Associated data for a theory of coexistence: healthcare educators assuming simulated patient roles

Educators don hospital gowns, steady their breathing, and assume the roles of simulated patients. Their voices quiver with carefully cultivated anxiety as students enter simulation suites. As the scenario unfolds, educators wonder: will the students learn? Will their learning objectives be met? Simultaneously, they juggle emotional labour, professional responsibility, and the ongoing tension between authenticity and pedagogy. This constructivist grounded theory study explored educators’ experiences, perceptions, and the consequences of assuming simulated patient roles, filling a critical gap in simulation-based education. While student learning is often prioritised, little attention has been given to the emotional, physiological, psychological and professional tolls on educators. This thesis introduces a theory of coexistence, which conceptualises the tension educators experience as they navigate their dual roles of altruistic facilitators of student learning and self-preserving individuals grappling with their own emotional and professional needs. The theory positions these competing motivations, altruism and egoism within the broader context of the educator's role, highlighting the inherent conflicts and coexistence of these forces. It provides a framework for understanding the emotional and psychological impact of simulation-based education, while also offering a lens through which to explore institutional support and the need for policies that protect educators' well-being and professional recognition. The findings reveal that educators were constantly torn between their altruistic dedication to student learning and egoistic concerns for professional recognition, emotional well-being and personal fulfilment. They also grappled with a strong sense of professional responsibility, balancing realism and authenticity while questioning whether their work was recognised as education rather than mere performance. As their immersion deepened, some found the experience rewarding, while others experienced internal conflict as they struggled to reconcile their commitment to student learning with their own emotional needs. These challenges were compounded by institutional gaps, as simulated patient roles were integrated into healthcare education without sufficient policies, standards or regulatory frameworks. Participants reported a lack of formal recognition, structured debriefing, and professional safeguards to mitigate the personal toll of these roles. The absence of clear institutional frameworks not only shifted responsibility onto individual educators but raised ethical concerns, threatened workforce sustainability, and exposed significant gaps in regulatory oversight and accountability in simulation-based education. The consequences of assuming simulated patient roles extended beyond individual experiences. The deep emotional engagement required in these roles often led to exhaustion, emotional strain, and difficulties in role detachment. Without formal debriefing structures, educators were left to manage these consequences on their own. Many felt their work remained undervalued, and advocated for greater institutional recognition, professional supervision, and peer support networks. These findings underscore the urgent need for policies, education and institutional safeguards to support educators, improve workforce sustainability, and strengthen simulation-based education. By centring educators in these discussions, this research expands the conversation on workforce retention and emphasises the need for regulatory frameworks that formally recognised and supported their contributions. It also contributes to the theoretical understanding of educator identity and role immersion in simulation-based education. Ultimately, this research highlights that behind each transformative simulation there is an educator carrying the silent weight of performance, care, and personal sacrifice. Their efforts deserve our recognition and our protection.

教育工作者身着病号服，调整呼吸，扮演模拟患者（simulated patient）的角色。当学生进入模拟实训套件（simulation suites）时，他们刻意营造出的焦虑令声音微微颤抖。随着模拟场景推进，教育工作者不禁思索：学生能否学有所成？预设的学习目标能否达成？与此同时，他们还要兼顾情感劳动、职业责任，以及真实性与教学法之间持续存在的张力。

本项建构主义扎根理论（constructivist grounded theory）研究探讨了教育工作者扮演模拟患者角色的经历、认知及其带来的后果，填补了模拟教育（simulation-based education）领域的一处关键空白。尽管学生的学习成果常被置于优先地位，但学界极少关注该角色给教育工作者带来的情感、生理、心理及职业层面的损耗。

本研究提出了共存理论（theory of coexistence），将教育工作者在双重角色中面临的张力进行概念化：他们既是利他的学生学习促进者，同时也是需要兼顾自身情感与职业需求的自我保护个体。该理论将利他主义与利己主义这两种相互竞争的动机，置于教育工作者角色的更广阔语境中，凸显了这些力量与生俱来的冲突与共存状态。它为理解模拟教育带来的情感与心理影响提供了分析框架，同时也为探讨制度支持以及制定保护教育工作者福祉与职业认可的政策提供了新视角。

研究结果显示，教育工作者始终在利他的学生学习奉献精神与利己的职业认可、情感福祉及个人成就感诉求之间摇摆不定。他们还承受着强烈的职业责任感，既要平衡场景的逼真性与真实性，又要质疑自身的工作是否被视作教育实践，而非单纯的表演。随着沉浸程度加深，部分教育工作者认为该经历颇具价值，但另有一些人则陷入了内心冲突：他们难以调和自身对学生学习的承诺与个人情感需求之间的矛盾。

由于模拟患者角色被纳入医疗教育体系时，并未配套足够的政策、标准或监管框架，这些挑战进一步加剧。受访对象表示，他们缺乏正式的职业认可、结构化的复盘（debriefing），以及能够减轻该角色个人损耗的职业保障机制。缺乏明确的制度框架不仅将责任转嫁至个体教育工作者身上，还引发了伦理层面的担忧，威胁到从业人员队伍的可持续性，并暴露了模拟教育领域在监管与问责层面的显著空白。

扮演模拟患者角色带来的影响远超个体体验范畴。该角色所需的深度情感投入，往往会导致身心疲惫、情绪紧张，以及难以从角色中抽离的困境。由于缺乏正式的复盘机制，教育工作者只能独自应对这些后果。许多人认为自身的工作未得到应有的重视，因此呼吁获得更多的制度认可、专业督导及同伴支持网络。

这些研究结果凸显了制定相关政策、开展专项培训以及建立制度保障机制的迫切性，以支持教育工作者、提升从业人员队伍可持续性，并强化模拟教育质量。本研究将教育工作者置于讨论的核心位置，拓展了关于从业人员留存的议题，并强调了需建立正式认可并支持其贡献的监管框架的必要性。同时，本研究也深化了对模拟教育领域教育工作者身份认同与角色沉浸的理论认知。

最终，本研究揭示了一个核心事实：每一场具有变革意义的模拟实训背后，都有一位教育工作者背负着表演、关怀与个人牺牲的无声重担。他们的付出理应得到我们的认可与保护。