Training medical students as peer simulated patients in undergraduate medical education: a narrative review and implementation framework.
Standardized patients (SPs) are a core modality in undergraduate medical education for teaching and assessing communication, history-taking, and clinical reasoning through simulated encounters and objective structured clinical examinations. Yet, scaling SP provision can be limited by financial cost, the availability of trained actors, and the faculty workload required for recruitment, training, and quality assurance (QA). A peer simulated patient (PSP) model, also described as "students as patients" or student standardized-patients model, trains senior medical students to portray SPs roles for junior learners and, in many designs, to provide structured feedback. This manuscript synthesizes evidence from systematic reviews and comparative studies of peer role-play, student SP, and occupational SP models and integrates peer-assisted learning theory, deliberate practice, and SP standards of best practice to propose an implementation framework suitable for medical schools. Available evidence suggests that peer simulation can be acceptable and sufficiently realistic for many educational goals, can yield learner outcomes comparable to occupational SPs in selected settings, may offer benefits for the senior students and may offer favorable cost profiles when programs are scaled. However, PSP programs may introduce risks, including variability in standardization, role confusion, confidentiality breaches, and psychological safety concerns for both junior learners and student-actors. We provide a stepwise framework covering recruitment, training (portrayal and feedback), QA, safeguarding psychological safety, and evaluation of outcomes for both learner and PSP cohorts. When carefully designed and governed, PSP programs can expand access to repeated, deliberate practice with feedback, strengthen senior students' teaching and professional identity formation, and reduce resource barriers to high-frequency simulation.