# When simulation becomes physical: vicarious symptoms in standardized patients during osces

## TL;DR

This study found that simulated patients in medical exams often experience physical symptoms linked to their roles, especially when the symptoms mirror personal experiences or when they have high health anxiety.

## Contribution

The study identifies factors like personal experience and health anxiety associated with vicarious symptoms in simulated patients during medical exams.

## Key findings

- 20% of simulated patients experienced vicarious symptoms either during or after OSCE exams.
- Personal experience of a similar condition and higher health anxiety scores were linked to increased vicarious symptoms.

## Abstract

Objective structured clinical examinations (OSCEs) are a cornerstone of undergraduate medical student assessment evaluating encounters between students and simulated patients (SPs). SPs are at risk of developing non-specific symptoms such as stress and anxiety. However, data on physical sensations related to their role, vicarious symptoms (VSs), are limited. We sought to measure the prevalence of VSs among SPs and identify factors among socio-demographic characteristics and psychometric scales associated with their presence.

This was a prospective single-center cohort study in a large French medical University during three OSCE exams. New VSs and their intensity using 0-100 numerical rate scale were assessed in SPs at the end of the examination day and seven days later using electronical survey. Health anxiety (excessive concern about illness) was measured before the examination using IAS scale. Interoceptive sensitivity (awareness of bodily signals) was also measured before the examination using MAIA-2 and THISQ scales. We performed a multinomial logistic regression to identify characteristics associated with the appearance of VSs.

Among the 428 SPs participating to the OSCEs examens, data from 244 SPs were analyzed. On the day of the OSCE, 12% of participants reported VSs (median intensity of 30, interquartile range 20–50). During the following week, 11% experienced similar symptoms (intensity 50, 30–60). Overall, 20% of SPs reported VSs either during the day of OSCEs or during the following week. Personal experience of a similar condition as the one played (adjusted odds ratio [aOR] 3.07, 95% confidence interval 1.33–7.07, p = 0.008) and higher IAS scores (aOR 1.03 per point, 1.01–1.05, p = 0.03) were associated with VSs occurrence. MAIA-2 and THISQ scores were not associated with the presence of these symptoms using multivariate analysis.

VSs are frequent among SPs particularly when the role is similar to a personal experience and in SP with higher IAS scores. The findings may inform on the selection and the preparation of SPs for OSCEs while shedding light on the influence of symptom portrayal on bodily experiences and its potential influence on the quality of the SPs acting across students.

Not applicable.

The online version contains supplementary material available at 10.1186/s12909-025-07950-w.