The rapid development of economic globalization has driven the transformation of the medical field (1). As a result, the demands on medical workers have risen significantly, and their tasks have become increasingly complex (2). The traditional teaching method keeps medical students away from frontline work and fails to mobilize students’ enthusiasm (3). Therefore, it is essential to provide students with scenario-based and experiential teaching methods.

Standardized Patients (SPs) and Role-Playing (RP) are commonly used teaching methods in medicine and education (4). SPs are trained individuals who simulate various medical cases and clinical scenarios (5). Through interactions with SPs, students can practice physical examination, diagnosis, communication, patient management, and medical decision-making skills. RP allows learners to assume roles and engage with different situations to enhance their skills and cognition (6). As a situational simulation teaching method, RP has been widely applied across various disciplines and fields (7). In medical education, both RP and SP methods represent a shift from a teacher-centered to student-centered approach. These methods simulate clinical settings, helping students apply theory and build skills like observation and communication.

At present, there have been many studies related to SPs and RP, such as the situational strategy and the reshaping strategy of learning interest (8). Different research environments, student groups, and implementation details may lead to differences in the effectiveness of the strategies in different contexts (9). Although existing studies have examined SPs and RP separately, there is still no clear consensus on which approach is more effective. This study aims to evaluate the relative effectiveness of SPs and RP in medical education. Specifically, it examines whether SPs are more effective than RP overall, and whether significant differences exist between the two methods across various dimensions of learning outcomes.

Many scholars have explored the impact of medical education using SPs. For instance, Ross et al. (10) found that combining SPs with lectures effectively educated nursing students about elder abuse. Similarly, Kim and Kim (11) reported that an 8-h psychiatric nursing simulation significantly improved students’ self-directed learning and self-efficacy. Webster (12) also confirmed the effectiveness of SPs in enhancing therapeutic communication skills. Ok et al. (13) showed that SPs reduced anxiety and improved communication in mental health training, while Ha (14) highlighted improvements in students’ self-confidence, nursing abilities, and interest in learning.

While the benefits of SPs are well-documented, some scholars have focused on RP as an alternative method that can also improve student learning. RP provides simulated scenarios that aim to improve students’ empathy and emotional intelligence. However, some studies have questioned the effectiveness of RP. Bayne (15) argued that regulatory factors might hinder learning outcomes, while Delnavaz et al. (16) reported no significant improvements in students’ skills or theoretical knowledge. Lee and Kim (17) similarly found no notable gains in emotional intelligence.

Despite the independent use of either SPs or RP in many studies, both methods share similarities. Several studies have compared the effectiveness of these two methods. Mounsey et al. (18) observed no significant differences between RP and SPs in post-teaching videos. Yeung (19) found that RP and SPs differed in their effects on self-efficacy but not on performance in adverse event disclosure training. Taylor et al. (20) and Schlegel et al. (21) both reported no significant differences between RP and SP in terms of communication skills and self-efficacy, respectively, suggesting comparable effectiveness in these domains.

Scholars have also conducted a literature review of SPs and RP. For example, Ma et al. (22) found that SP simulations significantly enhanced nursing students’ communication, self-efficacy, problem-solving, and learning satisfaction. Gelis et al. (23) showed that RP effectively improved communication skills and was more cost-effective than SPs. Dalwood et al. (24) found that peer simulation, where healthcare students role-play as patients, was more effective in enhancing empathy. Chua et al. (25) further supported this by demonstrating that simulation-based interventions effectively enhanced medical students’ empathy.

Although some systematic reviews have examined RP or SPs individually, few have compared the effectiveness of the two methods. Meta-analysis enables the systematic synthesis of empirical studies to obtain comprehensive effect estimates. Accordingly, this study employs a meta-analytic approach to examine the differences in the effectiveness of RP and SPs in medical education. The results can inform educators’ decisions in selecting appropriate instructional methods to enhance teaching outcomes.

There was no significant difference between SPs and RP in terms of their overall impact on students. Both teaching methods had a similar effect. When considering the specific dimensions of learning outcomes, no significant differences were found between the two methods regarding students’ communication, emotions, general performance, knowledge, professional competence, and self-efficacy. However, SPs had a more positive effect on improving students’ self-confidence compared to the RP method, which aligns with the findings of Cahyono et al. (36). This may be attributed to the fact that SPs expose students to realistic clinical scenarios that simulate emotional exchanges between patients and healthcare providers. The realistic interactions involved in SPs help students develop greater confidence in their ability to navigate real-world clinical scenarios (52). Emotional agitation, anxiety, and tension are common in clinical environments (53). The use of SPs enables students to develop emotion regulation and coping strategies within simulated clinical environments. Such training helps learners remain composed during emergencies and respond more effectively to patients’ emotional needs. For medical students who have not yet experienced real clinical settings, interacting with actual patients can cause anxiety and uncertainty (54). SPs training helps students gradually adapt to clinical roles, gain experience, and face real patients with more confidence during this transition (55). Through repeated interactions with SPs, students begin to perceive themselves as future healthcare professionals. This internalization of their professional identity plays a critical role in strengthening their self-confidence in clinical practice (56). These experiences have been shown to significantly enhance students’ self-confidence in real-world clinical practice. However, it is noteworthy that this improvement was domain-specific. SPs did not yield significantly greater benefits than RP in other learning domains, possibly because these outcomes demand broader or more sustained forms of engagement beyond confidence-building alone.

