Working with Actors to Train Students and Hospital Healthcare Providers

Sean Hennessey

Date

March 4, 2026

Topics

Mass General Brigham

Area of Expertise

Emergency Medicine

Interprofessional Education

Simulation-Based Education

Simulated participants valuable part of education equation at MGH Institute and within Mass General Brigham; co-won Daisy Award with Brigham and Women’s Hospital medical team

Inside the emergency department at Brigham and Women’s Hospital on a recent winter night, two nursing students enter a room to get the vital signs of a psychiatric patient who had just been brought in, a seemingly routine task repeated multiple times throughout the day.

But this was not an ordinary day, or ordinary vitals check.

The patient, a male, started screaming, cursing, and throwing items against the wall, startling the students.

“Get away from me!! Why am I here?” he railed.

The students backed away and the outburst continued, as the man began pounding the bed and then the wall, refusing to calm down.

While realistic, this was a training exercise, something the medical team at Brigham and Women’s Hospital holds on a regular basis. And the patient? A simulated participant — or trained actor — from the MGH Institute of Health Professions.

Simulating Any Scenario Needed

Nearly every academic program at the MGH Institute — Nursing, Physical Therapy, Physician Assistant, Occupational Therapy, Communication Science Disorders and Genetic Counseling — partners with simulated participants (SPs) to help train the next generation of healthcare leaders by acting out any scenario they’re likely to encounter in the clinical setting.

“Think about being able to communicate certain concepts and ideas such as, ‘How do you break bad news to a patient who has terminal illness or is going to have a child that may have a birth defect?” asks Tony Williams, simulated participant program manager. “How do you deal with conflict resolution, or de-escalating an agitated patient? All of these are complex skills that go into healthcare, and ones that a lot of our students will encounter.”

More than 100 SPs have worked with MGH Institute students since the initiative began in 2018. Portrayed by local actors, these “participants” simulate whatever clinical situation a student needs to learn from, ranging from telling a patient he/she has a life-threatening disease, to treating one with a sore shoulder.

“Students learning from a classroom setting and then trying to carry that over into the clinic setting can be daunting,” said Williams. “To provide a safe learning environment where students can develop interpersonal skills with trained human role players — individuals who understand the learning objectives — has been a tremendous benefit to their growth.”

SPs like Ezra Stevens relish the opportunity to simultaneously act — and teach.

“I love role-playing and going into a room and seeing how the students do, how they react to me and what the script says I need to throw at them,” said Stevens. “Whatever the student does, it’s a learning opportunity, and there’s something to be said for that.”

A man sits on a hospital bed talking to two healthcare professionals — A nurse comes into the emergency department to help diffuse the situation with Edgar Daniel, an MGH Institute simulated participant role-playing a psychiatric patient, during training at Brigham and Women’s Hospital.

A woman sits at a table talking while a man to her left listens — Dana Im, MD, MPP, MPhil, Vice Chair of Quality & Assistant Chief Medical Officer, Department of Emergency Medicine for Mass General Brigham, oversees the de-briefing after the training exercise.

A man sits against a wall while a row of people sit in front of him. — MGH Institute simulated participant Edgar Daniel sits off to the side as medical personnel at Brigham and Women’s Hospital discuss what went well in the use of restraints training exercise, and what could have been done better.

A man talks to people sitting at a table — Daniel offered some perspective to the group from his position as “the patient.”

A man sits on a hospital bed holding his arm and talking to a medical professional — In another use of restraints training exercise at Brigham and Women’s hospital, Daniel plays a drunk patient with a stab wound. He was yelling that someone stole his money and that he was “going to get them.” In this scenario, hospital personnel were able to calm the patient down, so security wasn’t needed.

Four men pose in a hospital room — (l-r) MGH Institute simulated participants Ezra Stevens, Matt Goldstein, Jamaal Eversley, and Edgar Daniel.

A man sits at a table with a laptop in front of him — Tony Williams is the simulated participant program manager. More than 100 SPs have been used to train MGH Institute students and Mass General Brigham personnel since the initiative began in 2018.

