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Background: Little research has examined standardized patient experiences in stressful simulation scenarios., Methods: Qualitative, secondary data analysis., Results: Emergent themes included: "Those kinds of things are important": The incorporation of personal experiences enhances communication accommodation experiential learning; "She was trying to buffer the bad news": How SPs recognize and address problematic divergent behaviors; and " The emotions come up": Interactions with excellent communication accommodation behaviors can lead to SP emotional and physical distress ., Conclusion: Standardized patient expertise enhances scenario realism and communication skills evaluation. To minimize distress, simulation educators should tailor safety measures specifically for the individual standardized patient and the scenario., Competing Interests: The authors have no financial disclosures or conflicts of interest.