A gold standard simulation involves a well-planned, well-executed scenario. An ideal or gold standard simulation scenario includes embedded participants (EPs) to portray roles in the scenario that are not designated as the patient or the learners. It is usual practice for a group of learners to alternate or take turns being the learner in one scenario, and then being an embedded participant in another scenario. These EPs are sometimes referred to colloquially as hot seat participants. The Healthcare Simulation Dictionary is a Society for Simulation in Healthcare (SSH) publication that defines simulation terminology. Although hot seat participant is not included, the term embedded participant (EP) is defined as: "An individual who is trained or scripted to play a role in a simulation encounter to guide the scenario, and might be known or unknown to the participants; guidance may be positive or negative, or a distractor based on the objectives, level of the participants, and the needs of the scenario" (Lioce et al., 2020, p. 16).
Historically, the term used to describe the role of EP was confederate. The Victorian Simulated Patient Network defined confederate as: "An individual other than the patient, who is scripted in a simulation to provide realistic experiences, simulate challenges, or additional information for the learner, e.g., paramedic, receptionist, family member, laboratory technician" (Lioce et al., 2020, p. 12). The Australian Society for Simulation in Healthcare defined confederate as: "An individual(s) who, during the clinical scenario, provides assistance locating and/or troubleshooting equipment. This individual(s) may provide support for participants in the form of 'help available,' e.g. 'nurse in charge,' and/or provide information about the manikin that is not available in other ways, e.g., temperature, color change, and/or to provide additional realism by playing the role of a relative or a staff member" (Lioce et al., 2020, p. 12). As of today, the term embedded simulation personnel (ESP) is considered the most politically correct and most up to date simulation term to describe this role. Even so, you may still find old and new literature that includes the terms EP, confederate, standardized patient, simulated patient, simulated person, role player, or actor.
In a 1993 Academic Medicine publication, HS Barrow recalled how, in the 1960s, he first defined the term standardized patient (SP), which per his definition, included either a simulated patient or an actual patient with specialized training. HS Barrow was one of the early adopters of SPs in healthcare simulation education and helped develop the role in academic medicine. The use of SPs has grown since the 1960s and is now ubiquitous. Sometimes an SP is enlisted to play the role of an ESP in a high-stakes/summative simulation scenario. The authors further define a standardized patient to be a person who is coached/trained to simulate a patient so accurately that a skilled clinician cannot detect the simulation. For both learner assessment of performance and provider assessment of the quality of care, SPs have been utilized as undercover, mystery, or incognito simulated patients/clients. Standardized patients are paid and often charge by the hour, sometimes with a minimum number of hours required at the time of booking.
Other times, a learner-volunteer is asked to step into the ESP role in low-stakes/formative simulation scenarios. The authors further define embedded simulation personnel (ESP) as an individual who is trained or scripted to play a role in a simulation encounter to guide the scenario and may be known or unknown to the participants. ESPs are often volunteers or unpaid, creating the term volunteer embedded participant (VEP). On occasion, VEPs may be given a gift for their participation and/or have costs covered, such as parking and lunch.