Ethical and Educational Perspectives on Involving Children and Adolescents as Simulated Patients in Pediatric Emergency Training
Simulation in healthcare education encompasses a broad range of approaches, from tabletop exercises to the use of sophisticated computer-controlled manikins that mimic the physical appearance and physiological parameters of human beings. The use of simulated or standardized patients (SPs) in healthcare education is not new; however, it has evolved significantly over the past decade, particularly following the publication of the Association of Standardized Patient Educators' Standards in 2017. These standards complement a regularly updated series of best practice standards published by the International Nursing Association for Clinical Simulation and Learning, which aim to provide evidence-based guidelines to improve simulation delivery methods, ensure high-quality learner experiences, and promote the adoption of up-to-date operational procedures. Despite increasing adoption, there remains limited consolidated guidance specific to pediatric emergency contexts, which this paper aims to address.
An area related to the use of SPs that remains controversial is the involvement of minors in an educational context. This narrative review synthesizes current literature and guidelines to examine the use of child and adolescent simulated patients (CASPs) in pediatric emergency medicine education, as well as their benefits and potential risks. It is recognized that the repetitive portrayal of certain medical conditions may have negative psychological or physical effects on children, and therefore, their involvement as SPs must be carefully considered. Specific measures should be implemented to protect young SPs and to prevent any adverse impact related to the roles they portray or the interactions they have with learners.
The use of CASPs requires structured governance frameworks, age-appropriate role design, and formal safeguarding mechanisms to ensure ethical and effective integration. These recommendations extend beyond pediatric emergency medicine to other simulation-based educational contexts.