{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T11:58:59Z","timestamp":1785499139883,"version":"3.56.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Standardized patients (SPs) are a core modality in undergraduate medical education for teaching and assessing communication, history-taking, and clinical reasoning through simulated encounters and objective structured clinical examinations. Yet, scaling SP provision can be limited by financial cost, the availability of trained actors, and the faculty workload required for recruitment, training, and quality assurance (QA). A peer simulated patient (PSP) model, also described as \u201cstudents as patients\u201d or student standardized-patients model, trains senior medical students to portray SPs roles for junior learners and, in many designs, to provide structured feedback. This manuscript synthesizes evidence from systematic reviews and comparative studies of peer role-play, student SP, and occupational SP models and integrates peer-assisted learning theory, deliberate practice, and SP standards of best practice to propose an implementation framework suitable for medical schools. Available evidence suggests that peer simulation can be acceptable and sufficiently realistic for many educational goals, can yield learner outcomes comparable to occupational SPs in selected settings, may offer benefits for the senior students and may offer favorable cost profiles when programs are scaled. However, PSP programs may introduce risks, including variability in standardization, role confusion, confidentiality breaches, and psychological safety concerns for both junior learners and student-actors. We provide a stepwise framework covering recruitment, training (portrayal and feedback), QA, safeguarding psychological safety, and evaluation of outcomes for both learner and PSP cohorts. When carefully designed and governed, PSP programs can expand access to repeated, deliberate practice with feedback, strengthen senior students\u2019 teaching and professional identity formation, and reduce resource barriers to high-frequency simulation.<\/jats:p>","DOI":"10.1093\/postmj\/qgag100","type":"journal-article","created":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T11:52:44Z","timestamp":1783770764000},"source":"Crossref","is-referenced-by-count":0,"title":["Training medical students as peer simulated patients in undergraduate medical education: a narrative review and implementation framework"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4575-3888","authenticated-orcid":false,"given":"Uri","family":"Pollak","sequence":"first","affiliation":[{"name":"Section of Pediatric Critical Care, Hadassah University Medical Center , Ein Kerem, PO Box 12000, Jerusalem 9112001 ,","place":["Israel"]},{"name":"The Center for Medical Education, Faculty of Medicine, The Hebrew University of Jerusalem , Ein Kerem Campus, PO Box 12271, Jerusalem 9112102 ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yael","family":"Feinstein","sequence":"additional","affiliation":[{"name":"Pediatric Cardiac Intensive Care Unit, Schneider Children\u2019s Medical Center of Israel , 14 Kaplan Street, PO Box 559, Petah Tikva 4920235 ,","place":["Israel"]},{"name":"Dina Recanati School of Medicine, Reichman University , 8 HaUniversita Street, Herzliya 4610101 ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"2026073107213604400_ref1","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1097\/00001888-199306000-00002","article-title":"An overview of the uses of standardized patients for teaching and evaluating clinical skills","volume":"68","author":"Barrows","year":"1993","journal-title":"AAMC Acad Med"},{"key":"2026073107213604400_ref2","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/j.1365-2923.1979.tb00918.x","article-title":"Assessment of clinical competence using an objective structured clinical examination (OSCE)","volume":"13","author":"Harden","year":"1979","journal-title":"Med Educ"},{"key":"2026073107213604400_ref3","doi-asserted-by":"publisher","first-page":"e1437","DOI":"10.3109\/0142159X.2013.818634","article-title":"The objective structured clinical examination (OSCE): AMEE Guide No. 81. Part I: an historical and theoretical perspective","volume":"35","author":"Khan","year":"2013","journal-title":"Med Teach"},{"key":"2026073107213604400_ref4","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1080\/01421590903002821","article-title":"The use of simulated patients in medical education: AMEE Guide No 42","volume":"31","author":"Cleland","year":"2009","journal-title":"Med Teach"},{"key":"2026073107213604400_ref5","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/s41077-017-0043-4","article-title":"The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP)","volume":"2","author":"Lewis","year":"2017","journal-title":"Adv Simul (Lond)"},{"key":"2026073107213604400_ref6","doi-asserted-by":"publisher","first-page":"23","DOI":"10.3102\/0013189X023003023","article-title":"Use of standardized patients in clinical assessments: recent developments and measurement findings","volume":"23","author":"Vu","year":"1994","journal-title":"Educ Res"},{"key":"2026073107213604400_ref7","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1186\/s12909-015-0468-1","article-title":"Cost-effectiveness