Advice and Support

Medical Role-Play Best Practice Guide

What is medical role-play?

The use of medical role-players, otherwise known as ‘simulated patients’, within the medical education system is well established. Medical students need to be trained and the public need to be confident that the doctors that emerge from the training process are fully competent, both in terms of their medical knowledge and ability to communicate effectively with patients. Medical role-play is vital to the National Health Service (NHS).

There are two broad areas where actors are employed:

  1. Clinical and communication skills training: where students practise their skills and receive personalised feedback, in the safe environment of a role-play and in the examination setting.
  2. OSCE examinations (Objective Structured Clinical Examination): actors help to provide a consistent and controlled setting for these assessments, benefitting students and examiners alike. There is a massive amount of organisation involved when setting up an OSCE. There may be upwards of 250 students per day, each will involve actors and medical examiners, and the examinations might run over five days.

To maintain consistency amongst actors, students and examiners, and continue to attract experienced medical role-players, we recommend agencies and institutions adopt the best practice contained in this guide.

Who benefits from improving medical role-play practices?

  • The institutions, who are aiming for good pass rates (and fewer challenges from candidates who fail and challenge the process).
  • The actors, who have needs that have to be considered so they can maintain their concentration and their well-being.
  • The general public, who benefit from a team of medical practitioners given the best possible preparation for their future work within the NHS.


Rates of pay should reflect that acting as a simulated patient (medical role-player) requires specialised skills. However, many hospitals and agencies have not increased their rates in line with inflation. It is important to maintain and attract a workforce of skilled practitioners of simulation role-play for the benefit of future NHS doctors and patients, and therefore rates of pay need to be raised annually and index linked, in line with current inflation rates.

Pay is also linked to accessibility and diversity. If payment is too low, it means that disabled and black and minority ethnic people are disproportionally impacted and often precluded from participating.

A medical role-player’s work can be sporadic and precarious. The daily rate is often very low, particularly compared to other skilled work, and especially when factoring in preparation and administration time. The work can also be intensive so a fee should fairly reflect this.

Medical role-players are normally paid at a much lower rate than role-plays in a corporate commercial setting. Part of the satisfaction of this type of work is that role-players know they are contributing to training our future doctors and nurses. But this should not be used as a reason to keep rates low.


Many role-players travel widely to fulfil hospital role play needs. Role-players required to do so should be given expenses at the Government Guidance Rates as set out on the government website

Role players should also be given parking costs.

Accessibility and diversity

Agencies should not charge or require unpaid training to access work.

To ensure a diverse workforce, it's important to recognise many enter the industry through various routes. This could be accredited training, youth training theatre, various modular classes, learning on the job via initial credits (perhaps as a child performer) for example. We frown upon any institution or agency citing the need for role-players to have "accredited drama school" training. This is just one route into the industry, and it’s not affordable or accessible to all. We ask institutions and agencies to allow a mix of training, experience and credits and thus overall CVs when applying for this work.

Dignity at Work

It is crucial that all role-players feel they are in a safe space, with a clear route to report anything that makes them uncomfortable.
Everyone has the right to be treated with respect and in a manner that allows them to maintain their dignity at all times. Any harassment and bullying should not be condoned.

All trusts and agencies must have a Dignity at Work policy that is monitored regularly and adhered to in practice. Model policies are available online including on the acas website

Cancellations, replacements and substitutions

Many actors rely on medical role play work as a means to sustain their broader career in the arts. On rare occasions, a medical role player may wish to pull out of a job in the event of an audition recall or an acting booking. For this reason the medical role-player needs to have some flexibility on the part of the employing institution or the agency.
What is crucial is that actors and their agency have a shared understanding of how such a situation might be handled.

We do understand that accommodating role-players in such circumstances can leave those agencies in a difficult position. If the agency doesn’t already have a suitable replacement available, it is the responsibility of the role player to offer an experienced replacement of the right demographic for the given scenario. It is our experience that the institutions for which the actor is working are very happy with this, although this is often less true for agencies.

Too many role-players are fearful that withdrawing from a job might preclude them from being given future work by a role play agency. If on the other hand they decide not to withdraw and miss the acting opportunity, their acting agent might have doubts about whether or not it is feasible to represent them. This is an extremely stressful dilemma for the actor/role-player, making it more difficult to fulfil the work to the best of their ability.

It is therefore important that agencies and institutions can offer some flexibility.

Similarly, many medical role-players rely on the work of medical role-play to help meet their day-to-day living costs. Cancellations at short notice can have a major impact as they are unlikely to be able to pick-up replacement work at such short notice.

