IMSH as a Mirror: What the 2026 Program Reflects About the State of Healthcare Simulation.

The Tide Is Turning: Organizational Structures to Embed Simulation in the Fabric of Healthcare

In 2003, almost simultaneously and independent of each other, two organizations dedicated to the advancement of medical simulation were organized. One was the Society for Medical Simulation (SMS). In 2006, in recognition of the broader scope of medical simulation, SMS changed its name to the Society for Simulation in Healthcare (SSH). The other organization was the Advanced Initiative for Medical Simulation (AIMS), which came about as a result of interactions between various individuals interested in furthering the use of simulation for the public good. AIMS held its first public meeting in May 2004. The birth of these two groups so temporally close to one another and their shared focus has led to confusion in the medical simulation community regarding the role of each organization and their complementary value for the physicians, scientists, educators, and industry who comprise the medical simulation community. This commentary seeks to clarify the purpose of AIMS and explain the separate roles that AIMS and the SSH each can play in the growth and acceptance of medical simulation. ADVANCED INITIATIVE FOR MEDICAL SIMULATION Initially, AIMS was a loosely organized group of individuals, mostly physicians, who gathered to establish the strategic framework under which AIMS would operate to promote simulation. This Planning Committee included individuals within the simulation community as well as key policy strategists (Appendix 1). From the beginning, the organizers recognized that the rationale for government support of simulation would be strongest if AIMS integrated simulation’s users and developers with the manufacturers of simulation systems. Thus, from its early existence, AIMS included an Industry Council that engaged key industry leaders from Haptica, Immersion Medical, Laerdal, Medical Education Technologies Inc. (METI), Simbionix, and Simulab Corporation to work with the AIMS Planning Committee. As of July 2006, the AIMS Industry Council has grown from its original six members to 14, representing many of the commercial vendors of simulation equipment, including B-Line Medical, Gaumard Scientific, Haptica, Immersion Medical, Laerdal, Limbs & Things, Medical Simulation Corporation, Medic Vision, METI, Simbionix, SimMedical, SimQuest, Simulab Corporation, and Verefi Technologies. In 2005, AIMS was incorporated as a 501(c)(6) professional trade association to advance the adoption of medical simulation and to promote the industry. It has two overarching strategies: increasing the visibility of medical simulation among national policymakers and, through that activity, obtaining additional financial support for simulation research and development as well as funds for medical, nursing, and allied health institutions to purchase equipment and related items. AIMS is led by a Board of Directors that includes David Gaba, MD, Dale Alverson, MD, Steven Dawson, MD, and two representatives from the AIMS Industry Council. Gardner, Carton & Douglas LLP (GCD), a national law firm specializing in health care and advocacy, manage and represent AIMS. Jackie Eder-Van Hook, MS, serves as its Executive Director and Bob Waters, JD, serves as its General Counsel. Mr. Waters provides AIMS with expertise in government relations and guides its approach to policymakers. Two founding organizations, Center for Integration of Medicine and Innovative Technology (CIMIT) at Partners Healthcare and Information Resources and Technology (IRT)—Immersive and Simulation-based Learning at Stanford University, have enabled growth of the AIMS effort. Since its inception, AIMS has had an international perspective and has included participants and leaders from Ireland, Norway, Australia, Sweden, and Israel, despite the fact that the driving principle of AIMS’s work is to foster U.S. government investment in medical simulation. Since its very first moments, AIMS has had the philosophy that “a rising tide lifts all boats.” The international cooperation in creating and sustaining AIMS has been a testimony to that belief. AIMS is more than a trade association; it is an idea personified by a coalition of individuals, universities, the simulation industry, and other national organizations whose purpose is to educate and influence health policy and other national policy makers concerning the value of medical simulation. Success for AIMS will be measured by its ability to create the synergy for and the actualization of a long-term federal investment to support simulation development and implementation broadly across the health care arena. AIMS serves as the voice for medical simulation in Congress and in federal agencies, encouraging the awareness of simulation’s potential to reduce errors, improve the performance of health care personnel, and create an environment where the practice of medicine does not always occur on patients themselves. AIMS coordinates its efforts through regular meetings of its leadership and an annual conference and exhibition in Washington, DC, which is entering its fourth year. The conference is an opportunity to bring national leaders in simulation research, users, industry, organized medicine, federal regulators, payers, and insurers together to discuss the state of medical simulation in their respective areas. The AIMS presentations are intended to discuss policy issues and place simulation in a broader context within the national health care system. The AIMS meeting does not present peer-reviewed