Table 2.

Application of table 1 to case study #1

Simulation practice	Contextual considerations	Strategies	Case study #1
Developing simulation scenarios Values: Safety Risk Trust Respect Inclusion Diversity Equity	What degree of curricular exposure and preparation do learners have for the simulation? What are the learning objectives of the simulation? What are the risks and benefits of including the simulation in the curriculum? What diversifying traits are required to meet the learning objectives?	Explore how diversity is relevant to the scenario. Include community members with lived experience and embodied knowledge alongside educators when developing scenarios. Balance threats to safety against the degree of authenticity required. Normalise diverse SP encounters without diversity as a major focus of the scenario.	The learners have had lectures on motivational interviewing earlier in the curricular year, but have not yet put this technique into practice. This will be their first time using motivational interviewing as a strategy with a patient. After further discussion with the educator in charge of this programming, you discover that the simulation’s learning objectives are more focused on motivational interviewing rather than on diabetes care. You both determine there are strong benefits to this simulation session for learners to practice their motivational interviewing skills. Your concerns about harm and perpetuating stereotype and stigma are legitimate; recruiting a specific body habitus is not necessary to achieve the case’s learning objectives, and in fact having a range of habitus helps to emphasise that diabetes can affect anyone.
Targeted SP recruitment for diversity Values: Safety Risk Trust Respect Inclusion Diversity Equity	What populations make up your community, and how is this reflected in your SPs? What community resources already exist? What relationships can be developed?	Include SPs who represent the diversity of our community. Develop relationships of trust with specific communities and community groups. Allow SPs to self-identify their gender identity, diversity (racial and ethnic group membership), and ability status. Cast diverse SPs when their membership is not the focus of the scenario.	Because this scenario’s learning objectives are focused on motivational interviewing, and diversity is not the focus of the case, you make an effort to include diverse SPs, especially because their membership is not the focus of the scenario.
Targeted SP recruitment for identity, appearance and lived experience Values: Safety Risk Informed choice Transparency Empowerment Trust Respect Inclusion Diversity Equity	Is the SP portraying a health condition or an identity? How important is appearance to meet the learning objectives? For this scenario, how can you balance authenticity and realism with the avoidance of risk? What degree of standardisation is required? Is the potential for risk unavoidable and necessary to meet the curricular objectives? When is your recruitment exclusionary?	Consider recruiting SPs who identify with the role, especially when identity is central to the scenario. If you have exhausted your resources, it may be justifiable to recruit SPs from other communities (who do not identify with the role). Screen for each role that might pose a risk, including an explanation of the potential for harm. Gain informed consent.	You articulate your concerns about targeting SPs who represent people living with obesity and request flexibility in recruiting SPs across a range of body habitus into the role. You are careful to screen SPs with their comfort about the topic and the ways learners might interact with them during the simulation, empowering them to consent to their participation. You are sure to mention that learners might specifically reference their body habitus.
Attending to SPs’ psychological safety Values: Safety Risk Informed choice Transparency Empowerment Trust Respect Inclusion Diversity Equity	What is the type of harm that might be encountered (eg, stereotype, microaggression, etc.)? How might you address the potential for psychological harm during recruitment, training and the simulation?	Screen for each role that might pose a risk, including an explanation of the potential for harm. Gain informed consent. Empower SPs to opt out at any time (during recruitment, training and simulation) for their own psychological safety, without punitive results. Be present during the simulation to observe and support SPs. Provide frequent breaks and/or rotations to limit the number of learner/SP interactions.	You are careful to screen SPs with their comfort about the topic and the ways learners might interact with them during the simulation, empowering them to consent to their participation. You are sure to mention that learners might specifically reference their body habitus. You remind SPs they can opt out at any time if they feel unsafe. You ensure you are present for the simulation, and you take advantage of your ability to remotely watch one of your newer SPs. As each SP is only interacting with two learners per session, you feel adding breaks is not necessary.
The value of a prebrief and debrief Values: Safety Risk Transparency Empowerment Trust Respect Inclusion Diversity Equity	How might you mitigate the emotional impact on SPs? How might you attend to unanticipated consequences of the simulation, such as students’ response to the simulation?	Plan for a prebrief to ensure participants are clear about the goals, expectations, guidelines, rules of engagement and parameters of the simulation. Plan for a debrief with trained facilitators to allow SPs to derole and to allow participants to reflect on their actions, impact and feelings of the simulation. Evaluate SPs’ experience with the simulation.	You organise a prebrief for learners, as an opportunity to remind them of the learning objectives for the simulation. You remind them of the need for respect of all participants. After the simulation, while the learners are debriefing with a facilitator, you have a separate debrief with the SPs to provide them with the opportunity to reflect on the impact of the simulation, and to discuss how they felt during the simulation. You provide the SPs with a link to an anonymous survey, allowing the SPs to evaluate their experience with the simulation.

SP, simulated participants.