The Association for Simulated Practice in Healthcare (ASPiH) annual conference is held in Bournemouth, England from the 11th to the 13th November 2025. The three-day conference includes more than 170 poster presentations, 75 oral presentations, and 42 workshops. As can be seen from the published abstracts, a wide range of topics are addressed concerned with simulation education, technical innovation, and the use of simulation for transformation. Presenters and attendees come from a wide range of healthcare professions and specialties from across the UK, Ireland, and internationally, with participation from more than 15 countries spanning all 5 continents. This global participation underscores the theme of the conference: Simulation for Impact. More specifically, the impact of simulation on culture, co-production, and creativity.
Culture has been described as a slippery and ubiquitous concept [1]. This statement reflects the fact that there is no one agreed definition of culture, and the meaning has shifted over time. An anthropological definition of culture is “the socially transmitted knowledge and behaviour shared by some group of people” (p.23) [2]. The behavioural component of culture means that it is something that can be influenced through healthcare simulation. There are many examples of the use of simulation to impact the organisational culture. It has been suggested that in-situ simulation is particularly suited to providing valuable insight into both how ‘work is done’ and the related cultural aspects of the work in a healthcare unit [3]. There are also examples of the use of simulation to address specific aspects of organisational culture: such as safety culture or patient safety culture. For example, a Danish study found an improvement in healthcare providers’ perceptions of patient safety culture of healthcare providers following an in-situ simulation intervention [4].
An approach to using simulation to impact culture relates to improving the cultural competency of healthcare providers. Cultural competency is concerned with addressing barriers to the accessibility and effectiveness of health care services for people from racial or ethnic minorities [5]. In more recent years this concept has also been expanded to include language, sexual orientation, gender identity, class and professional status [6,7]. A systematic review of 27 papers concerned with providing simulated participant cultural competency education to student healthcare providers found that the intervention improved the cultural competence and confidence of learners [8]. More recently there has been a move away from cultural competence to cultural humility [9]. This is due to a recognition that culture perceived from a competency perspective implies that there is an endpoint to understanding culture when in reality it is fluid and requires an open and self-aware position [9,10]. Using simulation to improve cultural humility has great potential to promote equitable treatment of different cultural groups, and support culture differences across the healthcare system [9].
Co-production is an approach used to meaningfully integrate the knowledge, expertise, and experience of healthcare users into the design and delivery of healthcare services and research [11]. A distinct feature of co-production is that it does not distinguish between healthcare providers and recipients. This is achieved by reducing the social distance, knowledge, and power imbalances between different participant groups in the co-production activity [12]. It has been suggested that although co-production has great promise, it may be limited due to the risk of entanglement in existing involvement frameworks and practices [13]. Simulation offers an approach to address this limitation by providing a forum to support co-production. To illustrate, a systematic review of co-production in nursing and midwifery education identified 23 studies. It was concluded that there was preliminary evidence that participatory approaches can improve learning and positively impact on nursing and midwifery students, service users, and carers [14]. Additionally, simulation has been used to co-produce new models of care, generate more integrated care, and bridge gaps in understanding [15,16,17]. However, co-production within simulation remains limited with no clear definition of co-production within the context of healthcare simulation [18].
Creativity is integral to simulation. The range of simulation applications covered in the abstracts, posters, and workshops at ASPiH 2025 is a clear demonstration of the creativity of the community. Simulation has been described as ‘theatre with purpose’ [19]. This theatre analogy is very apt and recognises the creativity and imagination required to design and deliver simulation activities. However, this is only one aspect of simulation creativity. Increasingly simulation is also being used to impact health and care through collective understanding, insight, and learning garnered from transformative simulation approaches [20]. A visit to the ASPiH conference exhibition hall demonstrates the creativity of the simulation industry and the resulting sophistication and realism of the latest simulator technologies. It is therefore important to recognise that simulation is as complex as healthcare and more, and therefore designing it requires collective creativity to ensure it is intentional and impactful.
Although the use of simulation in healthcare might seem a relatively recent phenomenon, simulators have, in fact, been used to support the education of healthcare professionals for thousands of years. It has been suggested that the 20th century was a ‘dark age’ for healthcare simulation as compared to the previous two centuries [21]. Yet, the range of presentations, workshops, and industry stands at the APSiH 2025 conference suggest that we are now in a new and exciting age of healthcare simulation. One where the convergence of different cultures, co-production, and creativity is possible if we align with purpose.
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.
Authors’ contributions. POC conceived and wrote the first draft of the article. All other authors reviewed and contributed to subsequent drafts of the article and approved the final version.
Funding. None declared.
Availability of data and materials. Not applicable
Ethics approval and consent to participate. Not applicable
Competing interests. None declared.
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2. Peoples JG, Garrick AB. Humanity: An Introduction to Cultural Anthropology. Belmont, CA: West/Wadsworth. 1994.
3. Patterson MD, Eisenberg EM, Murphy A. Using Simulation to Understand and Shape Organizational Culture. In: Deutsch ES, Perry SJ, Gurnaney HG (Eds.). Comprehensive Healthcare Simulation: Improving Healthcare Systems. London: Springer. 2021. pp. 169–17.
4. Schram A, Paltved C, Christensen KB, Kjaergaard-Andersen G, Jensen HI, Kristensen S. Patient safety culture improves during an in situ simulation intervention: a repeated cross-sectional intervention study at two hospital sites. BMJ Open Quality. 2021;10(1):e001183.
