johs Journal of Healthcare Simulation J Healthc Simul 2754-4524 Association for Simulated Practice in Healthcare London, UK HNRE6804 10.54531/HNRE6804 Protocol Volunteer simulated participants in healthcare providers’ education: a scoping review protocol https://orcid.org/0000-0001-6645-0168SmithCathy M.1 https://orcid.org/0000-0001-9770-2540AdamsMeaghan S.12 https://orcid.org/0000-0002-5238-0995HarlimJennifer3 https://orcid.org/0000-0003-2941-2298NestelDebra34 https://orcid.org/0000-0003-3583-8519SokoloffLisa Guttman56 WalshKillian7 https://orcid.org/0000-0002-4886-9691DoyleAndrea J.8 Baycrest Academy for Research and Education, Baycrest Centre for Geriatric Care, Toronto, Canada Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada School of Clinical Sciences, Monash University, Clayton, Australia Department of Surgery (Austin Precinct), University of Melbourne, Melbourne, Australia Faculty of Applied Health and Community Studies, Sheridan College, Brampton, Canada Department of Speech Pathology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada Library, RCSI University of Medicine and Health Sciences, Dublin, Ireland RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland Corresponding author: Cathy M. Smith, smith.cathy06@gmail.com 28052026 1 8 13122025 07042026 © The Author(s). 2026 2026 This article is distributed under the terms of the Creative Commons Attribution-Share Alike 4.0 International License (https://creativecommons.org/licenses/by-sa/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated). Introduction

Working with simulated participants (SPs) offers many benefits in healthcare providers’ simulation-based education. Although many SP programmes compensate SPs for their involvement, there are reports of volunteer simulated participant (VSP) programmes, where SPs contribute their time without financial compensation. Considerable variation exists in how their work is defined, documented and supported. Research is needed to clarify current practices and inform the development of future standards and frameworks for engaging with VSPs. This article describes the protocol for a scoping review addressing this gap.

 Research question

This scoping review asks: what is known about VSPs in healthcare providers’ education?

 Methods

This scoping review protocol follows Arksey and O’Malley’s framework as progressed by Levac et al. and guided by the Joanna Briggs Institute guidelines will be followed, including engaging knowledge users in a ‘co-creation through consultation’ process.

 Anticipated findings and implications

Findings will map current VSP practices, identify challenges and benefits and generate evidence-informed recommendations to guide the development of standards and frameworks for engaging with VSPs.

 Keywords volunteer simulated participants simulated patients simulation-based education healthcare providers’ education healthcare providers’ training scoping review knowledge user pmc-domainjohs article-lifecycle PAP crossmark 2026-05-28T18:20:17 Introduction<span id="s1" nov-type="cross-ref"/>

Simulated participants (SPs) are human role players in simulation who are trained to portray other people, such as patients, family members or health professionals. SPs interact with learners in education, assessment and research contexts. They may also provide feedback to and/or assess learners [1,2]. The value of working with SPs in healthcare providers’ education is well established: they enhance realism, offer authenticity, reinforce a human perspective, support the development of clinical reasoning and communication skills and provide feedback to learners from their unique perspective experiencing the interaction [3–12]. Although many SP programmes compensate SPs for their involvement, there are reports of volunteer simulated participant (VSP) programmes [13–16]. The literature suggests that these programmes are established for varied reasons across contexts; however, the underlying drivers remain unclear [14,17–19].

We define a VSP as a human role player who freely and willingly contributes their time in supporting simulation-based activities. They are unpaid for their work, but may receive small stipends, tokens of appreciation or reimbursements (e.g. for meals, transportation, parking). Their participation is motivated by personal motivations such as their interests, desire to learn, wish to create social connections and/or sense of service rather than any kind of obligation (e.g. educational, administrative). We derived this definition from the criteria established by the International Conference of Labour Statisticians (ICLS) [20].

VSPs work across diverse educational settings [21–26] and come from varied backgrounds, including faculty, staff, family or social circles of faculty or staff, alumni, clinicians, laypersons, actors, community members and learners [8,13,15,23,27–30].

