Effects of portraying psychologically and emotionally complex standardized patient roles

Background: The use of standardized patients (SPs) to portray emotionally intense roles has stimulated inquiry into the effects such roles might have on the actors. Purpose: Our study endeavored to obtain a rich description of the consequences of highly affective psychiatric roles on SPs. We wanted to find out what conditions made these consequences worse or better and what countermeasures, if any, SPs had evolved to address the effects of case simulation. Methods: In a pilot phase, 16 SPs completed a survey exploring the extent to which they were affected by playing emotionally intense roles. Based on these surveys, questions were developed for subsequent focus groups examining these effects. Four focus groups of 9 SPs each (N = 36) were taped, transcribed, and coded by 2 independent raters. Results: In the pilot survey 11 of 16 SPs (69%) described residual psychophysiological effects. In the focus groups, all SPs reported some effect of portraying emotional roles, sometimes lasting several days. Several variables appeared to increase or mitigate the likelihood of such residual effects. Conclusions: Understanding the ways in which SPs are affected by portraying emotionally intense roles, and the personal and situational variables that increase or mitigate these effects, can lead to improved recruitment, training, and performance.