Welcome to Sim-Versity
Simulation Education Diversity Toolkit website

From this website you will find various tips and resources to assist you to integrate diversity into your simulation-based education


To organise an effective simulation education requires careful planning and scripting to reveal learners frameworks and to optimize their performance and learning. The first phase of the learning experience in simulation education is pre-briefing.

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Simulation based learning (SBL) is an active learning method that provides learners with exposure to realistic clinical situations using life-like examples in a safe environment. Active learning strategies offer learners opportunities to develop their critical thinking, problem-solving, and reflection skills.

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It is suggested that postsimulation debriefing, a ‘structured and guided reflection process in which learners actively appraise their cognitive, affective and psychomotor performance’ (Al Sabei & Lasater 2016), is the most important element of the simulation learning process (e.g. Zigmont et al. 2011a, Levett-Jones & Lapkin 2014).

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Guide for conducting multicultural group simulations

We have prepared this video interview and a written guide for those clinical staff and trainers who conduct multicultural group simulations. Both of these Toolkit resources are based on a comprehensive literature review, staff interviews and experience of multicultural student group learning sessions.

Simulation Scenarios

Here are a few examples of how to integrate diversity into your simulation education.





Research References

Click here to see the research papers and references used in outlining the information contained within this introduction to the Toolkit

Literature on briefing

Al Sabei S & Lasater K. 2016. Simulation debriefing for clinical judgment development: A concept analysis. Nurse Education Today 45, 42-47.

Alinier G. 2011. Developing High-Fidelity Health Care Simulation Scenarios: A Guide for Educators and Professionals. Simulation and Gaming 42(1,) 9-26.

Arafeh J, Hansen S & Nichols A. 2010. Debriefing in simulated-based learning: Facilitating a reflective discussion. The Journal of Perinatal & Neonatal Nursing 24(4), 302-311.

Arthur C, Levett-Jones T & Kable A. 2013. Quality indicators for the design and implementation of simulation experiences: A delphi study. Nurse Education Today 33(11), 1357-1361.

Bambini D. 2016. Writing a simulation scenario. Advanced Critical Care 27(1), 6–70.

Bland A & Tobbell J. 2016. Towards an understanding of the attributes of simulation that enable learning in undergraduate nurse education: A grounded theory study. Nurse Education Today 44, 8–13.

Brackney D & Priode K. 2014. Creating context with prebriefing: a case example using simulation. J Nurs Educ Pract 5(1),129.

Chmil J. 2016. Prebriefing in simulation-based learning experiences. Nurse Educator 41(2), 64–65.

Costello M, Prelack K, Faller J, Huddleston J, Adly S & Doolin J. 2018. Student experiences of interprofessional simulation: Findings from a qualitative study. Journal of Interprofessional Care 32(1), 95–97.

Dieckmann P & Krage R. 2013. Simulation and psychology: creating, recognizing and using learning opportunities. Current Opinion in Anaesthesiology 26(6), 714–720.

Dieckmann P, Gaba D & Rall M. 2007. Deepening the Theoretical Foundations of Patient Simulation as Social Practice. The Journal of the Society for Simulation in Healthcare 2(3), 183-193.

Felton A & Wright N. 2017. Simulation in mental health nurse education: The development, implementation and evaluation of an educational innovation Nurse Education in Practice 26, 46-52.

Kolbe M, Grande B & Spahn D. 2015. Briefing and debriefing during simulation-based training and beyond: Content, structure, attitude and setting. Best Practice & Research: Clinical Anaesthesiology 29(1), 87-96.

Levett-Jones T, Andersen P, Reid-Searl K, Guinea S, McAllister M, Lapkin S, Palmer L & Niddrie M. 2015. Tag team simulation: An innovative approach for promoting active engagement of participants and observers during group simulations. Nurse Education in Practice 15, 345-352.

O’Regan S, Molloy E, Watterson L & Nestel D. 2016. Observer roles that optimize learning in healthcare simulation education: A systematic review. Advances in Simulation 1(4), 1–10.