Reported benefits of working with VSPs include perceptions of cost effectiveness, availability and friendliness [8,21,30–32]. VSPs with content expertise (e.g. healthcare providers) have been rated by learners as being more authentic and engaging in their role portrayal and feedback and perceived by educators as requiring less training or supervision because of their knowledge and experience [13,29]. VSPs themselves describe benefits such as filling a vocational void (e.g. after retirement), developing new skills, engaging in personal learning, finding satisfaction from supporting learners and the healthcare system, experiencing a sense of purpose and well-being and building social connections [16,19,22,33–36]. These benefits align with findings from various general studies related to the benefits of volunteerism – both for organizations and volunteers [37–39].

Noted challenges include role drift (e.g. content expert VSPs slipping into an instructor role), institutional underfunding driven by the assumption that volunteers require minimal support, and fluctuating levels of VSP commitment, reliability, interest and availability [15,21,29,40]. VSPs report concerns about unclear expectations regarding their workload and level of responsibility, insufficient recognition or being asked to do work that does not align with their motivations [16,22,35,36,41].

Despite some literature detailing the work of VSPs, there is inconsistency in how VSP practice is defined, documented and supported in healthcare providers’ simulation-based education [8,15,32,42]. While globally recognized frameworks for volunteer engagement address ethics, recruitment, preparation, training, management and evaluation [43,44], their integration with SP methodology is under-documented. The Association of SP Educators (ASPE) Standards of Best Practice (SOBP) [2] provide comprehensive guidance for human role players in simulation, but do not specifically address the engagement of VSPs. These gaps underscore the need for research to clarify current practices and inform the development of future standards and frameworks for engaging with VSPs, including the nature, scope and structure of their involvement.

Rationale for scoping review methodology

A scoping review methodology was selected for this study because the aim is to broadly explore the topic of VSPs in healthcare education. This methodology allows for the inclusion of diverse types of evidence, providing a comprehensive overview of current practices, definitions and supporting strategies [45,46]. By mapping the breadth of available literature, a scoping review will enable our team to identify gaps, summarize existing knowledge and inform future research and policy development in this emerging area.

To ensure that this broad exploration produces relevant and actionable findings, the review process will actively engage knowledge users (KUs). In health professions education, involving KUs enhances the quality, relevance and impact of scoping review findings [47]. Their input helps align the research question, inclusion criteria and dissemination strategies with real-world needs, making the evidence more credible and useful for educators, practitioners and policymakers [48]. Meaningful engagement with KUs also helps identify literature gaps, prioritize topics, foster co-learning, promote transparency and prevent tokenistic participation [49]. Overall, this collaborative approach strengthens the review’s ability to produce evidence that is responsive to the evolving challenges and opportunities in simulation-based education.

 Research team<span id="s3" nov-type="cross-ref"/> Core research team

The core research team will lead the design, administration and reporting of the scoping review. This team comprises individuals with expertise in simulation-based education, including working with VSPs, healthcare education research and scoping review methodology, as well as an information specialist. They work in three countries – Australia, Canada and Ireland. The core research team will liaise closely with KUs throughout the review to ensure that KU insights inform all stages of the process, including developing the search strategy, screening and selecting studies, extracting and charting data and synthesizing the findings. The core research team will also ensure methodological rigour, resolve conflicts during screening or extraction and oversee the iterative refinement of the data extraction tool.

 Knowledge users

KUs are individuals or groups who are positioned to apply research findings in practice, policy or education and whose experiential and contextual expertise can strengthen the relevance, legitimacy and societal impact of a study [50]. In health and applied research contexts, KUs are typically engaged as partners rather than passive recipients of evidence, contributing to shaping research questions, refining concepts and interpreting findings to enhance real-world relevance [49]. In this manuscript, KUs who work with VSPs were identified via our professional networks. We approached them for their interest in participating. KUs will be engaged throughout the review to provide practical insights and ensure the findings are relevant to real-world simulation education contexts. KUs consulted will include simulation educators, programme directors, researchers and VSPs from Australia, France, the UK and the USA. They will contribute to refining the research question, confirming the comprehensiveness of data extraction categories and interpreting preliminary findings. KU engagement will occur via structured synchronous and asynchronous consultation to facilitate co-creation of knowledge and enhance the applicability of review recommendations [49].

