DOI: 10.25946/30844388.v1
title: Associated data for a theory of coexistence: healthcare educators assuming simulated patient roles

description: 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.