Page-Cutrara K. 2014. Use of prebriefing in nursing simulation: a literature review. Journal of Nursing Education13(3), 136-41.

Literature on simulation

Aebersold M. 2016. The history of simulation and its impact on the future. AACN Advanced Critical Care 27(1), 56-61.

Andrea J & Kotowski P. 2017. Using standardized patients in an undergraduate nursing health assessment class. Clinical Simulation in Nursing 13, 309-313.

Arthur C, Levett-Jones T & Kable A. 2013. Quality indicators for the design and implementation of simulation experiences: A delphi study. Nurse Education Today 33(11), 1357-1361.

ASPiH, Association for Simulated Practice in Healthcare. 2017. Simulation-based education in healthcare: Standards framework and guidance. England: ASPiH. Retrieved from http://aspih.org.uk/standards-framework-for-sbe/

Aura S, Sormunen M, Jordan S, Tossavainen K & Turunen H. 2015. Learning outcomes associated with patient simulation method in pharmacotherapy education: An integrative review. Simulation in Healthcare 10, 170–177.

Aura S, Paakkonen H, Metsävainio K, Saano S, Selander T, Jordan S & Turunen H. 2017. Simulation- and web -based learning of intravenous pharmacotherapy: A 2 group comparison with 6 months’ follow up. Journal of Radiology Nursing 36, 117–124.

Bahreman N & Swoboda S. 2016. Honoring Diversity: Developing Culturally Competent Communication Skills Through Simulation. Journal of Nursing Education 55(2), 105-108

Baillie L & Curzio J. 2009. Students’ and facilitators’ perceptions of simulation in practice learning. Nurse Education in Practice 9(5), 297-306

Bambini D, Washburn J & Perkins R. 2009. Outcomes of clinical simulation for novice students: Communication, confidence, clinical judgment. Nursing Education Perspectives 30(2), 79-82.

Bambini D. 2016. Writing a Simulation Scenario: A Step-By-Step Guide. AACN Adv Crit Care. 27(1), 62-70.

Banks S, Stanley M, Brown S & Matthew W. 2019. Simulation-Based Interprofessional Education: A Nursing and Social Work Collaboration. Journal of Nursing Education 58(2), 110-113.

Barrows H. 1993. An overview of the uses of standardized patients for teaching and evaluating clinical skills. Academic Medicine 68(6), 443–453.

Cant R & Cooper S. 2010. Simulation-based learning in nurse education: Systematic review. Journal of Advanced Nursing 66(1), 3–15.

Cant R & Cooper S. 2017. The value of simulation- based learning in pre- licensure nurse education: A state-of-the-art review and meta-analysis. Nurse Education in Practice 27, 45-62.

Cooper S, Cant R, Porter J, Bogossian F, McKenna L, Brady S & Fox-Young S. 2012. Simulation based learning in midwifery education: A systematic review. Women and Birth 25, 64–78.

Cohen A, Kitai E, David S & Ziv A. 2014. Standardized patient-based simulation training as a tool to improve the management of chronic disease. Simulation in Healthcare 9(1), 40-47.

Defenbaugh N & Chikotas N. 2016. The outcome of interprofessional education: Integrating communication studies into a standardized patient experience for advanced practice nursing students. Nurse Education in Practice 16, 176-181.

Dieckmann P. 2009. Simulation settings for learning in acute medical care. In P. Dieckmann (eds.) Using simulations for education, training and research (pp. 40-138). PABST Science Publishers, Lengerich.

Endacott R, Bogossian F, Cooper S, Forbes H, Kain V & Young S. 2015. Leadership and teamwork in medical emergencies: Performance of nursing students and registered nurses in simulated patient scenarios. Journal of Clinical Nursing 24(1-2), 90-100.

Foronda CL, Baptiste D-L, Pfaff T, Velez R, Reinholdt M, Sanchez M & Hudson KW. 2018. Cultural Competency and Cultural Humility in Simulation-Based Education: An Integrative Review. Clinical Simulation in Nursing 15, 42-60.