 Methods<span id="s6" nov-type="cross-ref"/>

We are following the six-stage scoping review framework described by Arksey and O’Malley [45] and progressed by Levac et al. [46] to include the additional stage of involving KUs in the process. Our review will follow the Joanna Briggs Institute (JBI) guidelines, which build upon this framework and will be reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Scoping Review extension (PRISMA-ScR) [51]. This approach was selected because it is designed to guide scoping reviews that map the breadth and nature of existing literature, which aligns with the objectives of this study.

Stage 1: identifying the research question

The aim of this review is to explore and summarize what is known about VSPs in healthcare providers’ education. The Population, Context, Concept (PCC) framework, recommended by the JBI [52], was used to guide the formulation of the research question:

P (population) – volunteer SPs

C (concept) – simulation-based education for healthcare providers

C (context) – any – e.g. simulation centre in an academic institution or hospital, in situ

Review question

What is known about VSPs in healthcare providers’ education?

 Review objectives

To explore and summarize what is known about VSPs in healthcare providers’ education.

To synthesize and present current practices in light of the findings of the review.

To provide recommendations for working with VSPs, considering the findings of the review.

To highlight gaps in what is known about this topic that would benefit from future research.

Stage 2: identifying the relevant studies

In consultation with an information specialist (KW), using keywords from the previously outlined population, concept and context framework, a search strategy was developed and adapted for each database, including Ovid Medline, Embase, Ebsco Cinahl Ultimate, Scopus, Web of Science, PubMed and Ebsco APA PsycINFO. The strategy is presented in the Supplementary Material. Index terms and keywords from articles that were identified by the core research team informed the comprehensive search strategy. KUs were consulted to ensure search terms are correctly contextualized to their geographical region and area of speciality. After executing the search strategy, reference lists of the included studies will be hand-searched to identify further sources of information.

 Stage 3: study selection Eligibility criteria

The eligibility criteria will be applied to identify relevant literature relating to the focus of the study as well as intervention, study and publication characteristics. We will include studies that engage VSPs, related to interventions for education, assessment or research in healthcare providers’ education. All qualitative and quantitative methodologies, primary research and book chapters will be considered. We will include publications from all countries, written in English, where a full text is available. There is no restriction on the publication dates.

We will exclude studies that do not engage VSPs. There are other types of individuals who are described as VSPs or volunteer patients but, based on our criteria, are not included:

‘Paid volunteers’ refers to SPs who participate in time-limited projects and who are not considered employees of an institution (not even contractual). Their contribution is acknowledged through a stipend reimbursing their time and involvement (on an hourly rate). They are recruited only when needed for a specific session. These SPs are not volunteers by our definition as they are getting paid an hourly rate rather than freely donating their time; they are functioning as contractors [53].

Peer simulation refers to learners who are SPs for their own or related cohorts. When this participation is required by the curriculum or institution, it does not constitute voluntary engagement. However, if learners volunteer for other educational contexts not associated with their course of study or for credit, they would be considered a VSP [54].

SPs who are not paid but whose participation is incentivized with access to free or reduced cost healthcare are not VSPs. Access to free or reduced-cost healthcare may compromise the voluntary nature of their participation and introduce ethical or equity concerns.

‘Expert’ or ‘real’ or ‘volunteer’ patients, that is, individuals who directly use/share their actual lived experiences may be referred to as volunteers. If these individuals are described as being trained as SPs, they will be included. Individuals who are participating to share their lived experience without SP training will be excluded [55].

We will also exclude interventions that are not focused on healthcare providers’ education. Review articles, opinion pieces, perspective pieces, book reviews, letters, posters, conference abstracts, editorials and grey literature will be excluded from data extraction. Review articles will be used to identify additional articles, and relevant articles from this excluded group will be identified to support the final review manuscript. The eligibility criteria for this review are summarized in Table 1.