scientific papers. The annual Congressional exhibition provides a hands-on educational experience with a variety of simulation systems for Members of Congress, Congressional and Federal agency staff, the press, and the public. In 2006, the Third Annual AIMS Congressional exhibition had the bipartisan support of 134 Congressional Honorary Cohosts, representing 25% of the entire Senate and 24% of the U.S. House of Representatives. Information about the 4th Annual AIMS Conference and Exhibition is available at the AIMS website at www.medsim.org. AIMS’s capacity to hold this exhibition on Capitol Hill is greatly influenced by the ability to create Congressional champions of Members of Congress or staff. Senator Tom Harkin of Iowa has been a key supporter of AIMS’s efforts and has served as an Honorary Co-Chair of the Exhibition since its inception in 2004. In 2006, Virginia Congressman J. Randy Forbes, Chair of the Modeling and Simulation Caucus in the U.S. House of Representatives, also served as an Honorary Co-Chair. Congressman Forbes has taken an active interest in the medical aspects of simulation in addition to its applications in aviation and engineering. This level of Congressional interest represents significant progress in 3 years since the first meeting in 2004, when AIMS had one Honorary Cohost. Clearly, recognition of medical simulation is increasing on the Hill. AIMS: A VALUABLE COMPLEMENT TO SSH AIMS and SSH complement each other in a substantive manner, yet each has a unique mission. AIMS provides a national voice for medical simulation at the federal level. By realizing its mission to educate public and private policymakers, articulate the value of simulation to a broad national audience, and convene external stakeholders in an effort to find or create champions for medical simulation, AIMS will—and indeed already has begun to—change the face of medical simulation. In its short existence, AIMS has been at the forefront of raising awareness of federal agency staff to the potential of simulation. Among the early results of these efforts are a new program of $2.4 million in funds for research, the inclusion of medical simulation in the first Congressional Modeling and Simulation Exhibition in the House of Representatives in 2006, and success in adding language to the Fiscal Year 2007 House Appropriations Labor-HHS-Education Committee Report. AIMS has performed outreach to a number of federal agencies, such as the Institute of Medicine and the National Academies of Science in an effort to create synergy and to examine and define the value of medical simulation. Today, simulation’s science is presented at a growing number of meetings around the world, including the International Meeting for Simulation in Healthcare (IMSH), SIMTEC, the International Symposium on Biomedical Simulation (ISBMS), Medical Image Computing and Computer-Assisted Intervention (MICCAI), SIGGRAPH, and Medicine Meets Virtual Reality (MMVR). In the future, it is hoped that one organization, the SSH, will encompass the scientific leadership role for all of medical simulation in an expanded annual meeting. AIMS will then serve as a policy-oriented convener, educator, and advocate for medical simulation in the United States and around the globe. Together, AIMS and SSH can serve as focal points for convening the simulation science, practice, and development communities, thereby enhancing our scientific basis and extending our reach to a broader audience outside the health care arena. Both AIMS and SSH share the commitment that simulation as practiced now is only a hint of what will eventually be a much more widely used, broadly accepted, and institutionally integrated technology. Both organizations recognize that more research and development is necessary to create systems that answer healthcare’s evolving needs. As simulation expands from its original platforms to newer technologically advanced methods, trials will be needed to establish performance improvement in clinical settings. At this time, no one industry partner or institution is able to fund these studies adequately, yet working together AIMS and SSH can secure the visibility and funds for these efforts. As a nonprofit 501(c)(3) corporation, SSH is an international, multidisciplinary, academic society focused on education, assessment, and research. However, its nonprofit 501(c)(3) status precludes it from influencing public policy. AIMS, by contrast, was expressly incorporated as a 501(c)(6), a nonprofit designation that allows it to take a participatory role in government policy. AIMS can focus on areas where federal support would be crucial to further simulation integration, adoption, or development. SSH can then convene the users, educators, and scientists who will define the field. Although there is overlap among the individuals, organizations, and corporations interested in AIMS and SSH, some may find it more advantageous to affiliate with one or the other organization. Hopefully, most will appreciate the need for both organizations to be successful and participate in each, recognizing the important and unique roles that each organization plays in the future of medical simulation. In the end, these two organizations are working for the same goal: improved performance and reduced errors using broadly accepted, scientifically proven medical simulation systems to train providers. We look forward to jointly influencing many medical disciplines, as well as related fields from engineering and educational psychology to the insurers and our certifying boards. Together, AIMS and SSH can play synergistic roles in that future.

