IMTCM and the needs of students and to compare its efficacy with that of traditional teaching in improving TCM clinical competence among students. A prequestionnaire investigation was conducted before the course, and a VSP-TCM system was developed based on the results of the questionnaire. A randomized controlled trial was then conducted between February 26, 2020, and August 20, 2021. A total of 84 medical students were included and were divided into 2 groups: an observation group, trained with VSP-TCM (n=42, 50%), and a control group, trained with traditional academic training (n=42, 50%). Formative and summative assessments were conducted to evaluate teaching effectiveness. After completing the course, the students were administered a questionnaire to self-assess their satisfaction with the course. A questionnaire was also administered to 15 teachers to uncover their perspectives on VSP-TCM. All participants completed the study. In the formative assessment, the VSP-TCM group performed better in medical interviewing ability (mean 7.19, SD 0.63, vs mean 6.83, SD 0.81; P=.04), clinical judgment (mean 6.48, SD 0.98, vs mean 5.86, SD 1.04; P=.006), and comprehensive ability (mean 6.71, SD 0.59, vs mean 6.40, SD 0.58; P=.02) than the control group. Similarly, in the summative evaluation, the VSP-TCM group performed better in the online systematic knowledge test (OSKT; mean 86.62, SD 2.71, vs mean 85.38, SD 2.62; P=.046), application of TCM technology (mean 87.86, SD 3.04, vs mean 86.19, SD 3.08; P=.02), TCM syndrome differentiation and therapeutic regimen (mean 90.93, SD 2.42, vs mean 89.60, SD 2.86; P=.03), and communication skills (mean 90.67, SD 4.52, vs mean 88.24, SD 4.56; P=.02) than the control group. There was no significant difference in medical writing between both groups (mean 75.07, SD 3.61, vs mean 75.71, SD 2.86; P=.37). The postcourse feedback questionnaire indicated that VSP-TCM can better enhance students’ TCM thinking ability (n=39, 93%, vs n=37, 88%; P=.002), medical history collection (n=38, 90%, vs n=30, 72; P=.001), syndrome differentiation and treatment and critical thinking (n=38, 90%, vs n=37, 88%; P=.046), comprehensive clinical application ability (n=40, 95%, vs n=36, 86%; P=.009), interpersonal communication skills (n=36, 86%, vs n=28, 67%; P=.01), and autonomous learning ability (n=37, 88%, vs n=28, 67%; P=.01) than traditional academic training. Similarly, the teachers held a positive perspective on VSP-TCM. VSP-TCM enhances students’ TCM clinical competence and dialectical thinking and improves their ability to work autonomously. Moreover, the VSP-TCM system is feasible, practical, and cost-effective and thus merits further promotion in TCM education.

Background Standardized patients (SPs) simulation training models have been widely used in various fields, the study of using SPs in Traditional Chinese medicine (TCM) is still a new filed. Previous studies have demonstrated the effectiveness of occupational SP for TCM (OSP-TCM), which has an increasingly problem of high time and financial costs. The faculty SPs for TCM (FSP-TCM) simulation training model may provide a better alternative. This study aims to test and determine whether FSP-TCM simulations are more cost-effective than OSP-TCM and traditional educational models to improve the clinical competence of TCM students. Methods This study was a single-blind, prospective, randomized controlled trial conducted between February 2023 and October 2023. The participants were randomized into FSP-TCM group, OSP-TCM group and traditionally taught group (TT group) in the ratio of 1:1:1. The duration of this training program was 12 weeks (36 credit hours). Formative and summative assessments were integrated to evaluate the effectiveness of teaching and learning. Three distinct questionnaires were utilized to collect feedback from students, SPs, and teachers at the conclusion of the course. Additionally, analysis of cost comparisons between OSP-TCM and FSP-TCM were performed in the study. Results The study comprised a total of 90 students, with no dropouts during the research. In the formative evaluation, students assigned to both the FSP-TCM and OSP-TCM groups demonstrated higher overall scores compared to those in the TT group. Notably, their performance in “physical examination” ( P a  = 0.01, P b  = 0.04, P c  = 0.93) and “comprehensive ability” ( P a  = 0.01, P b  = 0.006, P c  = 0.96) significantly exceeded that of the TT group. In the summary evaluation, both SP-TCM groups students outperforms TT group in the online systematic knowledge test ( P a  = 0.019, P b  = 0.04, P c  = 0.97), the application of TCM technology ( P a  = 0.01, P b  = 0.03, P c  = 0.93) and real-time assessment ( P a = 0.003, P b  = 0.01, P c  = 0.93). The feedback questionnaire demonstrated that both SP-TCM groups showed higher levels of agreement for this course in “satisfaction with the course” ( P a  = 0.03; P b  = 0.02) and “enhanced TCM clinical skills” ( P a  = 0.02; P b  = 0.03) than TT group. The SP questionnaire showed that more FSPs than OSPs in “provided professional feedback” (FSPs: strongly agree 30%, agree 50% vs. OSPs: strongly agree 20%, agree 40%. P  = 0.69), and in “gave hints” during the course (FSPs: strongly agree 10%, agree 30% vs. OSPs: strongly agree 0%, agree 10%. P  = 0.42). It is noteworthy that FSP-TCM was significantly lower than the OSP-TCM in overall expense (FSP-TCM $7590.00 vs. OSP-TCM $17415.60), and teachers have a positive attitude towards the FSP-TCM. Conclusion FSP-TCM training mode showed greater effectiveness than traditional teaching method in improving clinical competence among TCM students. It was feasible, practical, and cost-effective, and may serve as an alternative method to OSP-TCM simulation.