Eligibility criteria

Include Exclude
Focus of the study Studies that engage VSPs. Studies that do not engage SPs in a volunteer capacity as we have defined it.
Intervention characteristics Interventions involving VSPs for education, assessment or research in healthcare providers’ education. Education that does not involve healthcare simulation.
Study characteristics All qualitative and quantitative methodologies, primary research and book chapters. Review articles will be used to identify additional articles but will be excluded from data extraction. Opinion pieces, perspective pieces, book reviews, letters, posters, conference abstracts, editorials and grey literature will be excluded from data extraction, but relevant studies will be identified to support the final review manuscript.
Publication characteristics All countries, English language only, full text available, not restricted by publication date. Studies written in languages other than English, no full text available.
Study selection

An information specialist (KW) will support the development and execution of the search strategy. All retrieved references will be exported to Covidence for screening. (Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia. Available at www.covidence.org) Covidence will facilitate collaboration among team members and streamline accessibility throughout the review process. Screening will be conducted in two stages: Step 1 – title and abstract screening; Step 2 – full-text review. Each of these steps will be completed independently by at least two reviewers. Reasons for full-text exclusion will be documented and reported in the PRISMA diagram. A pilot screening exercise will be undertaken to ensure the inclusion criteria are applied consistently, and any discrepancies will be resolved through discussion with a third member of the core research team.

 Stage 4: data charting

The core research team will refine a data extraction tool outlining key information to be charted, including:

Article metadata

Ref # or Manuscript TAG

Authors

Title of article

Year of publication

Name of journal

Country of first author

Geographical location (country) where VSPs work

Ethics approval reported

DOI

Article description

Type of article

Does the article describe a research study?

If yes, describe the research paradigm (e.g. qualitative, quantitative, mixed methods)

Aim of article/research question(s)

Methods

Research findings

Conclusion

Context of VSP simulation scenario

Are the scenarios for formative or summative purposes?

Is an aim/learning objectives/desired outcome (e.g. recognizing and managing confusion in an older patient in the ED) stated?

Role portrayed by VSP? (e.g. patient, family member, health professional)

Description of the VSP role characterization (e.g. patient is confused)

Setting (e.g. Emergency Department)

Learner group (e.g. Nursing Students)

Mode of delivery (e.g. face-to-face, online)

Simulation modalities used (e.g. SP methodology only or SP methodology combined with other modalities)

Characteristics of implementation of scenario (e.g. number of VSPs who participated, number of learners, length of session)

VSP details

Term(s) used to describe VSP

Reported age/age range of VSP(s)

Age/age range of character(s) portrayed by VSP

Background of VSP (e.g. professional actor, lay person, faculty member, content expert)

Description of specific characteristics of VSP (e.g. gender, race, ethnicity)

VSP scenario

Was a role or scenario provided?

Comment on role/scenario

Was information provided about role/scenario development?

If yes, describe.

VSP training for role portrayal, feedback and/or assessment

Was someone responsible for training the VSP?

If yes, describe

Is training for role portrayal provided for the VSP?

If yes, describe.

Did VSPs give feedback to learners?

If yes:

Is the process for training them described?

Are details about their participation in feedback conversations with learners described?

Did VSPs assess learners?

If yes, is the type of assessment described?

If yes, is the process for training them described?

VSP programme management

Was the reason for working with volunteers stated?

If yes, describe

Is there an established volunteer programme in the institution/setting where VSPs are recruited?

Were there any volunteer engagement frameworks/strategies reported?

If yes, describe

Was the VSP recruitment process described?

If yes, describe.

Was the onboarding process for VSPs described? (e.g. were they given a general orientation and training before training for their first role)

If yes, describe

Is there any information about how VSPs are kept engaged or retained in a programme?

If yes, describe

Were the benefits of working with VSPs mentioned? (e.g. cost effectiveness)

If yes, describe

Were any challenges in working with VSPs outlined?

If yes, describe

Describe any special considerations given to working with volunteer SPs.

Additional notes

Was there reference made to the ASPE SOBP?

If yes, describe.

Was there anything interesting/additional to add?

What are the reviewer’s key thoughts beyond the outcomes reported?

The draft data extraction form will be tested by the core research team using a sample of the included studies and refined iteratively based on feedback. Once finalized, the same approach will be applied to extract data from the remaining articles. Any disagreements will be discussed among reviewer pairs, with input from a third reviewer when consensus cannot be reached.

Data extracted using the charting tool will be used to address the review objectives. Findings will be summarized in both narrative and tabular form, with figures included where relevant. The study selection process will be illustrated using a PRISMA flow diagram [52], following the PRISMA-ScR guidelines [51].

