In the past 2 years, ASPiH (Association for Simulated Practice in Healthcare) annual conferences offered a space for reflection on crucial topics central to simulation-based activities [1,2], and this year is no exception. The ASPiH 2023 theme is Sustainable Simulation. The term sustainable derives from the Latin word ‘ The simulation community has been keen to share their reflections and strategies on how sustainability can support and enhance the quality and impact of health and care simulation activities. Many of the abstracts received demonstrate that our community is aware, concerned and actively developing sustainable solutions [4–15]. One of the primary aspects of sustainable simulation is resource efficiency. Health, care and educational institutions are often limited by budget constraints and environmental concerns. Sustainable simulation strategies help them make the most of their investments in simulation technology and facilities. By maximizing the utilization of their human resources, material, equipment and space, institutions can reduce costs and minimize their environmental footprint [4,5]. Moreover, sustainability in health and care simulation promotes the development of accessible, environmentally and economically responsible technological solutions. Low-cost solutions often involve finding affordable, non-disposable alternatives to expensive simulation tools and props. Durable, reusable materials, for example, drive both eco-friendly and cost-effectiveness goals simultaneously [6,7]. On the other hand, the use of cutting-edge technologies, such as virtual reality, provides immersive learning experiences while reducing the use of disposables, associated waste and travel [8,9]. Sustainable simulation also encourages collaborative partnerships among health, care and educational institutions, and industry stakeholders. These partnerships can facilitate the sharing of resources, expertise, best practices, and the development of standardized or innovative solutions. This collaborative approach ensures that health and care simulation activities maintain a high level of quality and relevance while conserving resources [10–12]. Furthermore, sustainable simulation aligns with the broader goals of health and care education and practice. By promoting resource efficiency and responsible use of technology, it prepares health and care professionals to be mindful of resource allocation at work. This is especially relevant in a world where sustainability and health and care outcomes are interconnected [13]. Sustainable simulation practices are inherently scalable. They can be adapted to accommodate growing student populations without a proportional increase in costs or environmental impact. This scalability is essential as health and care education strives to meet the rising demand for skilled professionals [14,15]. In conclusion, sustainable simulation is a pragmatic approach to improving health and care education and practice. By adopting sustainable practices in health and care simulation-based activities, we can ensure that these invaluable training tools remain accessible, effective and aligned with the evolving needs of health and care. As we move forward, let us embrace our evolving principles of sustainable simulation as means to elevate the quality and impact of health and care education, ultimately leading to better care and a more responsible use of resources. We invite you to continue this reflection and call to action during the 2023 ASPiH Conference in Brighton, 6–8 November 2023, which has a vibrant and rich scientific programme, as illustrated by the abstracts selected for publication in this special issue of the International Journal of Healthcare Simulation. Thank you to everyone who responded to the call for abstracts for this year’s ASPiH conference and to the scientific committee members involved in the reviewing process.