The use of high-fidelity simulation and standardized patients (SPs) in occupational therapy (OT) education is expanding. However, the implementation of simulation varies across programs, leading to inconsistent outcomes and research limitations. Furthermore, details on SP use and training are lacking in OT literature. This article aims to provide OT educators with considerations for improving simulation fidelity by effectively using highly trained SPs. For example, recruiting SPs from diverse backgrounds is necessary to improve sociological fidelity, and proper training of SPs is required to ensure psychological fidelity. This article also emphasizes the need for standardized training for SPs and recommends following the Association of Standardized Patient Educators (ASPE) guidelines to ensure best practices in OT education. Adequate SP training and ongoing professional development are essential for maintaining simulation fidelity during SP experiences and optimizing student learning outcomes. Implementing SP experiences within the OT curriculum, SP recruitment and training, case development, pre-briefing, and debriefing processes are discussed, with recommendations from current evidence and the authors' experience at an institution accredited by the Society for Simulation in Healthcare. Trained SPs can enhance simulation fidelity and provide students with realistic and compelling learning experiences, better preparing them for fieldwork and clinical practice. While further research is needed to explore the efficacy of SP encounters in OT education and the student experience, this article reinforces the need to standardize the use and training of SPs to enhance simulation fidelity and support the reliability and validity of future research efforts surrounding the use of SPs.