We therefore recommend that any cancellations by medical institutions or role-play agencies must be a minimum of one week, otherwise the following minimum payment should be made:

  • Less than one week’s notice but more than 3 days’ notice: 50% of full expected fee.
  • Less than 3 days’ notice: 100% of full expected fee.

Online role-play

Since COVID-19, online role-play has become more and more popular. As much as colleges/institutions are trying to minimise the differences between online role-play and in person role-play, there are some elements involved in online role-play that have to be addressed separately.


Any filming by institutions and agencies to be used for wider training should ensure permission is sought in advance of filming and that an appropriate payment is made for the use of the film. This should generally include full details of how the film will be used, for how long the agreement lasts, and how much the medical role-player will be paid for the recording and use.

This is a legal obligation under the Copyright, Designs and Patents Act 1988 for recording and use of a qualifying performance. Furthermore, medical role-players are legally entitled to “equitable remuneration” for the exploitation of a qualifying performance.


When an agency/intermediary secures a contract there is an alarming culture of asking role-players to attend even earlier than when the client/hospital trust requires, often in unpaid time. This is done to give the agency peace of mind that all their role-players are ready for the client. The problem with such a culture is that this ends up diluting the role-player’s fee by making their working day longer. In extreme cases this has led to role-players having to arrive up to two hours before a circuit begins and, even in circumstances when they are paid, can impact on their ability to give the best performance.

The call time should be agreed by both the institution and intermediary. The former needs to be aware of the hours the medical role-player is officially being asked to work, in light of the offered fee. Consideration should be made by agencies and institutions as to whether extending the day in this way is detrimental to the overall work expected of the medical role-player.

Where it is required or demanded, institutions and agencies should reflect this in their day rate or make sure role-players are paid appropriately for extra work.

Medical role-play agencies

There is a worrying practice of agencies operating opaquely in respect of role-players’ pay. In fairness to trusts who use agencies to fulfil the medical role-play service, we believe they are not made aware of the difference between companies and what percentage of the overall fee ends up with the agency as profit rather than in the pockets of workers.

If an institution chooses to outsource the supply of role-players to a third-party agency, we ask that during any tender or commissioning process, they set minimum requirements for guaranteed pay rates role-players will receive in order to be awarded a tender/commission.
This allows the institution/hospital trust to have a more informed view when assessing the perceived value of the bid and to not work with exploitative agencies who do not fairly value the work that medical role-players do.

We understand that agencies have outgoings from administering and supporting medical role-play work, and many abide by solid pay and commission practices. However, it is vital that the actual day/hourly rate the role-player receives is an integral part of any institution’s tender decision-making process. Failure to do so affects the accessibility and diversity of this industry, contributes to burn-out and weakening of overall service provision, adversely impacting on the NHS as a whole and its patients.

Trusts should ensure that medical role-players receive a minimum hourly or daily fee and where they use a medical role-play agency to fulfil this service, this should represent a minimum of 80% of the overall fee paid to any agency. In other words, the agency fee is in addition to the role-player’s fee. This should be stipulated in any tendering or commissioning process.
Similarly, we recommend that medical role-play agencies should ensure that a minimum of 80% of their overall turnover goes to medical role-play actors.

Agency considerations

Finish times

Very occasionally role-plays can run over their allotted times. Role-players should never feel pressured to stay on after their stated finish time. If medical role-play is running over time and a role-player is reasonably required to stay on, the extra time worked must be paid for.

This also applies to online role-play, where role-players have experienced sessions running over their allotted break and finish times due to technical difficulties. For many simulations, circuits need to run at the same time. So if one circuit is experiencing a delay due to an examiner/role-player/student’s connection problems, it can delay the whole circuit, causing everyone to fall behind schedule. We understand this is unavoidable. However, institutions and agencies should adjust for this, either by extending break/finish times for role-players and reflecting this in their day rate or offering role-players an option to stay on.

Info provided in advance

We understand that unlike training days, due to confidentiality and exam security a lot of scenario information cannot be provided until on the day.

However, given many trusts/institutions have differing rates of pay and "station intensity", it is important that any medical role-player is advised in advance of the number of stations (and length of station) and overall circuit hours with break ratio that is expected to occur on the day.

This allows the role-player to fairly assess whether the job is feasible for them and have an idea of what to expect on the day. This is particularly crucial when many self-employed will have to schedule in other work commitments in their week (or perhaps their evening). They rely on this information to determine whether or not this is something they can commit to.

If an agency has the contract, then the minimum information mentioned above should be provided to them, in addition to the fee when offering out the work to a role-player. Any reasonable changes must also be communicated in a timely manner.

OSCE focused conditions of work

In addition to the best practice outlined above, below are some specific considerations that should be made in order to operate best practice in OSCE medical role-play.

Further advice

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