Some studies were excluded from the analysis due to concerns about potential contributions to heterogeneity. To further explore this issue, publication types were categorized as either “articles” or “theses,” and a subgroup analysis was conducted. The results indicated that SPs had a significantly greater positive effect in theses compared to other methods. In contrast, studies published as articles showed no significant difference between SPs and RP, possibly due to the limited number of studies in this subgroup. Regarding teaching implementation, sample size did not appear to significantly affect instructional outcomes overall. However, larger sample sizes were associated with more favorable results, particularly for SPs. This may be due to the inherent challenges of maintaining classroom discipline and engagement during RP activities in large groups, where instructors may struggle to effectively manage the learning environment, thereby reducing RP’s instructional effectiveness compared to SPs.

Significant differences were observed across different sample areas. Our analysis included studies conducted in five countries: the United States, China, Germany, Indonesia, and Korea. Among these, Indonesia showed the most significant effect, with an effect size of 0.906, which was statistically significant at the 0.1% level. However, this finding should be interpreted cautiously due to the small number of Indonesian studies. Overgeneralizing from such limited data may lead to inaccurate conclusions. Cumulative analysis showed that the effect size was initially small and highly variable but gradually increased over time, indicating an overall upward trend. This pattern may reflect improvements in research design and methodology over the years. As studies adopted more rigorous controls, the reported effect sizes became more stable and pronounced. In earlier periods, studies with small or non-significant effects were less likely to be published—a phenomenon known as the “file drawer effect.” However, growing emphasis on study registration and research transparency in recent years has helped reduce publication bias and expanded the range of studies available for cumulative analysis.

In order to optimize the use of standardized patients, clear learning objectives should be defined prior to implementation (57). These objectives should be aligned with course goals to ensure appropriate scenario selection and meaningful performance evaluation. Our findings suggest that SPs is particularly effective in enhancing students’ self-confidence. Therefore, when confidence-building is a central instructional goal, SPs should be prioritized when feasible. During course sessions, educators should guide the activity through timely, constructive feedback (58), helping students reflect and improve without disrupting their immersion.

The duration of simulation-based teaching should be carefully planned and adjusted based on the complexity of each scenario (59). More complex situations may require longer sessions and extended discussion time to ensure students can fully comprehend and apply relevant knowledge and skills (60). Each phase should be appropriately timed to avoid the negative effects of excessively long or short sessions on learning outcomes. Flexibility in time management is essential (61). For instance, if students are actively engaged, extending the session may enhance reflection and learning. Conversely, if students appear fatigued or time is limited, the session can be shortened. Clearly defined learning objectives help instructors select suitable scenarios and roles and assess whether student performance meets expectations. Teachers should also be mindful of when to intervene, avoiding interruptions during moments of deep engagement, as this may disrupt the learning process.

Given the variability in students’ learning preferences and responsiveness, educators should consider different instructional approaches (62). Some students may benefit more from RP, while others respond better to SPs. Thus, teaching methods should be selected and adapted based on students’ needs and the complexity of the course content.

This study has the following advantages: first, the experimental data were retrieved from multiple major databases from the establishment of the study up to 2024. Secondly, the included studies are of high quality. We also conducted a subgroup analysis, which partially explains the sources of heterogeneity in this study.

We have to admit that the study has some limitations. The limitation is related to the study sample, which is a common issue in almost all meta-analyses. For instance, in our subgroup analysis based on sample region, only two studies from Indonesia were included. The small number of studies in this subgroup may lead to less precise estimates. In the future, some unpublished literature needs to be included, and as the number of studies increases, this problem can be solved more effectively. The second limitation is that this study considered only a limited set of variables that may affect the effectiveness of the intervention. Important factors such as gender differences and prior frontline work experience were not included, although they may significantly influence student outcomes. This omission was primarily due to the fact that many of the included studies did not report these variables in sufficient detail. Future research should aim to incorporate such factors to provide a more comprehensive understanding of their potential impact on intervention effectiveness. Finally, language bias may be present, as most studies were conducted in English. Future research could include studies in other languages to enhance the robustness of the overall findings.

This meta-analysis synthesized findings from studies comparing SP and RP methods in medical education. Our findings indicate that, in terms of overall impact, the effects of both methods on students are similar. However, SPs are more effective in improving self-confidence. Although this study offers a new comparative perspective, cultural and sample differences may limit the generalizability of the findings. While limitations remain, this study contributes meaningful evidence to the ongoing debate on the relative effectiveness of RP and SPs.