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A Systematic Review of Emotional, Cognitive, and Logistical Factors Influencing Simulated Patient Performance in
Evelyn F Folorunsho1,2, Usman H Malabu1,3, Emma Anderson1
1College of Medicine and Dentistry, James Cook University, Douglas, Townsville, QLD, 4811, Australia.
Advances in Medical Education and Practice
|December 10, 2025
Summary
Simulated patient (SP) performance in healthcare education is influenced by emotional, cognitive, and logistical factors. Addressing these elements can enhance student learning outcomes, but SP well-being must be prioritized.
Area of Science:
- Medical Education
- Healthcare Simulation
- Human Factors in Medicine
Background:
- Simulated patients (SPs) are integral to simulation-based education (SBE) for skill development.
- Limited research exists on factors affecting SP performance and learner outcomes.
Purpose of the Study:
- To systematically review factors influencing simulated patient performance in healthcare education.
- To identify impacts of SP performance on learner outcomes.
- To provide recommendations for optimizing SP roles in SBE.
Main Methods:
- Systematic review of studies published between 2013-2025.
- Searched six databases for research on human SPs in healthcare education.
- Analyzed 19 studies using inductive thematic analysis and assessed quality with QATSDD.
Main Results:
- Key influencing domains identified: emotional (anxiety, fulfillment), cognitive (complexity, improvisation), and logistical (training, scheduling).
- SP roles improved learner empathy, communication, and clinical reasoning.
- Effectiveness was sometimes limited by SP fatigue, stress, or cognitive overload.
Conclusions:
- Authentic SP portrayals are vital for student learning.
- Structured training, feedback, and attention to SP well-being are recommended.
- Future research should focus on long-term SP impact and cognitive/cultural factors.