of peer role play and standardized patients in undergraduate communication training","volume":"15","author":"Bosse","year":"2015","journal-title":"BMC Med Educ"},{"key":"2026073107213604400_ref8","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1037\/0033-295X.100.3.363","article-title":"The role of deliberate practice in the acquisition of expert performance","volume":"100","author":"Ericsson","year":"1993","journal-title":"Psychol Rev"},{"key":"2026073107213604400_ref9","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1080\/01421590500046924","article-title":"Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review","volume":"27","author":"Issenberg","year":"2005","journal-title":"Med Teach"},{"key":"2026073107213604400_ref10","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1097\/ACM.0b013e318217e119","article-title":"Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence","volume":"86","author":"McGaghie","year":"2011","journal-title":"Acad Med"},{"key":"2026073107213604400_ref11","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1001\/jama.2011.1234","article-title":"Technology-enhanced simulation for health professions education: a systematic review and meta-analysis","volume":"306","author":"Cook","year":"2011","journal-title":"JAMA"},{"key":"2026073107213604400_ref12","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1111\/medu.14058","article-title":"Students as patients: a systematic review of peer simulation in health care professional education","volume":"54","author":"Dalwood","year":"2020","journal-title":"Med Educ"},{"key":"2026073107213604400_ref13","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1097\/SIH.0000000000000412","article-title":"Peer role-play for training communication skills in medical students: a systematic review","volume":"15","author":"Gelis","year":"2020","journal-title":"Simul Healthc"},{"key":"2026073107213604400_ref14","doi-asserted-by":"publisher","DOI":"10.1080\/0142159X.2025.2570820","article-title":"\u2018Acting it out really makes it stick in your brain\u2019: educating students for patient portrayal during peer simulation","volume":"48","author":"Dalwood","journal-title":"Med Teach"},{"key":"2026073107213604400_ref15","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/1472-6920-10-27","article-title":"Peer role-play and standardised patients in communication training: a comparative study on the student perspective on acceptability, realism, and perceived effect","volume":"10","author":"Bosse","year":"2010","journal-title":"BMC Med Educ"},{"key":"2026073107213604400_ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.rcsop.2021.100081","article-title":"Comparing trained student peers versus paid actors as standardized patients for simulated patient prescription counseling","volume":"4","author":"Willson","year":"2021","journal-title":"Explor Res Clin Soc Pharm"},{"key":"2026073107213604400_ref17","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1186\/s12909-023-04198-0","article-title":"Student standardized patients versus occupational standardized patients for improving clinical competency among TCM medical students: a 3-year prospective randomized study","volume":"23","author":"Zeng","year":"2023","journal-title":"BMC Med Educ"},{"key":"2026073107213604400_ref18","doi-asserted-by":"publisher","first-page":"1281","DOI":"10.1186\/s12909-025-07758-8","article-title":"Comparison of teacher-standardized patients and peer role-play in assessing medical students\u2019 history-taking skills","volume":"25","author":"Wei","year":"2025","journal-title":"BMC Med Educ"},{"key":"2026073107213604400_ref19","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1111\/tct.12016","article-title":"Medical student experience as simulated patients in the OSCE","volume":"10","author":"Burgess","year":"2013","journal-title":"Clin Teach"},{"key":"2026073107213604400_ref20","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1097\/SIH.0000000000000698","article-title":"The impact of the patient role on medical student learning during peer simulation: a qualitative phenomenological study","volume":"19","author":"Rudinsky","year":"2024","journal-title":"Simul Healthc"},{"key":"2026073107213604400_ref21","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.pec.2011.10.007","article-title":"The effect of using standardized patients or peer role play on ratings of undergraduate communication training: a randomized controlled trial","volume":"87","author":"Bosse","year":"2012","journal-title":"Patient Educ Couns"},{"key":"2026073107213604400_ref22","doi-asserted-by":"publisher","DOI":"10.1080\/10872981.2022.2045670","article-title":"Can patient-physician interview skills be implemented with peer simulated patients?","volume":"27","author":"Tengiz","year":"2022","journal-title":"Med Educ Online"},{"key":"2026073107213604400_ref23","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1080\/0142159X.2023.2291999","article-title":"Third year medical students acting as simulated patients in final year OSCEs: two birds, one stone?","volume":"46","author":"Patel","year":"2024","journal-title":"Med Teach"},{"key":"2026073107213604400_ref24","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1097\/SIH.0000000000000276","article-title":"Preparing