Gaba D. 2011. Training and nontechnical skills: The politics of terminology. Simulation in Healthcare 6(1), 8–10.

Hamstra S, Brydges R, Hatala R, Zendejas B & Cook D. 2014. Reconsidering fidelity in simulation-based training. Academic Medicine 89(3), 387–392.

Haugland V & Reime M. 2018. Scenario-based simulation training as a method to increase nursing students’ competence in demanding situations in dementia care. A mixed method study. Nurse Education in Practice 33, 164–171.

Hayden J, Smiley R, Alexander M, Kardong-Edgren S & Jeffries P. 2014. The NCSBN National Simulation Study: A Longitudinal, Randomized, Controlled Study Replacing Clinical Hours with Simulation in Prelicensure Nursing Education. Journal of Nursing Regulation 5(2), C1-S64.

Hill A, Davidson B & Theodoras D. 2010. A review of standardized patients in clinical education: implications for speech-language pathology programs. International Journal of Speech-Language Pathology 12 (3), 259e270

Howard VM, Ross C, Mitchell AM & Nelson GM. 2010. Human patient simulators and interactive case studies: A comparative analysis of learning outcomes and student perceptions. CIN: Computers, Informatics, Nursing 28(1), 42-48.

Jakobsen R, Gran S, Grimsmo B, Arntzen K, Fosse E, Frich J & Hjortdahl P. 2018. Examining participant perceptions of an interprofessional simulation-based trauma team training for medical and nursing students. Journal of Interprofessional Care 32(1), 80–88.

Jeffries P & Rogers K. 2007. Theoretical framework for simulation design. In P.R. Jeffries (Ed.), Simulation in 39: From Conceptualization to Evaluation (pp. 21-33). New York, NY: National League for Nursing.

Jeffries P. 2005. A framework for designing, implementing, and evaluating simulations used as teaching strategies in nursing. Nurs. Educ. Perspect. 26, 96.

Kardong-Edgren S, Adamson K & Fitzgerald C. 2010. A review of currently published evaluation instruments for human patient simulation. Clinical Simulation in Nursing 6(1), 25–35.

Kelly M, Berragan E, Husebo S & Orr F. 2016. Simulation in nursing education. Journal of Nursing Scholarship 48(3), 312–321.

Koo L, Layson-Wolf C, Brandt N, Hammersla M, Idzik S, Rocafort T, Tran D, Wilkerson G & Windemuth B. 2014. Qualitative evaluation of a standardized patient clinical simulation for nurse practitioner and pharmacy students. Nurse Education in Practice 14(6), 740-746.

Kunst E, Mitchell M & Johnston A. 2016. Using simulation to improve the capability of undergraduate nursing students in mental health care. Nurse Education Today 5, 29-35.

Levett-Jones T & Lapkin S. 2014. A systematic review of the effectiveness of simulation debriefing in health professional education. Nurse Education Today 34(6), e58-63.

Maddry J, Varney SM, Sessions D, Heard K, Thaxton R & Ganem V. 2014. A comparison of simulation-based education versus lecture-based instruction for toxicology training in emergency medicine residents. Journal of Medical Toxicology 10(4), 364-368.

Mariani B, Ross J, Paparella S & Allen L. 2017. Medication safety simulation to assess student knowledge and competence. Clinical Simulation in Nursing 13(5), 210-216.

McGaghie W, Issenberg S, Barsuk J & Wayne D. 2014. A critical review of simulation-based

Mastery learning with translational outcomes. Medical Education 48(4), 375–385.

McCaughey CS & Traynor MK. 2010. The role of simulation in nurse education. Nurse Education Today 30(8), 827-832.

Norman J. 2012. Systematic review of the literature on simulation in nursing education. The Association of Black Nursing Faculty ABNF Journal 23(2), 24-28.

