Full environment simulation is achieving wide adoption despite weak evidence of its impact on outcome. It is doing so because it has strong face validity, creates much enthusiasm from both students and teachers, and because it is what other high hazard industries do to mitigate errors and to create and maintain a culture of safety. Yet most of us working with simulation technologies and techniques generally try to maintain our objectivity. We ask ourselves if it really does what we think it does, how much fidelity is needed to achieve our educational goals, and how we weigh the costs and benefits. When we are using it for non-technical training such as improving teamwork, we want to understand how it should be used to meet the real objective—creating real lasting behavior and culture changes that will make health care more effective and safer.

The paper in this issue of QSHC by Shapiro and colleagues¹ demonstrates a model for using …