Coaching SPs

By: Beth Hallmark and Cedar Wang

Now that you have hired and scheduled the actor, coaching a standardized patient (SP) on his/her role is essential to ensure a safe, productive educational outcome for all involved. Like the director of a film or stage production, the SP trainer/coach directs and guides the actor to convey the story in the most meaningful and appropriate manner. According to the Association of Standardized Patient Educators Standards of Best Practice (Lewis et al., 2017), SP training should include how to portray the assigned role (including understanding the scenario objectives and scenario “flow”), how to give feedback, and, as applicable, how to complete evaluation instruments. How and when all this is done may vary, but key components of the coaching process are likely the same.

Objectives:  As is the case with any simulation scenario design, the learning objectives form the central thread from which everything else spins. First and foremost, the SP must understand the learning objectives to be able to guide the learner. Whether the communication of objectives takes place over email or in person, the nurse educator must ensure they are clearly understood.

Scenario Specifics and Support: Once the SP demonstrates an understanding of all scenario objectives, the nurse educator reviews the expected scenario flow. Providing this information in writing is critical so that the SP is able to rehearse and review independently. A character profile with medical and social history is helpful to support the SP in developing the character. Expected questions learners may ask and appropriate answers should be included in SP background materials. In addition, the SP should be aware of the facilitation method the educator plans to use. Will the scenario be paused or interrupted? How long is the scenario expected to last? Establishing a “safe word” or code word that the SP uses to stop the scenario for any reason protects the SP from unforeseen harm or discomfort. Some institutions use online training and others require training in person; the essential items are noted in the previously cited Standards of Best Practice.

Debriefing Expectations: As an active participant in the simulation educational process, the SP may or may not participate in debriefing the learner. If the nurse educator wishes the SP to take part in the debriefing, separate training and evaluation of debriefing methods are a prerequisite to this task. Expectations of time and debriefing topics should be clearly defined ahead of time. The unique perspective of the SP can offer useful insight, but a negative debriefing experience can distract the learner from the scenario objectives.

Completing Assessment Instruments: When training anyone to complete an evaluation instrument, it is imperative that the rater is familiar with the instrument and understands the skills to be evaluated. Training ensures interrater reliability.

SPs are a valuable simulation resource with exceptional potential to increase fidelity and facilitate immersive learning. Careful consideration of all aspects of SP coaching is a critical component of any simulation design. What about you? What advice do you have? How do you train SPs?


Lewis, K. L. , Bohnert, C. A. Gammon, W. L. , Hölzer, H., Lyman, L., Smith, C., . . . Gliva-McConvey, G. (2017). The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP). Advances in Simulation, 2, 10.

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