 Stage 5: data synthesis and reporting

A descriptive analytical approach will be used, aligning with the objectives of a scoping review. The included studies will be examined narratively to summarize key findings and trends. A numerical summary will be presented to outline study characteristics, including publication year, study design, population demographics and context. The discussion will highlight the practical implications of the findings, identify gaps in the existing literature and suggest directions for future reviews and primary research. The format and structure of data presentation will be further refined following analysis of the review findings.

 Stage 6: KU engagement

KUs will be engaged throughout the review process to ensure the findings are relevant and applicable to simulation-based education practice. Consistent with the extension of the Arksey and O’Malley framework [45] by Levac et al. [46], KU engagement will include educators, researchers, programme directors and VSPs. The engagement process will follow the co-creation through consultation approach outlined by Doyle et al. [49], promoting active and meaningful engagement with KUs at all stages of the review. KUs contributed to refining the research question and eligibility criteria and to advising on search terms in the development of this protocol. It is planned that KUs will continue to support the review and will confirm the clarity and comprehensiveness of data charting categories. They will also be consulted during the interpretation of findings to validate key characteristics of the data and inform practical recommendations. This iterative consultation will take place through online meetings and e-mail correspondence. Engaging the panel of KUs in these stages will help ensure that the review captures the breadth of perspectives on VSPs, supports translation of findings into practice and identifies priorities for future research. We acknowledge the author team and KUs are positioned in the Global North. While we have made efforts to engage with KUs from the Global South, structural barriers have made this difficult. Challenges include that their SP programmes fell outside of the inclusion criteria and/or time frames did not permit participation. We recognize this is a limitation of the work and will frame our findings as such in the resulting manuscript.

 Anticipated findings and implications for practice<span id="s17" nov-type="cross-ref"/>

This scoping review will explore what is currently known about working with VSPs in healthcare providers’ education. The findings are expected to map existing practices, terms and contexts in which VSPs contribute to education, assessment and research, while identifying any gaps and inconsistencies in how they are supported to do their work. This synthesis will provide a clearer understanding of current approaches and offer recommendations to guide those working with VSPs. The results are anticipated to inform the refinement of simulation standards, policies and frameworks and to identify priorities for future research and guideline development for those working with VSPs.

 Acknowledgements<span id="a1" nov-type="cross-ref"/>

We would like to thank the KU group: Krista Anderson, Anne Bellot, Neil Harrison and Kiran Thwaites. We would also like to thank Tonya Mahar, Manager, Library Services at Baycrest for her support with the literature search.

 Supplementary material<span id="s18" nov-type="cross-ref"/>

Supplementary data are available at Journal of Healthcare Simulation online.

 Declarations<span id="s19" nov-type="cross-ref"/> Authors’ contributions

CMS and MSA conceived the initial idea for the study. CMS, MSA, JH, DN, LGS and AJD devised the research protocol. KW oversaw the search strategy. CMS and AJD drafted the initial protocol manuscript. KUs were consulted at the protocol stage and provided feedback on the proposed scoping review, which was integrated into the document. All authors contributed to the revision and editing of the manuscript and have reviewed and approved the final manuscript.

 Funding

This research is not funded.

 Availability of data and materials

Not applicable.

 Ethics approval and consent to participate

Not applicable.

 Competing interests

There are no conflicts of interest in this project. CS, DN and AD declare that they are members of the editorial board of JoHS.