IntroductionSuspension of disbelief (SoD) is a concept that relates to participants in healthcare simulation being willing to suspend their disbelief, being able to accept the unreal elements of a simulation, but still act as if the situation was real, so that they may become immersed in the simulation. However, the evidence to support this commonly used concept is not clear. This protocol sets out the methods to be used to undertake a scoping review of the literature relating to SoD in healthcare simulation.MethodsA scoping review methodology will be used to undertake a comprehensive database (l: MEDLINE, Psychology and Behavioural Sciences Collection, CINHAL Plus with Full text, APA PsycINFO APAPsycArticles, AMED – The Allied and Complementary Medicine Database and Scopus) literature search focussing on healthcare simulation following the Population, Concept and Context framework (healthcare professionals, SoD, and simulation). Included literature will be assessed using the Mixed Methods Appraisal Tool for primary research papers and the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist for grey literature.AnalysisData analysis will be undertaken using thematic analysis and narrative reporting. This work will contribute to the wider understanding of the concept within healthcare simulation. It will help to provide guidance and a focus for future research into the concept.

The Society for Simulation in Healthcare (SSH) as the world's largest and most authori-tative Medical Simulation Education Association, accept the application for certification in 4 fields, includ-ing assessment, research, education and system integration. This paper introduces the core standards that need to be followed in applying for certification, and the respective standards of the above 4 fields. Further-more, in order to promote the development of medical simulation education in China, this paper points out the possible problems that may be faced in the future. Key words: The Society for Simulation in Healthcare; Certification; Standard

The Society for Simulation in Healthcare (SSH) is the international association that provides a forum for the simulation community to share ideas, concerns, and interests (Fig. 38.1). By design, SSH is interdisciplinary and multispecialty in its programmes, leadership and membership. From its inception in 2004, SSH was envisioned as an umbrella organization that would provide a central point for regional associations with an interest in simulation to collaborate. As such, a number of organizations, such as the Society in Europe for Simulation Applied to Medicine, and the Australian Society for Simulation in Healthcare, have joint membership agreements with SSH and use the society’s journal as an official publication of their own society.

Whereas most educators have a good grasp on the history of simulation in healthcare, the current state and types of modalities related to simulation in healthcare education, and the future direction of healthcare simulation, many educators do not have an in-depth understanding of the metrics available to assess the use of simulation. The purpose of this literature synthesis is to build a repository of the metrics being used to evaluate nursing and healthcare provider simulation. Additionally, the level of fidelity and desired learning domains that the matrices purport to evaluate is examined. A secondary purpose of the literature synthesis is to determine if a suitable metric is available that can be used universally to evaluate nursing and healthcare related simulations. Finally, conceptual frameworks suitable for serving as the bases of instrument development related to nursing and health care simulation are explored. Primary studies, meta-analyses, and systematic reviews that discussed or evaluated metrics used to measure outcomes of simulation were analyzed. Recent articles, published within the last five years, which discussed the evaluation of nursing and or healthcare simulation, were eligible for inclusion. Additionally, descriptive, inferential, qualitative, and quantitative studies were eligible for inclusion.

The Society for Simulation in Healthcare held its third research summit in January 2023 with the aim of establishing evidence-based guidelines for healthcare simulation training. A panel of researchers, clinicians, and subject-matter experts conducted reviews of the literature addressing 12 key topics and followed a formal process to generate 16 guidelines for simulation-based training in healthcare. Eleven peer-reviewed literature reviews accompany these guidelines. Over the last 12 years, the Society for Simulation in Healthcare research summits have evolved with a consistent aim to advance simulation research, culminating in the formal set of guidelines published in this special issue.

In the past two decades, the field of simulation in healthcare has experienced a dramatic expansion. Numerous simulators, simulation-based training curricula and programmes now exist, across a range of healthcare specialties. Many healthcare and education practitioners have developed their careers in the field of simulation-based education and training. There are basic and advanced courses and qualifications that can be obtained to demonstrate knowledge and mastery of simulation as an approach to education and training in a number of countries. The overall investment in simulation from the perspective of human and organisational resources, as well as financial commitment is significant. A wide range of peer-reviewed outlets now exist, publishing scientific investigations of simulation-based applications. Multiple conferences across the globe led by learned societies specialising in simulation take place every year, where the latest studies and nascent developments are shared and discussed. To add to those, simulation has now permeated mainstream general and specialty-specific clinical meetings (eg, in surgery, nursing, anaesthesia, or obstetrics to name but a few), such that simulation studies are also regularly presented to clinical audiences at large. This expansion has been driven by a range of inter-related factors. Ever increasing pressures to shorten clinical trainees’ learning curves; the quest to ensure the highest levels of safety at the point of care; technological developments (eg, virtual reality), including industry initiatives; as well as cross-industry influences from sectors where simulation-based training and development have long been part of operational training or personnel selection …

