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Creating new realities in healthcare: the status of simulation-based training as a patient safety improvement strategy
  1. Eduardo Salas1,
  2. John T Paige2,
  3. Michael A Rosen3
  1. 1Institute for Simulation & Training, University of Central Florida, Orlando, Florida, USA
  2. 2Department of Surgery, LSU Health New Orleans Health Sciences Center, School of Medicine, New Orleans, Louisiana, USA
  3. 3Department of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Eduardo Salas, Institute for Simulation & Training, University of Central Florida, UCF, Orlando, FL 11111, USA; esalas{at}

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Patients and their families in addition to healthcare providers, administrators and workers of many types must deal with an increasingly complex healthcare system.1 Fortunately, the scientific understanding of how this complexity can introduce errors and produce patient harm has advanced significantly in recent years.2 Unfortunately, this progress has been accompanied by the realisation that producing lasting change in such a complex system is very difficult.3 Researchers, educators, policy makers and regulators alike have reached a broad consensus that effectively managing these challenges requires transformative change in educational4 and healthcare delivery systems.1 The articles in this special issue demonstrate the critical role simulation plays in these changes. Strong evidence now supports the efficacy of simulation as a learning strategy for individuals and teams in healthcare and progress is being made on its applications to unit and organisational level learning.

This commentary seeks to situate the articles in this special issue within the broader context of what we know about simulation in healthcare. Specifically, by extracting some themes from the articles in this volume and other relevant literature, we address three main questions: does simulation-based training (SBT) work; under what conditions does SBT work best; and what are critical future research and application directions for SBT as a patient safety strategy?

SBT works!

In healthcare, the term “simulation” has been defined as “instruction that makes use of facsimiles of clinical contexts wherein learners interact to acquire knowledge, skills, and affective elements that will ultimately transfer to the real clinical context.5” SBT, therefore, involves the application of several scientific, theory-based approaches to design and delivery of training that include information, demonstration and practice-based methods; as such, it is a tool to accelerate expertise.

Recently, an emerging evidence base has emerged supporting the use of simulation to build individual …

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  • *Special Issue on Simulation: Edited by Eduardo Salas and Michael Rosen in collaboration with Elizabeth Hunt (Johns Hopkins University, School of Medicine, Division of Pediatric Critical Care Medicine, Baltimore, USA) and Pamela R Jeffries (The Johns Hopkins University, School of Nursing, Baltimore, USA)

  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.