 References<span id="nov000-30" nov-type="cross-ref"/> Bearman M, Nestel D. The future of simulated patient methodology. In: Nestel D, Bearman M, editors. Simulated patient methodology: theory, evidence and practice. Chichester: Wiley. 2015. p.145–149. Lewis KL, Bohnert CA, Gammon WL, Hölzer H, Lyman L, Smith C, et al The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP). Advances in Simulation. 2017;2(1):10. doi: 10.1186/s41077-017-0043-4 Clark L, Doyle A, Elcin M, McNaughton N, Nicholas C, Owens T, et al Call to action: honoring simulated participants and collaborating with simulated participant educators. Simulation in Healthcare. 2025;20(4):211–214. doi: 10.1097/SIH.0000000000000840 Bokken L, Rethans JJ, Van Heurn L, Duvivier R, Scherpbier A, Van Der Vleuten C. Students’ views on the use of real patients and simulated patients in undergraduate medical education. Academic Medicine. 2009;84(7):958–963. doi: 10.1097/ACM.0b013e3181a814a3 Nestel D, Burn CL, Pritchard SA, Glastonbury R, Tabak D. The use of simulated patients in medical education: guide supplement 42.1 Viewpoint. Medical Teacher. 2011;33(12):1027–1029. doi: 10.3109/0142159X.2011.596590 Ma J, Lee Y, Kang J. Standardized patient simulation for more effective undergraduate nursing education: a systematic review and meta-analysis. Clinical Simulation in Nursing. 2023;74:19–37. doi: 10.1016/j.ecns.2022.10.002 Siew AL, Wong JW, Chan E-Y. Effectiveness of simulated patients in geriatric education: a scoping review. Nurse Education Today. 2021;100:104856. doi: 10.1016/j.nedt.2021.104856 Cleland JA, Abe K, Rethans JJ. The use of simulated patients in medical education: AMEE Guide No 42.1. Medical Teacher. 2009;31(6):477–486. doi: 10.1080/01421590903002821 Doyle AJ, Sullivan C, O’Toole M, Tjin A, Simiceva A, Collins N, et al Training simulated participants for role portrayal and feedback practices in communication skills training: a BEME scoping review: BEME Guide No. 86. Medical Teacher. 2024;46(2):162–178. doi: 10.1080/0142159X.2023.2241621 Lovink A, Groenier M, van der Niet A, Miedema H, Rethans J-J. The contribution of simulated patients to meaningful student learning. Perspectives on Medical Education. 2021;10:341–346. doi: 10.1007/s40037-021-00684-7 Nestel D, Sanko J, McNaughton N. Simulated participant methodologies: maintaining humanism in practice. In: Nestel D, Kelly M, Jolly B, Watson M, editors. Healthcare simulation education: evidence, theory and practice. Oxford: Wiley-Blackwell. 2018. p. 45–53. Nestel D, McNaughton N, Smith C, Schlegel C, Tierney T. Values and value in simulated participant methodology: a global perspective on contemporary practices. Medical Teacher. 2018;40(7):697–702. doi: 10.1080/0142159X.2018.1472755 Mavis B, Turner J, Lovell K, Wagner D. Developments: faculty, students, and actors as standardized patients: expanding opportunities for performance assessment. Teaching and learning in medicine. 2006;18(2):130–136. doi: 10.1207/s15328015tlm1802_7 Sokoloff LG, Smith CM, Bellot A, Gao SP. Working with volunteer older adult simulated participants. In: Smith CM, Alsaba N, Sokoloff LG, Nestel D, editors. Comprehensive healthcare simulation: geriatric simulation training – a focus on older adults as simulated participants. Cham: Springer Nature. 2024. p.85–94. Nestel D, Calandra A, ElIiott RA. Using volunteer simulated patients in development of pre-registration pharmacists: learning from the experience. Pharmacy Education: An International Journal of Pharmaceutical Education. 2007;7(1):35–42. doi: 10.1080/15602210601084440 Carlton KH. Community and alumni volunteers enhancing simulation fidelity and quality across curriculum: lab coordination and management perspective. Clinical Simulation in Nursing. 2012;8(8):e396–e397. doi: 10.1016/j.ecns.2012.07.031 Nestel D, Tierney T, Kubacki A. Creating authentic simulated patient roles: working with volunteers. Medical Education. 2008;42(11):1122. doi: 10.1111/j.1365-2923.2008.03196.x Cleland J, Abe K, Rethans J. The use of simulated patients in medical education: AMEE Guide No 42.1. Medical Teacher. 2009;31(6):477–486. doi: 10.1080/01421590903002821 Ho Y-C, Kao S-P, Chen C-H, Chu S-Y. Older Taiwanese volunteers as standardized patients: service motivation, identity formation, and internal transformation. Simulation in Healthcare. 2024;19(3):158–163. doi: 10.1097/SIH.0000000000000754 International Labour Organization. Work Statistics – 19th International Conference of Labour Statisticians (ICLS) (WORK database). Geneva: ILO. 2013. Available from: https://ilostat.ilo.org/methods/concepts-and-definitions/description-work-statistics-icls19/#elementor-toc__heading-anchor-14 [Accessed 13 November 2025]. Smithson J, Bellingan M, Glass B, Mills J. Standardized patients in pharmacy education: an integrative literature review. Currents in Pharmacy Teaching and Learning. 2015;7(6):851–863. doi: 10.1016/j.cptl.2015.08.002 Hackel JM, Roberts TME. The effectiveness of an educational project using older adult volunteers for training primary care nurse practitioners in geriatric assessment. Journal of Nursing Education and Practice. 2020;10(3):51–56. doi: 10.5430/jnep.v10n3p51 Gamble A, Bearman M, Nestel D. A systematic review: children & adolescents as simulated patients in health professional education. Advances in Simulation. 2016;1(1):1. doi: 10.1186/s41077-015-0003-9 Ghate D, Bodnarchuk B, Sanders S, Deokule S, Kedar S. The ability of healthy volunteers to simulate a neurologic field defect on automated perimetry. Ophthalmology. 2014;121(3):759–762. doi: 10.1016/j.ophtha.2013.10.024 King MA, Ott J. Actors needed: clinical faculty get the call. Nurse Educator. 2012;37(3):105–107. doi: 10.1097/NNE.0b013e3182504122 Nestel D, Tabak D, Tierney T, Layat-Burn C, Robb A, Clark S, et al Key challenges in simulated patient programs: an international comparative case study. BMC Medical Education. 2011;11(1):69. doi: 10.1186/1472-6920-11-69 UBC Health. Patient engagement in education in UBC health programs. Vancouver, BC: UBC Health. 2018. Available from: https://health.ubc.ca/sites/default/files/documents/Patient%20Engagement%20in%20Education%20Report_April2018_cover.pdf [Accessed 22 November 2025]. Keränen N, Tirkkonen A, Tervajärvi L, Hutri N, Varis R. Standardized patient simulation in healthcare education [Internet]. Theseus; 2023. Available from: https://urn.fi/URN:NBN:fi-fe202402025477. [Accessed 4 May 2026]. Sanko JS, Shekhter I. Using embedded simulated persons (aka ‘Confederates’). In: Maxworthy J, Epps C, Okuda Y, Mancini M, Palaganas J, editors. Defining excellence in simulation programs. 2nd edition. Philadelphia, PA: Lippincott Williams & Wilkins. 2022. p.825–837. Clever SL, Dudas RA, Solomon BS, Yeh HC, Levine D, Bertram A, et al Medical student and faculty perceptions of volunteer outpatients versus simulated patients in communication skills training. Academic Medicine. 2011;86(11):1437–1442. doi: 10.1097/ACM.0b013e3182305bc0 Mack A, Escher A, Wong J. Barriers, challenges, and supports to the implementation of standardized patients and simulated environments by occupational therapy education programs. Journal of Occupational Therapy Education. 2022;6(2):13. doi: 10.26681/jote.2022.060213 Husson N, Zulkosky KD. Recruiting and training volunteer standardized patients in the NCSBN national simulation study. Clinical Simulation in Nursing. 2014;9(10):487–489. doi: 10.1016/j.ecns.2014.05.001 Crittenden J, Thompson K. Motivations and experiences of older adult volunteers in a telehealth nursing simulation activity. Innovation in Aging. 2021;5(suppl. 1):945. doi: 10.1093/geroni/igab046.3415 Davies E, Crawford L, Crawford T, Musolino R, Hutchinson R, Pelentsov L, et al Capturing and cultivating the simulated patient/participant (SP) experience: a qualitative study exploring how the perspectives of SPs can inform the co-production of an orientation resource guide. Advances in Simulation. 2025;10(1):14. doi: 10.1186/s41077-025-00334-6 Thompson J, Tiplady S, Hutchinson A, Cook G, Harrington B. Older people’s views and experiences of engagement in standardised patient simulation. BMJ Simulation and Technology Enhanced Learning. 2017;3(4):154–158. doi: 10.1136/bmjstel-2017-000197 Schelgel C, Smith CM. ‘Please let me know when I do not realize it myself’: a qualitative analysis of senior simulated patients’ experiences. Advances in Simulation. 