Abstract Simulation technologies (ST) in health and medical education are undergoing rapid development due to the undoubted advantages of the methods and forms of simulation used - high quality, significant efficiency, economy, reliability and safety for the patient. At the same time, the application of ST is still underrepresented in the education of health care students. The main aim of this study was to identify the barriers and perspectives for the application of ST in the education of health professional students in Bulgaria from the perspective of the respondents’ expertise. A qualitative study of the expert (n = 17) opinion of those directly involved in the introduction, application, and evaluation of the use of ST in the education of healthcare students was conducted in 2023 in Varna. The questionnaire regarding the barriers and perspectives in the use of ST in the education of undergraduate and postgraduate students in health specialties students was used. The main barriers to the widespread use of ST in the training of students were identified as follows: the lack of adapted curricula that combine traditional practical sessions with patients and those on simulators; the lack of a sufficient number of trained and motivated trainers; the reluctance of trainers to introduce or more widely use ST; lack of or insufficient space to locate a simulation centre or equipment in relevant core units; the high cost of purchasing and maintaining ST and limited financial resources, as well as the large number of students in the groups. According to one of the experts, ‘there are no barriers to the use of ST, but real patient contact and a personalized approach to the patient is impossible to replicate through technology,’ highlighting the importance in combining traditional training with real patients and modern with the use of technology. Ethical issues in training healthcare professionals with simulators appear to be a new aspect of medical education with the application of ST. Key messages • In the effort for widespread implementation of ST in the training of health professions students, it is important to achieve a balance with traditional training experienced with real patients. • Identifying and overcoming barriers is an important prerequisite for the rapid and widespread application of ST in the training of health care students.