This study investigates the impact of standardized patient simulation-based compassionate care training on nurses' emotional intelligence and empathy. The growing emphasis on compassionate care in healthcare settings highlights the need for nurses to cultivate emotional intelligence and empathy to enhance patient interactions and care quality. Standardized patient simulation has emerged as an effective method for developing these essential skills. A quasi-experimental design was employed. 124 staff nurses were divided into a study group (62 nurses) and a control group (62 nurses). Pre- and post-intervention assessments measured emotional intelligence and empathy using validated scales. Data were collected from December 2024 to February 2025. The study group exhibited substantial improvements in emotional intelligence post-intervention (38.74 ± 8.11) in contrast to the control group (29.5 ± 11.4) with a p-value < 0.001. Empathy scores also significantly increased in the study group (8.15 ± 1.97) versus the control group (6.07 ± 2.52), p < 0.001. The findings underscore the effectiveness of standardized patient simulation in developing emotional intelligence and empathy among nurses. These skills are crucial for improving patient care quality, suggesting healthcare institutions should integrate this training into professional development programs. Ongoing research is required to explore long-term impacts and the role of organizational support in skill development.

Self-efficacy is an individual's belief in oneself and in one's own judgment and ability to be successful in a task. Strong self-efficacy allows for the achievement of success, well-being, personal development and the diversification of skills. An individual's perception of his/her self-efficacy plays a key role in adopting behaviors and initiating and sustaining change. The first aim of this study is to evaluate the effects of simulation-based learning on the self-efficacy and performance of first-year nursing students. The second aim is to examine students' pre- and post-scenario proficiency in their self-assessment of competence in regard to scenario objectives to compare the students' self-assessment and their instructor's assessment in terms of performance evaluations. This semi-experimental study was conducted with sixty-five first-year nursing students. A standardized patient method was used as a simulation technique. Students' self-efficacy and their perceptions of their own competence in completing skills were measured using the General Self-Efficacy Scale and the Proficiency Assessment Form, respectively. Students’ actual performance was evaluated via an Objective Structured Clinical Assessment and performance evaluation checklists. The mean self-efficacy score of students was 52.68 (±10.19) before the scenario and 49.59 (±12.90) post-scenario (p = .001). With regard to their scenario objectives, a decrease was observed in students’ proficiency in their post-scenario self-assessment of competence. This decrease was only statistically significant in the “Establishing a safe patient unit” objective (t = 2.27; p = .03). We observed that self-efficacy scores declined in the post-simulation scenario. Using standardized patients in simulation training allows novice nursing students to meet a real patient and to recognize their own true self-efficacy. •Simulation-based training provides opportunity for participants to evaluate their self-self-efficacy.•Watching video recordings after simulation allows students to assess their own performance.•Simulation-based training allows for students to experience what they can experience when they meet a real patient.

Effective interprofessional collaboration is essential in today’s complex health care environment. The primary objective of this project was to develop and implement interprofessional standardized patient encounters within the nurse practitioner and physician assistant students’ program of study as part of student training. The goal was to improve collaboration and clinical skills and to assess students feedback after their involvement in 4 standardized patient encounters. A mixed-methods approach was used combining survey results and debriefing interviews. Results showed that students had a positive experience and considered the interprofessional activity an effective learning opportunity that increased their patient care skills, collaboration, and communication. •The Interprofessional Education Collaborative has charged health care education with increasing interprofessional opportunities.•This report discusses the implementation and evaluation of an interprofessional education (IPE) project.•This IPE simulation series improved student collaboration, communication, and patient care skills.•Faculty considered this a positive curriculum and program improvement and have continued to implement this IPE simulation series.