Simulated patient methodology applied in health services research: a scoping review.

backgroundThe simulated patient (SP) methodology is a valuable tool in health services research, allowing for the assessment of healthcare providers’ (HCPs) real-world behavior and performance through covert interactions. Although several evidence syntheses have examined its application in pharmaceutical settings, there is a gap in synthesizing recent research findings in other healthcare disciplines. Therefore, we aimed to map the application of the SP method in non-pharmaceutical healthcare settings.

methodsWe conducted a scoping review, following the updated JBI (formerly Joanna Briggs Institute) guidance for scoping reviews. In October 2023, we searched MEDLINE (PubMed) and Embase (Elsevier) databases. We focused on peer-reviewed journal reports of primary studies of any design, published from May 2004 onwards, in English or German, that covertly utilized SPs in non-pharmaceutical healthcare settings. Two reviewers independently screened records and reports. Data extraction was conducted by one reviewer and validated by another one. We presented findings in table and diagram formats, accompanied by a narrative summary.

resultsOur search identified 1,796 records, with 163 reports meeting the eligibility criteria. Between 2004 and 2023, the use of SP methodology in non-pharmaceutical healthcare settings increased, with nearly twice as many reports published between 2014 and 2023 compared to the previous decade. The median number of SP-HCP contacts was 202.5, with a median of eight SPs per study. Most reports originated from North America (63.8%), followed by Africa and Asia (each 12.9%). Interactions primarily occurred in clinics (39.9%) and practices (36.8%), with face-to-face (58.9%) and telephone (42.9%) being the most common modes of interaction. 48.5% of reports indicated that HCPs were informed of covert assessments by SPs before the study began. Many reports lacked details on HCP specialties (41.1%) and professions (46.0%). Post-study feedback to HCPs was rarely reported (7.4%), and ethics approval processes varied, with 12.3% of reports not addressing them at all.

conclusionsOver the past two decades, the SP methodology has been widely adopted across various regions and settings. However, inconsistent reporting and varying ethical considerations highlight the need for clearer guidelines to enhance the reliability and educational value of SP studies, ultimately leading to improved HCP practices and patient care quality. SCOPING REVIEW REGISTRATION: https://osf.io/8z9tn .