2019;4(1):18. doi: 10.1186/s41077-019-0109-6 Anderson ND, Damianakis T, Kröger E, Wagner LM, Dawson DR, Binns MA, et al The benefits associated with volunteering among seniors: a critical review and recommendations for future research. Psychological Bulletin. 2014;140(6):1505–1533. doi: 10.1037/a0037610 Jenkinson CE, Dickens AP, Jones K, Thompson-Coon J, Taylor RS, Rogers M, et al Is volunteering a public health intervention? A systematic review and meta-analysis of the health and survival of volunteers. BMC Public Health. 2013;13(1):773. doi: 10.1186/1471-2458-13-773 Nichol B, Wilson R, Rodrigues A, Haighton C. Exploring the effects of volunteering on the social, mental, and physical health and well-being of volunteers: an umbrella review. Voluntas: International Journal of Voluntary and Nonprofit Organizations. 2024;35(1):97–128. doi: 10.1007/s11266-023-00573-z Heine N, Ferguson D. Management of standardized patient programs. In: Maxworthy J, Epps C, Okuda Y, Mancini M, Palaganas J, editors. Defining excellence in simulation programs. 2nd edition. Philadelphia, PA: Lippincott Williams & Wilkins. 2022. p.317–404. Feigerlova E. Training framework for high-stakes OSCE: experience from volunteer standardized patients’ bank. The Clinical Teacher. 2024;21(6):e13787. doi: 10.1111/tct.13787 Stewart R, Sweet L, Thistlethwaite J. Volunteer simulated patients: characteristics and confidence in giving feedback. Focus on Health Professional Education: A Multi-Professional Journal. 2010;12(2):74–85. Available from: https://search.informit.org/doi/10.3316/informit.575443032981011 [Accessed 8 May 2026]. Standards Working Group. The global volunteering standard version 3. Ottawa: International Forum for Volunteering in Development (Forum). 2025. Available from: https://forum-ids.org/global-volunteering-standard/ [Accessed 13 November 2025]. International Association for Volunteer Effort (IAVE). Universal declaration on volunteering. Washington, DC: IAVE. 2001. Available from: https://www.iave.org/the-universal-declaration-on-volunteering/ [Accessed 13 November 2025]. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology. 2005;8(1):19–32. doi: 10.1080/1364557032000119616 Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implementation Science. 2010;5:1–9. doi: 10.1186/1748-5908-5-69 Maggio LA, Larsen K, Thomas A, Costello JA, Artino Jr AR. Scoping reviews in medical education: a scoping review. Medical Education. 2021;55(6):689–700. doi: 10.1111/medu.14431 Pollock D, Tricco AC, Peters MD, Mclnerney PA, Khalil H, Godfrey CM, et al Methodological quality, guidance, and tools in scoping reviews: a scoping review protocol. JBI Evidence Synthesis. 2022;20(4):1098–1105. doi: 10.11124/JBIES-20-00570 Doyle A, Colquhoun H, Sullivan C, Condron C, Mulhall C, O’Toole M. Scoping reviews: an approach to co-creation through consultation. Journal of Healthcare Simulation. 2024:1–9. doi: 10.54531/NRZC6853 Reed MS, Merkle BG, Cook EJ, Hafferty C, Hejnowicz AP, Holliman R, et al Reimagining the language of engagement in a post-stakeholder world. Sustainability Science. 2024;19(4):1481–1490. doi: 10.1007/s11625-024-01496-4 Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of Internal Medicine. 2018;169(7):467–473. doi: 10.7326/M18-0850 Peters MD, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al Updated methodological guidance for the conduct of scoping reviews. JBI Evidence Synthesis. 2020;18(10):2119–2126. doi: 10.11124/JBIES-20-00167 Akturan S. A volunteer-driven standardized patient training unit: a sustainable model for resource-limited institutions. Clinical Simulation in Nursing. 2025;104:101741. doi: 10.1016/j.ecns.2025.101741 Dalwood N, Bowles KA, Williams C, Morgan P, Pritchard S, Blackstock F. Students as patients: a systematic review of peer simulation in health care professional education. Medical Education. 2020;54(5):387–399. doi: 10.1111/medu.14058 Saif J, Mellor D, Rogers D, Stocker C. Integrating expert patients perspectives on the processes of engaging them in early medical education. Research Involvement and Engagement. 2024;10(1):124. doi: 10.1186/s40900-024-00655-2