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.

教育工作者身着医院病号服，平复呼吸，扮演模拟患者（simulated patient）的角色。当学生进入模拟实训空间（simulation suites）时，他们刻意营造出颤抖的焦虑语气。随着场景推进，教育工作者不禁思索：学生们能否学有所成？教学目标能否达成？与此同时，他们还要兼顾情绪劳动（emotional labour）、职业责任，以及真实性与教学法（pedagogy）之间持续存在的张力。本项建构主义扎根理论（constructivist grounded theory）研究探索了教育工作者扮演模拟患者角色的经历、感知及其影响，填补了模拟教学（simulation-based education）领域的一处关键空白。过往研究往往将学生的学习置于优先地位，却极少关注这一角色给教育工作者带来的情绪、生理、心理与职业层面的损耗。本研究提出了共存理论，将教育工作者在周旋于双重角色时所经历的张力概念化：一方面他们是助力学生学习的利他性引导者，另一方面又是需要应对自身情绪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，凸显了这些力量固有的冲突与共存状态。它为理解模拟教学带来的情绪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视角。研究结果显示，教育工作者始终在利他性的学生学习投入与利己性的职业认可、情绪福祉与个人成就感诉求之间摇摆。他们还背负着强烈的职业责任感，既要平衡教学场景的真实性与可信度，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这一经历颇具价值，但也有一些人陷入了内心冲突，难以调和对学生学习的承诺与自身的情绪需求。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、标准或监管监督（regulatory oversight）框架，这些挑战进一步加剧。参与者表示，目前缺乏正式的职业认可、结构化的复盘研讨（debriefing）以及缓解该角色带来的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给了个体教育工作者，还引发了伦理层面的担忧，威胁到从业队伍的可持续性，并暴露了模拟教学领域监管监督与问责机制的显著空白。扮演模拟患者角色带来的影响远超个体体验范畴。这类角色所需的深度情感投入，往往会导致倦怠、情绪紧张以及角色抽离困难。在缺乏正式复盘研讨机制的情况下，教育工作者只能自行应对这些后果。许多教育工作者认为自身的工作未得到应有的重视，他们呼吁获得更多的制度认可、专业督导与同伴支持网络。这些研究结果凸显了制定政策、开展相关教育以及建立制度保障机制的迫切性，以支持教育工作者、提升从业队伍可持续性，并完善模拟教学体系。本研究将教育工作者置于讨论的核心位置，拓展了关于从业队伍留存的讨论，并强调了制定正式认可并支持其贡献的监管框架的必要性。同时，本研究也丰富了对教育工作者身份认同以及模拟教学中角色沉浸的理论认知。归根结底，本研究揭示了每一场变革性的模拟教学背后，都有一位背负着表演、关怀与个人牺牲的无声重担的教育工作者。他们的付出理应得到我们的认可与保护。