Norman G, Dore K & Grierson L. 2012. The minimal relationship between simulation fidelity and transfer of learning. Medical Education 46(7), 636-647.

Paige J & Morin K. 2013. Simulation fidelity and cueing: A systematic review of the literature. Clinical Simulation in Nursing 9(11), e481-9.

Perry A, Woodland L & Brunero S. 2015. eSimulation: A novel approach to enhancing cultural competence within a health care organization. Nurse Education in Practice 15(21), 218-224.

Reime M, Johnsgaard T, Kvam F, Aarflot M, Breivik M, Engeberg J & Brattebø G. 2016. Simulated settings; powerful arenas for learning patient safety practices and facilitating transference to clinical practice. A mixed method study. Nurse Education in Practice 21, 75-82.

Reising DL, Carr DE, Gindling S, Barnes R, Garletts D & Ozdogan Z. 2017. Team communication influence on procedure performance: Findings from interprofessional simulations with nursing and medical students. Nursing Education Perspectives 38(5), 275-276.

Rooney D, Hopwood N, Boud D & Kelly M. 2015. The role of simulation in pedagogies of higher education for the health professions: Through a practice-based lens. Vocations and Learning 8(3), 269-285.

Rudolph J, Raemer D & Simon R. 2014. Establishing a safe container for learning in simulation: the role of the presimulation briefing. Simul Healthc 9(6),339–49.

Sabus C & Mccauley K. 2016. Simulation in Physical Therapy Education and Practice: Opportunities and Evidence-Based Instruction to Achieve Meaningful Learning Outcomes. Journal of Physical Therapy Education 30(1).

Schmidt E, Goldhaber-Fiebert S, Ho L & McDonald K. 2013. Simulation exercises as a patient safety strategy: A systematic review. Annals of Internal Medicine 158(5), 426-432.

Shin S, Park J & Kim J. 2015. Effectiveness of patient simulation in nursing education: Meta- Analysis. Nurse Education Today 35(1), 176–182.

Slater L, Bryant K & Ng V. 2016. Nursing student perceptions of standardized patient use in health assessment. Clinical Simulation in Nursing 12(9), 368–376.

Smith N, Prybylo S & Conner-Kerr T. 2012. Using simulation and patient role play to teach electrocardiographic rhythms to physical therapy students. Cardiopulmonary Physical Therapy Journal 23(1), 36–42.

Stayt L, Merriman C, Ricketts B, Morton S & Simpson T. 2015. Recognizing and managing a deteriorating patient: A randomized controlled trial investigating the effectiveness of clinical simulation in improving clinical performance in undergraduate nursing students. Journal of Advanced Nursing 71(11), 2563–2574.

Stubbs B, Brefka S & Denkinger M. 2015. What Works to Prevent Falls in Community-Dwelling Older Adults? Umbrella Review of Meta-analyses of Randomized Controlled Trials. Physical Therapy 95(8), 1095-110.

Walshe N, O’Brien S, Murphy S & Hartigan I. 2013. Integrative learning through simulation and problem-based learning. Clinical Simulation in Nursing 9(2), 47–54.

Webster D. 2014. Using standardized patients to teach therapeutic communication in psychiatric nursing. Clinical Simulation in Nursing 10(2), 81–86.

Literature on debriefing

Al Sabei S & Lasater K. 2016. Simulation debriefing for clinical judgment development: A concept analysis. Nurse Education Today 45, 42-47.

Banks S, Stanley M, Brown S & Matthew W. 2019. Simulation-Based Interprofessional Education: A Nursing and Social Work Collaboration. Journal of Nursing Education 58(2), 110-113.
Barbour J. 2013. The making of a butterfly: Reflective practice in nursing education. International Journal for Human Caring 17(3), 7-12.

Beaird G, Nye C & Thacker L. 2017. The use of video recording and standardized patient feedback to improve communication performance in undergraduate nursing students. Clinical Simulation in Nursing 13(4), 176-185.