Background. Escape rooms have been adapted from a range of educational purposes across disciplines, including healthcare simulation. The use of this technique has become increasingly popular among industry and faculty members. We sought to clarify the characteristics of healthcare simulation escape rooms in order to work toward a shared mental model and definition. Methods. A scoping review of the literature with an environmental scan of websites and other public information was performed to identify concepts which describe educational and healthcare simulation escape rooms to differentiate between and determine key features and scope of this clinical education tool to provide an interprofessional definition. Twenty-three references were used. Results. Healthcare simulation escape rooms share many of the characteristics of those being used for education and may be utilized for teaching a variety of skills. These may be conducted either within a simulation scenario, within the simulation/simulated environment, and/or with associated equipment. It is essential that the development and implementation of these escape rooms follow design standards of best practice for healthcare simulation for optimal learning. Only one definition of simulation escape rooms was found. Discussion. While similar to escape rooms utilized in other forms of education, there are principal differences between those escape rooms and ones used in healthcare simulation. Key features include utilization of core healthcare simulation principles, including providing a safe and realistic learning environment. Conclusion. Escape rooms may be used to engage learners in a simulation experience. It is important to differentiate between true simulation escape rooms and escape rooms that do not reflect healthcare simulation-based learning experiences. An expanded definition is provided, as reflected by the literature review, to provide a clearer understanding of the term as applied to healthcare simulation and enhance repeatable studies to advance the science of healthcare simulation.

Coming of Age: Online Continuing Education for the Journal and the Society for Simulation in Healthcare

: 1641 individuals attended the 2009 International Meeting on Simulation in Healthcare and had access to Post graduate courses, panels, keynotes, roundtables, and workshop sessions to further their knowledge of use of simulation in healthcare to improve patient safety and manage resources. 29 workshops provided both hands-on and interactive learning in the areas of conducting research, outcomes based assessment, case development, disaster training, needs assessment and competency based training. Panels and keynotes addressed education, research, simulations operations, interactive environments, credentialing and assessment, clinical areas, economics of simulation and standardized patients. 91 peer reviewed research abstracts were presented and selections will be published in the Society's Journal, Simulation in Healthcare. Additionally, 175 non-peer reviewed works in progress abstracts were presented and published in the course program.

: 1200 individuals attended the 2007 International Meeting on Simulation in Healthcare and had access to panels, keynotes and workshop sessions to further their knowledge of use of simulation in healthcare to improve patient safety and manage resources. 26 workshops provided both hands-on and interactive learning in the areas of conducting research, outcomes based assessment, case development, disaster training, needs assessment and competency based training. Panels and keynotes addressed education, research, simulations operations, interactive environments, credentialing & assessment, clinical areas, economics of simulation and standardized patients. 72 peer reviewed abstracts were presented and are published in the Society s Journal, Simulation in Healthcare.

The complexities of modern biomedicine are rapidly increasing. Thus, modeling and simulation have become increasingly important as a strategy to understand and predict the trajectory of pathophysiology, disease genesis, and disease spread in support of clinical and policy decisions. In such cases, inappropriate or ill-placed trust in the model and simulation outcomes may result in negative outcomes, and hence illustrate the need to formalize the execution and communication of modeling and simulation practices. Although verification and validation have been generally accepted as significant components of a model’s credibility, they cannot be assumed to equate to a holistic credible practice, which includes activities that can impact comprehension and in-depth examination inherent in the development and reuse of the models. For the past several years, the Committee on Credible Practice of Modeling and Simulation in Healthcare, an interdisciplinary group seeded from a U.S. interagency initiative, has worked to codify best practices. Here, we provide Ten Rules for credible practice of modeling and simulation in healthcare developed from a comparative analysis by the Committee’s multidisciplinary membership, followed by a large stakeholder community survey. These rules establish a unified conceptual framework for modeling and simulation design, implementation, evaluation, dissemination and usage across the modeling and simulation life-cycle. While biomedical science and clinical care domains have somewhat different requirements and expectations for credible practice, our study converged on rules that would be useful across a broad swath of model types. In brief, the rules are: (1) Define context clearly. (2) Use contextually appropriate data. (3) Evaluate within context. (4) List limitations explicitly. (5) Use version control. (6) Document appropriately. (7) Disseminate broadly. (8) Get independent reviews. (9) Test competing implementations. (10) Conform to standards. Although some of these are common sense guidelines, we have found that many are often missed or misconstrued, even by seasoned practitioners. Computational models are already widely used in basic science to generate new biomedical knowledge. As they penetrate clinical care and healthcare policy, contributing to personalized and precision medicine, clinical safety will require established guidelines for the credible practice of modeling and simulation in healthcare.

