Evidence & Resources
A practical approach, grounded in evidence.
In-situ simulation offers an opportunity to practise clinical care, strengthen teamwork, and identify problems in the systems we use every day.
Our rural simulation program was informed by the work of educators and researchers who have demonstrated that meaningful learning doesn't necessarily require elaborate facilities or expensive technology.
01 / Evidence
Our work in Espanola
Can implementation of in situ simulation support rural emergency provider self-confidence and improve patient safety? A mixed-methods study.
Diebel S, Wharton A, King P, Parker M. Canadian Journal of Rural Medicine. 2025;30(4):182–188.
We studied a series of in-situ simulation sessions conducted during regular clinical operations in our small rural emergency department. Participants reported high satisfaction and confidence following simulation. The sessions also identified equipment and workflow issues that could be addressed through local quality improvement.
This was a small, single-centre study evaluating feasibility, participant experience and safety threats - not a demonstration of improved patient outcomes. It provided an encouraging foundation for continuing the program.
Selected reading
In situ simulation: Detection of safety threats and teamwork training in a high-risk emergency department.
Patterson et al. BMJ Quality & Safety, 2013.
A foundational study demonstrating how short simulations conducted in an active emergency department can uncover latent safety threats. Across 90 simulations, the team identified 73 threats involving equipment, processes and team responsibilities.
Translational simulation: Not “where?” but “why?”
Victoria Brazil. Advances in Simulation, 2017.
An influential perspective on connecting simulation directly to clinical improvement. The emphasis shifts from the sophistication of the simulation environment to what the exercise accomplishes for patients, teams and healthcare systems.
Establishing a safe container for learning in simulation.
Rudolph, Raemer & Simon. Simulation in Healthcare, 2014.
An important discussion of psychological safety, prebriefing and learner engagement. A useful starting point for educators who want simulation to feel like an opportunity for improvement rather than a test of competence.
The role of debriefing in simulation-based learning.
Fanning & Gaba. Simulation in Healthcare, 2007.
A foundational review of why guided reflection is essential to simulation-based learning. Particularly useful for educators developing confidence with debriefing.
02 / Resources for simulation educators
Health Sciences North Simulation Laboratory
The Simulation Laboratory at Health Sciences North in Sudbury supports interprofessional simulation education across Northern Ontario, including collaboration with rural hospitals.
Their faculty development offerings include introductions to simulation, case writing and debriefing, as well as more advanced instruction in simulation design, program evaluation and facilitation.
The HSN Simulation Lab has been an important educational resource in the development of our program.
Explore the HSN Simulation Lab and courses →
Healthcare Simulation Standards of Best Practice
The International Nursing Association for Clinical Simulation and Learning (INACSL) publishes practical, evidence-informed standards covering simulation design, prebriefing, facilitation, debriefing and evaluation.
An excellent reference for educators developing or improving a simulation program.
Center for Medical Simulation
The Center for Medical Simulation provides resources on psychologically safe learning, debriefing and faculty development.
Two particularly helpful starting points are The Basic Assumption, which establishes a respectful stance toward learners, and the Debriefing Assessment for Simulation in Healthcare (DASH), a tool for developing debriefing skills.
Debriefing Assessment (DASH) →
Start small. Learn together. Improve something.
These resources provide the foundation. The next step is to run a case in your own department and see what your team discovers.