A theory of coexistence: healthcare educators assuming simulated patient roles—a grounded theory study

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 objectives be met? Simultaneously, they juggle the tension between authenticity and pedagogy. This study employed constructivist grounded theory to construct a theoretical framework from 19 semi-structured interviews with simulation educators, exploring their experiences and the consequences of assuming simulated patient roles—a perspective rarely examined in healthcare education. While student learning is often prioritised, little attention has been given to the emotional, psychological, and professional tolls on educators. Addressing this gap, the thesis introduces a theory of coexistence, conceptualising the tension educators experience as they navigate dual roles: altruistic facilitators of student learning and self-preserving individuals managing emotional and professional needs. This framework positions competing motivations—altruism and egoism—within the broader context of educator identity, highlighting inherent conflicts and their coexistence.Findings reveal educators were torn between dedication to student learning and concerns for recognition, well-being, and personal fulfilment. They grappled with professional responsibility, balancing realism and authenticity while questioning whether their work was valued as education rather than performance. Some found the experience rewarding; others faced internal conflict and emotional strain. Institutional gaps compounded these challenges. Simulated patient roles were integrated without sufficient policies, standards, or safeguards. Participants reported a lack of formal recognition, structured debriefing, and professional support, raising ethical concerns and threatening workforce sustainability. Emotional engagement often led to exhaustion and difficulties detaching from roles, with educators left to manage consequences alone. These findings underscore the urgent need for policies, education, and institutional frameworks to protect educators’ well-being and strengthen simulation-based education. By centring educators in these discussions, this research advances theoretical understanding of educator identity and role immersion, while emphasising the need for regulatory structures that formally recognise and support their contributions. Behind each transformative simulation is an educator carrying the silent weight of performance, care, and personal sacrifice—efforts that deserve recognition and protection.