Four people pose with an award on a stage — At the International Meeting on Simulation in Healthcare in San Antonio, Assistant Dean for Interprofessional Practice Rachel Pittmann (second from right) accepted the 2026 DAISY Team Award for the collaborative training MGH Institute simulated participants conducted with Brigham and Women’s hospital.

A certificate for the SSH Daisy Team Award — The certificate the Center for Interprofessional Education and Practice won for its collaboration training with Brigham and Women’s Hospital.

Good Word Gets Around

As simulated participants continued their successful foray into healthcare education for nearly a decade, word began to spread around the Mass General Brigham system about the use of actors and their role in training.

“And then before you knew it, we were getting inquiries and requests for SPs from programs across the system,” recalled Williams. “Massachusetts General Hospital, the Brigham and Women's psych department, their nursing department, their emergency medicine, all of these different groups.”

Not only are SPs training students, but today they’re helping train actual healthcare professionals with anti-racism and bias training, along with de-escalation scenarios – different than the patient simulations SPs portray for students at the MGH Institute. And that brings us back to the scenario in the Brigham and Women’s emergency department.

“When we do the simulation at the MGH Institute, we're working with students, so you have to be gentle. There's no real amping it up or cursing of any kind,” said simulated participant Edgar Daniel. “But when we do the de-escalation in a hospital, we're working with nurses that have been doing this for 15-20, years. So, they've seen it all and that gives you freedom to just go as much as possible.”

Which is what explains Daniel’s antics during the training scenario at the Brigham, where he played a patient who is agitated because he’s going through a mental health crisis.

“This person has been sent to the psychiatric ward, and he’s not happy about it,” noted Daniel, whose day job is a phlebotomist and lab manager at a correctional facility in Danvers. “I'll get into it with, ‘Oh, I have to get to work, I have kids to feed, I have to choose between paying my bills and feeding my kids.’ And I look for a trigger word, such as understand. They're not supposed to say, ‘I understand.’ If they say, understand, that's when you get the freedom to say, ‘Oh, you understand, huh? Oh, you can't pay your bills either or feed your kids, huh? Is that what you’re saying?”

The goal is to put trainees in uncomfortable yet likely scenarios and see how they handle it.

A few years ago, Mass General Brigham looked at all of its hospitals and found racial disparities in physical restraint use in the emergency department setting, a finding replicated in many other studies across the nation, including in pediatric settings.

“As a system, we really wanted to think about how we could mitigate this, and we felt that education and awareness were the places to start,” said Dana Im, MD, MPP, MPhil, Vice Chair of Quality & Assistant Chief Medical Officer, Department of Emergency Medicine for Mass General Brigham. “That’s because specifically at our Academic Medical Centers, there weren't any structured, multidisciplinary de-escalation training for our staff. For myself, I went to Harvard Medical School, and I trained in our residency program at MGH and the Brigham, and I work in the emergency department, and I see agitated patients every single day, and I never received any structured training in de-escalation.”

So, Dr. Im’s team turned to Williams and his team of simulated participants to address racial disparities and implicit biases through training. To Im, de-escalation wasn’t just about the healthcare provider and patient, it was about interprofessional teamwork that includes doctors, nurses, trainees, social workers, chaplains, and security officers.

Led by a group of residents in emergency medicine at MGH and Brigham and Women’s Hospital, a pilot program was launched in 2021 at Brigham and Women’s Hospital and with the help of grants, expanded to Massachusetts General Hospital and Faulker Hospital; the goal — reaching as many providers, nurses, and security officers across the sites in the emergency departments as possible.

“Kudos to Tony — he worked really hard on making sure that we were recruiting the right SPs who could serve in these roles,” remarked Im. “We're talking about historically marginalized patient group with certain racial and ethnic background, and Tony really did that work very sensitively with us to design the course, and then also to recruit the SPs.”

Five years later, more than 80 training sessions have been conducted for more than 600 staff across the sites. Monthly training is still ongoing at the Brigham (funding reasons precluded continuation at MGH and Faulkner) as the program has been embedded into nursing education, along with the onboarding of physicians and physician assistants in the hospital’s emergency department.

