Simulation-based healthcare training aims to offer learners invaluable hands-on experience while minimizing risks to real patients. This focus on patient safety should also extend to standardized patients (SPs), especially when they belong to marginalized communities like the LGBTQ+ population. Let us explore the potential psychological harms to SPs and the concrete strategies to mitigate them.

Identifying Potential Harms

When SPs are recruited based on their LGBTQ+ identity, they may be cast in roles that perpetuate stereotypes. For example, a gay SP might solely be used in HIV-related scenarios, simplifying a complex identity and creating emotional strain for the SP. This approach undermines the goal of cultural competency, which is to promote understanding and respect for diverse patient backgrounds rather than reinforcing existing biases and stereotypes.

SPs may also experience emotional burden and stress, particularly when simulating personal or traumatic experiences. Gender non-conforming SPs portraying patients seeking gender-affirming care are putting themselves in vulnerable positions that could bring up unpleasant feelings or traumas relating to societal discrimination or gender dysphoria, causing emotional strain that clashes with their professional role as an educator.

Additionally, microaggressions—subtle, often unintentional discriminatory comments—can have a cumulative negative impact. Incorrect pronoun usage or baseless assumptions about sexual orientation can create a hostile environment for the SP, even if done inadvertently.

Other forms of harm may include stigmatization, role confusion, stress, and anxiety. Stigmatization can result from scenarios that perpetuate harmful cultural or social norms. Role confusion happens when SPs struggle to separate their personal experiences from the simulated role. SPs may also experience stress and anxiety from high-fidelity simulations, especially if they are not adequately prepared or debriefed.

Implementing Strategies for Psychological Safety

Researchers have suggested a range of strategies to address these challenges. The first step is a robust screening and informed consent process. For instance, during the recruitment phase, SPs could be presented with a detailed list of scenarios they might enact, allowing them to opt out of potentially triggering roles. Detailed informed consent documents should also highlight the availability of psychological support services, empowering SPs to make fully informed decisions.

Breaks and rotations are not just logistical elements but crucial psychological safeguards. For example, in a full day of performances, SPs could be rotated every couple of hours and be provided with quiet, private spaces for rest and reflection. This minimizes the risk of emotional fatigue or burnout.

Prebrief and debrief sessions require special attention. Prebriefs should include logistical details and clear guidelines on respectful interaction and identification of potential triggers. Debrief sessions could benefit from the presence of a mental health professional who can facilitate a more nuanced discussion about the emotional and psychological aspects of the simulation.

De-rolling is a critical process, allowing SPs to gracefully transition from the immersive world of a patient simulation back into their own selves. It serves as a vital mechanism for safeguarding an SP's mental and emotional well-being, enabling them to separate from the role and reestablish their safety and agency. We suggest working this into the scenario training so SPs can enact this process throughout their performance day.

Lastly, gathering anonymous feedback from SPs after simulations can provide invaluable insights. Advanced data analytics tools can be utilized to identify patterns in SP experiences, enabling targeted improvements. This ensures a feedback loop that prioritizes both the educational experience's quality and SPs' well-being.

In conclusion, healthcare simulation training aims to offer safe, controlled learning environments. Yet, the safety of SPs—especially those from vulnerable communities like the LGBTQ+ population—must be of parallel concern. By being proactive and nuanced in our approach, we can safeguard their psychological well-being, enhancing the educational experience for everyone involved.

Struggling to provide a psychologically safe and inclusive training environment for your healthcare learners? Learn more about how Simclusive can elevate your training programs and foster true cultural responsiveness.