Simulation as part of a complex and entangled puzzle

Simulation-based education (SBE) is “massively on the rise, highly technological, but under-theorised” (p. 905) [1]. Discussion of potential and actual applications [2, 3], often focus on methods and technologies [4, 5], seeing SBE sessions as an “add on” to an existing curriculum [6], without paying much attention to how SBE sits within its wider ecosystem. Important questions include: how does SBE work in combination with other activities (e.g. lectures, tutorials, and clinical placements)? How do external forces (e.g. accreditation requirements, research evidence, available resources) influence the design, facilitation and experience of simulation? What is the influence of the different purposes and values of teachers, learners and other stakeholders?

Our cross-institutional team in Scotland was recently awarded a Scottish Medical Education Research Consortium (SMERC) grant to explore these questions. Figure 1 shows our initial thoughts about how a simulation session is “entangled” [7] in not just methods and technologies but in how simulation sessions are situated in the wider context, where purposes and values are in play. As members of the IJoHS community we would be delighted to have your thoughts and input into shaping this early proposal of an entangled view of simulation.

An entangled view of a simulation session

Figure 1: An entangled view of a simulation session


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2. Walsh C, Lydon S, Byrne D, Madden C, Fox S, O’Connor P. The 100 Most Cited Articles on Healthcare Simulation: A Bibliometric Review. Simul Healthc. 2018; 13(3): 211–20.

3. Nestel D, Hui J, Kunkler K, Scerbo MW, Editors AWC. Healthcare Simulation Research. Nestel D, Hui J, Kunkler K, Scerbo MW, Editors AWC, editors. Healthcare Simulation Research. A Pracitcal Guide. Springer; 2019.

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5. Battista A, Nestel D. Simulation in Medical Education. In: Understanding Medical Education: Evidence, Theory, and Practice. Oxford: Wiley-Blackwell; 2019. pp. 151–62.

6. Gaba DM. The future vision of simulation in health care. Qual Saf Heal Care. 2004; 13(SUPPL. 1): 2–10.

7. Fawns T, Hislop J, Oliver N, Somerville S. An entangled view of an educational activity. [Internet]. 2022. Available from: