The Development of a PTSD Standardized Patient Encounter

For nursing students

Study summary

This MedEdPORTAL resource, published in 2015 by Jessica Doolen and colleagues at the University of Nevada, Las Vegas, describes how the team built a standardized patient (SP) case to teach nursing students about post-traumatic stress disorder (PTSD). The project responded to newer accreditation expectations that health professions education prepare students to collaborate across disciplines, and it specifically targets veterans' health, which the authors describe as a national healthcare priority.

An SP is a person trained to portray a patient consistently so students can practice real clinical interactions in a safe, repeatable setting. In this case, the SP was trained to portray a patient with PTSD who experiences a flashback triggered by a stimulus during the encounter. That design choice is deliberate: instead of just talking about PTSD symptoms in a lecture, students have to notice early warning signs, respond in the moment, and try to prevent the flashback from escalating into a full crisis.

The encounter itself took place in a simulated hospital suite that the team modified to look like an inpatient clinic room, which helps students feel like they are in a real clinical environment rather than a classroom. Each encounter was digitally recorded so it could be reviewed afterward during debrief, when students, faculty, and the SP talk through what happened and what could be done differently. The scenario had a firm time structure: a maximum of 20 minutes, with a 15-minute warning announcement so students knew to start wrapping up. Either the faculty or the students themselves could end the encounter early if the learning goals had already been met, which keeps the simulation efficient rather than dragging it out for its own sake.

After the encounter, the SP had up to 15 minutes to step out of character, review the guidelines for how the debrief should go, and organize their thoughts before giving feedback. This matters because SPs are not just actors reciting lines; part of their job is to give students honest, structured feedback from the patient's point of view, and that requires a deliberate transition out of role. Once ready, the SP joined the students and faculty for a guided debrief, offering feedback on what felt caring, therapeutic, or empathetic during the interaction. After the debrief, students completed a web-based evaluation of the SP encounter.

The results were positive. Of the 40 undergraduate nursing students who took part, most agreed or strongly agreed that the SP encounter was an effective way to learn. In their written comments, students said the interaction rewarded caring relationship-building strategies, helped them develop a therapeutic relationship with a patient in distress, and gave them a concrete opportunity to demonstrate empathy for someone living with PTSD.

One design feature the authors highlight is that the SP's PTSD symptoms were built to escalate or de-escalate depending on how well the student established a caring relationship during the encounter. In other words, the simulation responds to the student's communication choices in real time, rather than following a fixed script regardless of what the student does. The authors argue, based on both student and SP comments, that this kind of dynamic, responsive interaction teaches therapeutic communication more effectively than a lecture or assigned reading would.

For nursing students, the practical takeaway is that recognizing the early signs of a PTSD-related flashback and responding calmly and empathetically is a skill that can be practiced, not just something you either have or don't. This resource also reminds you that "trauma-informed" care is not an abstract phrase; it means noticing cues, adjusting your approach in the moment, and building trust quickly with a patient who may be in crisis. As you read the original resource, remember it is a teaching case description with a program evaluation attached, not a large controlled trial, so its evidence about effectiveness is limited to what 40 students at one program reported.

For educators

Teaching and appraisal notes

This MedEdPORTAL publication (Doolen, Guizado de Nathan, Johnson, Perna, & Giddings, 2015) is a peer-reviewed teaching resource submission rather than a traditional empirical study: it packages a standardized patient (SP) case for PTSD together with a brief program evaluation of student reactions. The case was developed in response to accreditation language calling for interprofessional collaborative preparation, and it deliberately foregrounds veterans' health as the clinical context, positioning the resource within MedEdPORTAL's broader collection of interprofessional teaching and learning strategies.

The pedagogical design is the main contribution. The SP is scripted to display an escalating PTSD flashback triggered by an in-scenario stimulus, and — importantly for debriefing purposes — the SP's symptom trajectory is built to respond dynamically to the student's communication: a caring, therapeutic approach de-escalates the portrayal, while a poor approach allows it to escalate. This gives faculty a concrete, observable behavioral anchor for feedback during debrief, rather than relying only on a checklist of "did the student ask about X." The encounter takes place in a modified simulated hospital suite standing in for an inpatient clinic room, is capped at 20 minutes with a 15-minute cue to close, and can be ended early by either faculty or students once objectives are met. Encounters are digitally recorded to support debrief review.

The SP role itself is structured with intentional de-roling time: up to 15 minutes after the scenario for the SP to exit character, review debrief guidelines, and organize feedback before joining the joint debrief with students and faculty. This is a detail worth highlighting for programs building or refining their own SP protocols, since it protects both SP wellbeing and feedback quality.

On evaluation: 40 undergraduate nursing students completed a web-based post-debrief evaluation, and the abstract reports that a majority agreed or strongly agreed the encounter was an effective learning experience. Free-text comments indicated students perceived the case as rewarding caring relationship-building, supporting development of a therapeutic relationship, and providing a concrete opportunity to practice empathy toward a patient with PTSD. The abstract does not report specific quantitative satisfaction scores, a comparison group, or statistical testing, so this should be read as a positive but preliminary program-level reaction evaluation (Kirkpatrick Level 1–2, roughly), not an outcomes or transfer-of-skill study.

For curriculum planning, this resource is most useful as a template for a scenario-responsive SP case in mental health/trauma-informed care content, and as a discussion prompt for how to build escalation/de-escalation logic into an SP script so debrief has clear behavioral evidence to reference. Instructors should be transparent with students that the supporting evidence here is a single-cohort satisfaction evaluation from one nursing program, and should consider pairing this case with a validated outcome measure (e.g., a communication or self-efficacy instrument) if adopting it for their own curriculum evaluation purposes. Full methodological detail — including exact survey items, response distribution, and any qualitative coding of comments — was not retrieved for this abstract-based summary; MedEdPORTAL is an open-access journal, and the complete resource (with its appendices: case script, SP training materials, evaluation instrument) is freely available on registration, so instructors adopting the case should download it directly from MedEdPORTAL before implementation.