Bogo M, Schlonsky A, Lee B & Serbinsky S. 2014. Acting like it matters: A scoping review of simulation in child welfare training. Journal of Public Child Welfare 8(1), 70–93.
Cheng A, Grant V, Dieckmann P, Arora S, Robinson T & Eppich W. 2015. Faculty development for simulation programs: Five issues for the future of debriefing training. Simulation in Healthcare 10(4), 217-222.

Chmil J. 2016. Prebriefing in simulation-based learning experiences. Nurse Educator 41(2), 64–65.

Dieckmann P, Gaba D & Rall M. 2007. Deepening the theoretical foundations of patient simulation as social practice. Simulation in Healthcare 2(3), 183–193.

Dieckmann P & Krage R. 2013. Simulation and psychology: creating, recognizing and using learning opportunities. Current Opinion in Anaesthesiology 26(6), 714–720.

Dufrene C & Young A. 2014. Successful debriefing – Best methods to achieve positive learning outcomes: A literature review. Nurse Education Today 34(3), 372–376.

Craig S, McInroy L, Bogo M & Thompson M. 2017. Enhancing Competence in Health Social Work Education Through Simulation-Based Learning: Strategies From a Case Study of a Family Session. Journal of social work education 53 (1), S47–S58.

Gardner D, Wettstein R, Hart M, Bhasin P, Tran K, Sanchez J & Restrepo R. 2018. Using Standardized Patients as Part of a Preclinical Simulation. Respiratory Care Education Annual 27, 43–55.

Husebo S, Dieckmann P, Rystedt H, Soreide E & Friberg F. 2013. The relationship between facilitators’ questions and the level of reflection in postsimulation debriefing. Simulation in Healthcare 8(3), 135-142.

Kane J, Pye S & Jones A. 2011. Effectiveness of a simulation-based educational program in a pediatric cardiac intensive care unit. Journal of Pediatric Nursing 26(4), 287-294.

Kirkman T. 2013. High fidelity simulation effectiveness in nursing students’ transfer of learning. International Journal of Nursing Education Scholarship 10(1), 1-6.

Kolbe M, Grande B & Spahn D. 2015. Briefing and debriefing during simulation-based training and beyond: Content, structure, attitude and setting. Best Practice & Research: Clinical Anaesthesiology 29(1), 87-96.

Lavoie P, Pepin J & Cossette S. 2015. Development of a post-simulation debriefing intervention to prepare nurses and nursing students to care for deteriorating patients. Nurse Education in Practice 15(3), 181-191.

Lee J, Lee Y, Lee S & Bae J. 2016. Effects of high-fidelity patient simulation led clinical reasoning course: Focused on nursing core competencies, problem solving, and academic self-efficacy. Japan Journal of Nursing Science 13(1), 20-28.

Mariani B, Cantrell M & Meakim C. 2014. Nurse educators’ perceptions about structured debriefing in clinical simulation. Nursing Education Perspectives 35(5), 330-331.

Shinnick M, Woo M, Horwich T & Steadman R. 2011. Debriefing: The most important component in simulation? Clinical Simulation in Nursing 7(3), e105-e111.

Stegmann K, Pilz F, Siebeck M & Fischer F. 2012. Vicarious learning during simulations: Is it more effective than hands-on training? Medical Education 46, 1001–1008.

Zamjahn J, Carvalho R, Baroni de Carvalho Raquel, Bronson M, Garbee D & Paige J. 2018. eAssessment: development of an electronic version of the Objective Structured Assessment of Debriefing tool to streamline evaluation of video recorded debriefings. Journal of the American Medical Informatics Association 25(10), 1284-1291.

Zigmont J, Kappus L & Sudikoff S. 2011a. The 3D model of debriefing: defusing, discovering, and deepening. Seminars in Perinatology 35(2), 52-8.

Zigmont J, Kappus L & Sudikoff S. 2011b. Theoretical foundations of learning through simulation. Seminars in Perinatology 35(2), 47-51.