In this article, we describe the preparation and execution of the first Research Consensus Summit (Summit) of the Society for Simulation in Healthcare (SSH) held in January 2011 in New Orleans, Louisiana. The goals of the Summit were to provide guidance for better simulation-related research, to broaden the scope of topics investigated, and to highlight the importance of simulation-related research. An international Core Group (the authors of this article) worked with the SSH Research Committee to identify 10 topic areas relevant for future research that would be examined by the 10 Topic Groups composed of Topic Chairs and Topic Group Members. Each Topic Group prepared a monograph and slide presentation on their topic which was presented at the 2-day Summit. The audience provided feedback on each presentation. Based on this feedback, the Topic Groups revised their presentations and monographs for publication in this supplement to Simulation in Healthcare. The Core Group has synthesized an overview of the key Summit themes in this article. In some groups, the agreement was that there is currently no consensus about the state of the science in certain topic aspects. Some key themes emerged from the Topic Groups. The conceptual and theoretical bases of simulation-related research, as well as the methods used and their methodological foundations, need to be more explicitly described in future publications. Although no single method is inherently better, the mix of research methods chosen should match the goal of each study. The impact of simulation, whether direct or indirect, needs to be assessed across different levels of training, and larger, more complex contexts need to be taken into account. When interpreting simulation-related research, the ecological validity of the results needs to be taken into consideration. The scope of simulation-related research can be widened from having simulation as the focus of research (research about simulation), to using simulation to investigate other research questions (research with simulation). Simulation-related research can benefit from an improved understanding of structural differences and similarities with other domains. The development of simulation equipment and concepts will benefit from applying known and available science-based design frameworks. Overall, the context of simulation-related research needs to be better understood. The progress of research depends on building overarching and sustainable research programs that relate individual studies with each other. The Summit was successful in taking a snapshot of the state of the science. Future summits might explore these topics further, monitor progress, and address new topics.

The construct of reliability in health professions education serves as a measure of the congruence of interpretations across assessment tools. When used as an assessment strategy, healthcare simulation serves to elicit specific participant behaviors sought by medical educators. In healthcare simulation, reliability often refers to the ability to consistently reproduce a simulation and that reproducing a simulation setting can consistently expose participants to the same conditions, thus achieving simulation reliability. However, some articles have expressed that simulations are vulnerable to error stemming from design conceptualization to implementation, and the impact of social factors when participants interact and engage with others during participation. The purpose of this definitional review is to examine how reliability has been conceptualized and defined in healthcare simulation, and how the attributes of simulations may present challenges for the traditional concept of reliability in health professions education.Data collection and analysis was approached through a constructivist perspective and grounded theory strategies. Articles between 2009-2019 were filtered applying keywords related to simulation development and design. Data winnowing was structured around a framework viewing simulation as a social practice where participants interact with simulation setting attributes.Healthcare simulation setting reliability is not directly defined but described as errors introduced by the interactions between simulation design attributes and tasks performed by simulated participants. Based on the ontology of simulation’s design attributes believed to introduce setting errors, lexical terms related to reliability suggest how simulated participants are trained to refine or maintain their performance tasks that aim to mitigate errors.To achieve reliability in health professions education (HPE) and healthcare simulation, both domains seek to assess the consistency of a construct being measured. In HPE, reliability refers to the consistency of quality measures across a range of psychometric tests used to assess a participant’s medical aptitude. In healthcare simulation setting, reliability refers to the consistency of a simulated participant (SP) performing a task that is tailored to mitigate errors introduced by simulation design attributes. Consequently, inconsistencies in SP performance subject participants to setting errors exposing them to unequal conditions that influence competency achievement.What is already known on this subject: Performance competency assessment using healthcare simulation is increasingly common. The types of design attributes incorporated into a simulation setting. The use of incorporating simulated participants into a simulation setting. Simulated participants require training prior to simulation setting implementation.What this paper adds: Identifies attributes of a simulation setting that are most commonly thought to interfere with setting reliability. Identifies the relationships among setting attributes and simulated participant performances that influence setting reliability. Identifies terms tied to the achievement of simulation setting reliability. Examines simulated participant training processes aimed to mitigate errors introduced by simulation design attributes.