physiotherapy students for clinical placement: student perceptions of low-cost peer simulation. A mixed-methods study","volume":"13","author":"Dalwood","year":"2018","journal-title":"Simul Healthc"},{"key":"2026073107213604400_ref25","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1080\/01421590701606799","article-title":"Peer teaching in medical education: twelve reasons to move from theory to practice","volume":"29","author":"Ten Cate","year":"2007","journal-title":"Med Teach"},{"key":"2026073107213604400_ref26","doi-asserted-by":"publisher","first-page":"157","DOI":"10.2147\/AMEP.S14383","article-title":"Medical students-as-teachers: a systematic review of peer-assisted teaching during medical school","volume":"2","author":"Yu","year":"2011","journal-title":"Adv Med Educ Pract"},{"key":"2026073107213604400_ref27","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1186\/1472-6920-14-115","article-title":"Medical students as peer tutors: a systematic review","volume":"14","author":"Burgess","year":"2014","journal-title":"BMC Med Educ"},{"key":"2026073107213604400_ref28","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1111\/medu.14672","article-title":"Peer-assisted learning in medical education: a systematic review and meta-analysis","volume":"56","author":"Brierley","year":"2022","journal-title":"Med Educ"},{"key":"2026073107213604400_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.nedt.2024.106377","article-title":"The influence of near-peer teaching on undergraduate health professional students\u2019 self-efficacy beliefs: a systematic integrative review","volume":"143","author":"Pierce","year":"2024","journal-title":"Nurse Educ Today"},{"key":"2026073107213604400_ref30","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1007\/s10459-006-9049-8","article-title":"Understanding the experience of being taught by peers: the value of social and cognitive congruence","volume":"13","author":"Lockspeiser","year":"2008","journal-title":"Adv Health Sci Educ Theory Pract"},{"key":"2026073107213604400_ref31","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1080\/01421590701477449","article-title":"Why medical students should learn how to teach","volume":"29","author":"Dandavino","year":"2007","journal-title":"Med Teach"},{"key":"2026073107213604400_ref32","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1097\/SIH.0000000000000047","article-title":"Establishing a safe container for learning in simulation: the role of the presimulation briefing","volume":"9","author":"Rudolph","year":"2014","journal-title":"Simul Healthc"},{"key":"2026073107213604400_ref33","doi-asserted-by":"publisher","first-page":"1349","DOI":"10.1080\/0142159X.2023.2214305","article-title":"Twelve tips for the pre-brief to promote psychological safety in simulation-based education","volume":"45","author":"Somerville","year":"2023","journal-title":"Med Teach"},{"key":"2026073107213604400_ref34","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s12909-019-1914-2","article-title":"Simulated patient\u2019s feedback to improve communication skills of clerkship students","volume":"20","author":"Qureshi","year":"2020","journal-title":"BMC Med Educ"},{"key":"2026073107213604400_ref35","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1080\/03075070600572090","article-title":"Formative assessment and self-regulated learning: a model and seven principles of good feedback practice","volume":"31","author":"Nicol","year":"2006","journal-title":"Stud High Educ"},{"key":"2026073107213604400_ref36","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/s12909-019-1898-y","article-title":"Peers as OSCE assessors for junior medical students\u2014a review of routine use: a mixed methods study","volume":"20","author":"Schwill","year":"2020","journal-title":"BMC Med Educ"},{"key":"2026073107213604400_ref37","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1080\/0142159X.2018.1457212","article-title":"Medical students\u2019 professional identity development from being actors in an objective structured teaching exercise","volume":"40","author":"De Grasset","year":"2018","journal-title":"Med Teach"},{"key":"2026073107213604400_ref38","doi-asserted-by":"publisher","first-page":"350","DOI":"10.2307\/2666999","article-title":"Psychological safety and learning behavior in work teams","volume":"44","author":"Edmondson","year":"1999","journal-title":"Adm Sci Q"},{"key":"2026073107213604400_ref39","volume-title":"StatPearls","author":"Madireddy","year":"2023"}],"container-title":["Postgraduate Medical Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/pmj\/advance-article-pdf\/doi\/10.1093\/postmj\/qgag100\/70409514\/qgag100.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/pmj\/advance-article-pdf\/doi\/10.1093\/postmj\/qgag100\/70409514\/qgag100.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T11:21:44Z","timestamp":1785496904000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/pmj\/advance-article\/doi\/10.1093\/postmj\/qgag100\/8748254"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":39,"URL":"https:\/\/doi.org\/10.1093\/postmj\/qgag100","relation":{},"ISSN":["1469-0756"],"issn-type":[{"value":"1469-0756","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,31]]},"article-number":"qgag100"}}