# Pre-roling: an operational framework for facilitators and simulating participants (SPs) to prepare for both acting and educating safely

## TL;DR

This paper introduces a framework called pre-roling to help facilitators and SPs prepare for medical simulations more effectively and safely.

## Contribution

The pre-roling framework systematically aligns facilitators and SPs in simulations through five distinct aspects, improving safety and educational outcomes.

## Key findings

- The framework improves alignment between facilitators and SPs during simulations.
- It supports clearer preparation and reduces dissonance in simulation settings.
- Pre-roling enhances SP safety and learners' experiential learning opportunities.

## Abstract

Sometimes scenario-based simulations do not go as expected because facilitator and simulating participant (SP) are not sufficiently aligned. This innovation paper presents a pre-roling framework that offers an operational, theoretically informed tool for facilitators and SPs to prepare systematically for scenario-based simulations in health professions education. The framework development was based on four months of ethnographic fieldwork at the Copenhagen Academy for Medical Education and Simulation (CAMES) and informed by action theory.

The pre-roling framework guides facilitators and SPs through five analytically distinct aspects of simulation performance — meaning (educational purpose), narrative (intended course of events), style (tone, tempo), character (the portrayed person), and health professions education (clinical picture, learning environment, task distribution, and care for the SP). Facilitators hold primary responsibility for meaning, narrative and style, while SPs hold primary responsibility for the character, with explicit collaboration across all domains.

The framework and its accompanying pocket card and worksheet were iteratively refined in dialogue with SPs, course leaders and scenario designers. It is intended as a flexible, context-sensitive preparation tool that can be used symmetrically by SPs and facilitators, from novice to experienced, and in diverse simulation settings. It fills a previously unoccupied space between general guidelines and the moment of action by systematizing preparation without prescribing content, thereby supporting clearer alignment, more deliberate improvisation, and explicit attention to SP safety. Using the framework can reduce dissonance between SPs and facilitators, enhance the coherence of dramaturgical and educational intentions, improve learners’ experiential learning opportunities, and help prevent distress among SPs.

The online version contains supplementary material available at 10.1186/s41077-026-00419-w.