“The SPs are so great — they really simulate and portray what our patients might be experiencing in that moment,” marveled Im. “In response to that, our team members are expected to come together and engage with the patient who's very agitated by using the techniques that we have taught them to de-escalate the situation.”

“I really enjoy helping healthcare professionals and students learn,” added Matt Goldstein, another simulated participant. “Simulating the patient experience is critically important and I’m glad to play an important role in it.”

Making a Difference

Back at the Brigham’s emergency department training session, Edgar Daniel — the simulated participant — was acting in crisis mode.

“I’ve been here for hours,” he screamed. “I’ve missed work, and now I’m in danger of missing the shift of my second job!!”

Fears of getting fired and not being able to pay his bills fueled the fury, the mental angst worsened by the patient’s belief of what his own children thought.

“My kids will be better off without me,” Daniel continued, confirming suspicions this patient might hurt himself or take his life had he not been checked in.

A nurse came in to help, followed by Dr. Im, who indicated security could be called if need be. Finally, a chaplain entered the room and asked about the man’s kids, then said the hospital could contact his employers and provide a note to explain the absence from work. Only then did the patient calm down.

As with every simulated participant experience, a de-brief with the hospital team followed. Dr. Im led the team through what worked and what didn’t, and Daniel shared moments he noticed and what worked to calm him down. When Dr. Im asked whether the team wanted security involved, several of the female caregivers mentioned they were more likely to want security if the patient was an imposing man like Daniel, and that was followed by a discussion of biases and structural racism.

The training has made a difference, translating directly into patient care.

“When we look at the pre- and post- data, we see a significant improvement in our participants’ perceived comfort level and skill sets in being able to de-escalate patients,” noted Im. “We’re able to mitigate bias when it comes to de-escalating patients, and there’s also an overall reduction in physical restraint use over the years thanks to the implementation of this program.”

Valuable Work Recognized

Earlier this year, the MGH Institute SPs along with the Brigham and Women’s Hospital Department of Emergency Medicine and the STRATUS Center for Medical Simulation, won the Society for Simulation in Healthcare 2026 DAISY Team Award for their work with the Anti-Racism and Trauma-informed (ART) De-escalation Training Program. Daniel, and fellow SPs Jamaal Eversley and Ezra Stevens were specifically cited.

“This group of highly skilled professionals brings clinical encounters to life by providing realistic, emotionally responsive interactions that enable learners to strengthen their communication, clinical reasoning, professionalism, and physical exam skills in safe simulated environments,” said Rachel Pittmann, assistant dean of interprofessional practice and director of the Sanders IMPACT Practice Center, Center for Interprofessional Education & Practice.

“It’s just another testament to the hard work that our SP team is doing,” said Williams. “it's humbling, satisfying, and gratifying to see these things kind being recognized on such a big stage, so I’m really proud of our SPs and really proud of our team.”

Williams is not alone in feeling that way, especially when it comes to the impact being made.

“It’s really good practice with people skills and how to handle yourself under pressure,” observed Eversley. “I think training like this needs to be in all hospitals.”

Stevens agrees, adding that the reality these actors bring to their roles is instructive.

“I feel the character, and then I just go,” he noted. “We are going to give healthcare providers and students what they’re going to get in a clinical setting. And sometimes that can be scary for them, but it’s reality.”

“I feel like it's something that can bring healthcare provides back to a baseline of where they need to be,” said Daniel. “I'm glad it helps. I hope that somehow this reaches all hospitals and teaches people.”

Hospitals like Brigham and Women’s, which has allied with MGH Institute SPs in the following areas: Nursing, Emergency Department, Psychiatry, the STRATUS Center, Pulmonary and Critical Care, and Radiology.

“We're very excited and feel very honored by this award,” concluded Im. “We really feel that this training collaboration with the MGH Institute has really been a fruitful collaboration that I look forward to continuing.”

It’s the kind of training students have been benefitting from for most of the past decade and will continue into the next as it improves care at the bedside and clinician resiliency.

“Having actual humans who bring a measure of their real-world perspective within the guidelines that they've been provided is what our SPs bring to the table,” noted Williams. “We’re making a difference across the board and are more than happy to collaborate with any other medical entities who might benefit from our simulated participants.”