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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.
Purpose:
Simulated patients (SPs) are critical to simulation-based education (SBE) in developing learners' clinical, communication, and professional skills. However, limited research has examined the factors influencing SP performance and consequent learning outcomes.
Patients And Methods:
We conducted a systematic review (2013-2025) using six databases, focusing on human SPs in healthcare education. Nineteen studies met the inclusion criteria and were analyzed using inductive thematic analysis. Study quality was assessed using the QATSDD tool.
Results:
Inductive thematic analysis identified three key domains influencing SP performance: emotional (anxiety, fulfillment), cognitive (task complexity, improvisation), and logistical (training, scheduling). SP involvement enhanced educational outcomes (empathy, communication, clinical reasoning) but was sometimes limited by SP fatigue, stress, or cognitive overload. Among the reviewed studies, 7 were high and 12 were of medium quality (no low-quality studies).
Conclusion:
Authentic SP portrayals enhance student learning, but factors such as emotional strain and cognitive load can limit effectiveness. We recommend structured SP training, robust feedback mechanisms, and attention to SP cognitive and cultural challenges. Future research should prioritize long-term SP outcomes, measurement of SP cognitive load, and exploration of ethical and cultural dimensions of SP engagement.
