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Simulated participants (SPs) are crucial in health professional education, offering a controlled environment for students to develop clinical, diagnostic, and communication skills. However, limited research focuses on the structured evaluation of SP competencies, a key factor for maintaining educational quality. This scoping review aims to identify and categorize the strategies, tools, and instruments used to assess simulated participants’ (SPs) performance in health professional education; examine how these approaches assess and provide feedback on SP performance; and highlight gaps in the current research and practice regarding the assessment of SPs. A comprehensive literature search was conducted in Medline, EMBASE, and LILACS databases from 1990 to April 2025. Eligible studies included SP performance assessments at all levels of Miller’s pyramid (knowledge, application, demonstration, and action). Both qualitative and quantitative data were extracted and categorized based on the types of competencies assessed (communication, role accuracy, feedback) and the tools’ validation status. Descriptive statistics were employed to summarize the findings. Out of 7724 articles screened, 52 studies met the inclusion criteria. Most studies (75%) did not focus exclusively on SP assessment but included it in broader educational outcomes. Commonly used assessment tools were rating scales (29%) and self-perception surveys (26%), primarily measuring role-playing accuracy and communication skills. Only 40% of these tools had undergone formal validation. Additionally, the studies often lacked consistency in the criteria used for evaluating SP performance, with a heavy focus on communication and realism. At the same time, other competencies, such as providing structured feedback and adherence to case protocols, were less frequently assessed. Tools that evaluated SP feedback delivery were found in only 21% of the studies, despite the recognized importance of this skill for effective student learning. Furthermore, several studies highlighted the need for continuous SP training and reassessment to maintain high-quality performance. This review identifies significant gaps in the comprehensive evaluation of SP competencies, particularly regarding the validation and standardization of assessment tools. Future research should prioritize the development of robust, validated frameworks that assess a broader range of SP skills, including feedback delivery and adherence to simulation protocols. Such advancements are essential to enhance the reliability and educational impact of SPs in health education.