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Session Overview
Short Presentation5: Quality assurance of role portrayal of simulated patients - The current status of a multicenter qualitative-exploratory study (Peters, Tim; Bauer, Daniel; Brem, Beate; Eberz, Peter; Goerges, Ulf; Schwarz, Laura; Weckmann, Gesine; Thrien, Christian)
Wednesday, 31/Aug/2022:
3:30pm - 5:00pm

Location: CHUV auditorium Auguste Tissot

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Quality assurance of role portrayal of simulated patients - The current status of a multicenter qualitative-exploratory study

Tim Peters1, Daniel Bauer2, Beate Brem2, Peter Eberz3, Ulf Goerges4, Laura Schwarz5, Gesine Weckmann6, Christian Thrien7

1University of Bielefeld, Germany; 2University of Bern, Switzerland; 3Charité Berlin, Germany; 4University of Oldenburg, Germany; 5University of Witten/Herdecke, Germany; 6University of Applied Sciences Rhein/Erft, Germany; 7University of Köln, Germany


Working with simulated patients (SPs) is an established and indispensable method in medical education (Cleland et al. 2009, Lewis et al. 2017, Nestel 2015). In this context, adequate role portrayal and its quality assurance are of great importance both in teaching and, in particular, in standardized, summative assessments. Tensions may occur between role specifications and local contextual conditions on the one hand and a credible and authentic role portrayal on the other. With the Fair-OSCE (Brem et al. 2015), the Maastricht assessment of Simulated Patients (Wind et al. 2004) and the Nijmegen Evaluation of the Simulated Patient (Bouter et al. 2013), tools exist that focus partly on the role portrayal of SPs in medical education, but a broad, scientific evaluation of the importance of good role portrayal and relevant aspects of quality assurance is lacking so far in the international literature.


To address this research gap, a working group was formed within the German Society for Medical Education’s standing committee on simulated persons and the following research questions were formulated: (1) What is the influence of the quality of simulated patients’ role portrayal for the achievement of learning objectives/examination goals in health professions education? (2) What is good role portrayal in the context of simulations in health professions education? Subsequently, a research concept was created to address these questions. Taking a qualitative-explorative approach, semi-structured interviews and focus groups will be conducted at institutions of medical and health professions education in the German-speaking countries Austria, Germany, and Switzerland. The audio data will be transcribed according to the GAT 2-scheme (Selting et al. 2009) and subsequently analyzed inductively according to qualitative content analysis (Mayring 2000) following concepts of grounded theory.


In the course of the multicenter preparations, the four stakeholder groups, students, lecturers, SP-trainers, and simulated patients were identified. For each stakeholder group, relevant aspects of role portrayal and quality assurance were identified in several workshop rounds over a period of 2 years and interview guides for the stakeholder groups were developed and consented. To gather data from both individual statements and group-dynamic discussions, individual semi-structured interviews and focus group discussions are planned with each stakeholder group. IRB approval for this study is in progress and the study start is planned for the summer or early fall 2022; first results can be expected in spring 2023.


Despite the high significance of employing SP methodology, the understanding of terms such as "quality" and "good acting" or "sufficient role portrayal" can vary greatly depending on the perspective. Research is needed to address this lack of standardization. Because of the high effort of the research needed to address this issue, it is of central importance for the group of authors to discuss the concept with experts in the international area before it goes into implementation.


Brem B, Christen R, Richter S, Schnabel K. Anwendung einer Liste von Qualitätsmerkmalen des Rollenspiels von SPs im Rahmen von OSCE-Prüfungen. Poster presented at: Annual Conference of the German Association for Medical Education; 30. Sep to 03. Oct 2015; Leipzig, Germany.

Bouter S, van Weel-Baumgarten E, Bolhuis S. Construction and validation of the Nijmegen Evaluation of the Simulated Patient (NESP): assessing simulated patients’ ability to role-play and provide feedback to students. Acad Med. 2014;88(2):253-259. DOI: 10.1097/ACM.0b013e31827c0856.

Cleland JA, Abe K, Rethans JJ. The use of simulated patients in medical education: AMEE Guide No 42. Med Teach. 2009;31(6):477-486. DOI: 10.1080/01421590903002821.

Lewis KL, Bohnert CA, Gammon WL, Hölzer H, Lyman L, Smith C, Thompson TM, Wallace A, McConvey GM. The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP). Adv Simul. 2017;2:10. DOI: 10.1186/s41077-017-0043-4.

Mayring P. Qualitative Inhaltsanalyse. Weinheim: Beltz; 2010.

Nestel D, Bearman M. Simulated Patient Methodology: Theory, Evidence and Practice. Chichester: John Wiley & Sons; 2015.

Selting M, Auer P, Barth-Weingarten D, Bergmann J, Bergmann P, Birkner K, Couper-Kuhlen E, Deppermann A, Gilles P, Gunthner S, Hartung M, Kern F, Mertzlufft C, Meyer C, Morek M, Oberzaucher F, Peters J, Quasthoff U, Schutte W, Stukenbrock A, Uhmann S. Gesprächsanalytisches Transkriptionssystem 2 (GAT 2). Gesprächsforschung – Online-Zeitschrift zur verbalen Interaktion. 2009;10:353-402.

Wind LA, van Dalen J, Muijtjens AMM, Rethans JJ. Assessing simulated patients in an educational setting: the MaSP (Maastricht Assessment Simulated Patients). Med Educ. 2004;38(1):39-44. DOI: 10.1111/j.1365-2923.2004.01686.x.

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