5. Truong M, Paradies Y, Priest N. Interventions to improve cultural competency in healthcare: a systematic review of reviews. BMC health services research. 2014;14(1):99.
6. Yu H, Flores DD, Bonett S, Bauermeister JA. LGBTQ+ cultural competency training for health professionals: a systematic review. BMC medical education. 2023;23(1):55.
7. World Health Organisation. Cultural contexts of health and well-being principal author and editor culture matters: using a cultural context of health approach to enhance policymaking. 2020. Available from: https://www.euro.who.int/__data/assets/pdf_file/0009/334269/14780_World-Health-Organisation_Context-of-Health_TEXT-AW-WEB.pdf.
8. Walkowska A, Przymuszała P, Marciniak-Stępak P, Nowosadko M, Baum E. Enhancing cross-cultural competence of medical and healthcare students with the use of simulated patients- a systematic review. International Journal of Environmental Research and Public Health. 2023;20(3):2505.
9. Gonzales-Walters F, Weldon S, Essex R. Cultivating cultural humility through healthcare simulation-based education: a scoping review protocol. International Journal of Healthcare Simulation. 2024; doi: 10.54531/rafh4191.
10. Foronda C, Baptiste DL, Reinholdt MM, Ousman K. Cultural humility: a concept analysis. Journal of Transcultural Nursing. 2016;27(3):210–217.
11. Filipe A, Renedo A, Marston C. The co-production of what? Knowledge, values, and social relations in health care. 2017; PLoS Biology. 15(5): e2001403.
12. Ramrez R. Value co-production: intellectual origins and implications for practice and research. Strategic Management Journal.1999;20:4965.
13. Bovaird T. Beyond engagement and anticipation: user and community co-production of public services. Public Administration Review. 2007;67: 846860.
14. O’Connor S, Zhang M, Trout KK, Snibsoer AK. Co-production in nursing and midwifery education: A systematic review of the literature. Nurse Education Today. 2021;102:104900
15. Weldon SM, Kneebone R, Bello F. Collaborative healthcare remodelling through sequential simulation: a patient and front-line staff perspective. BMJ Simululation and Technology Enhanced Learning. 2016. 27;2(3):78–86.
16. Weldon S-M, Ralhan S, Paice E, Kneebone R, Bello F. Sequential simulation of a patient pathway. Clinical Teacher. 2016;14(2):90–94.
17. Kneebone R, Weldon S-M, Bello F. Engaging patients and clinicians through simulation: rebalancing the dynamics of care. Advances in Simulation 2016;1:19. doi: 10.1186/s41077-016-0019-9.
18. Philpott L, Markowski M & Weldon SM. Lived experience co-production in simulation education and practice- a scoping review protocol. Journal of Healthcare Simulation. 2025. [In print].
19. Dieckmann P, Gaba D, Rall M. Deepening the theoretical foundations of patient simulation as social practice. Simulation in Healthcare. 2007; 2(3):183–93.
20. Weldon SM, Buttery AG, Spearpoint K, Kneebone R. Transformative forms of simulation in health care-the seven simulation-based ‘I’s: a concept taxonomy review of the literature. International Journal of Healthcare Simulation. 2023 Jul 7:1–13.
21. Owen H. Early Use of Simulation in Medical Education. Simulation in Healthcare. 2012;7(2):102–116.
Cancer is a major public health issue, and it has a huge impact on the healthcare system and professionals [1]. Additionally, the number of people affected by cancer is constantly increasing, and, in Canada, it is expected that 44% of the population will develop cancer during their lifetime [2]. Health care for cancer patients is complex and involves different stages and processes that can include prevention, screening, diagnosis, active treatment and post-treatment (survivorship and end-of-life care) [3]. Even though there are different healthcare professionals working together to provide cancer care to patients, the major stakeholders are usually nurses and physicians due to the scope of their practice [4–6].
Also, although there is an increasing number of people living with and beyond cancer, there is evidence that cancer patients have several unmet needs before, during and after cancer treatment that can negatively impact their quality of life [7,8]. Studies investigating different barriers that hamper cancer patients’ access to the care required have highlighted that interventions to improve nurses’ and physicians’ knowledge and/or practice are currently needed [9–11]. There are different types of educational strategies that can be used to improve healthcare professionals’ skills, but simulation-based education is an area, which, despite being relatively new, has shown promising results to improve healthcare professionals’ knowledge, critical thinking, skills, performance and satisfaction [12].
Simulation-based education can be an effective strategy to educate adult learners as it builds on existing knowledge and helps to increase proficiency levels related to specific practices, consequently reducing the risk of errors in the processes [13]. Additionally, there are different types of clinical simulation, the most common being in situ simulation and virtual simulation. In situ simulation involves the use of standardized patients and/or life-like manikins in a replicated or authentic clinical environment with the learner playing the role of healthcare professional, or an educator/actor being the professional during a clinical scenario [14]. Virtual simulation can include video recordings of high-fidelity simulation to be used as a more accessible and flexible learning intervention, or computer games where the learner accesses a game and needs to choose answers related to clinical decision-making points (can be virtual-reality or recordings of life-like scenarios) [15–17].
Although it is important to understand the role of simulation-based education to improve nurses’ and physicians’ care for cancer patients, currently, there is a gap related to this area as publications are still fragmented in the literature. What is more, a recent integrative review investigating simulation-based education use to improve nursing professionals’ and students’ provision of cancer care highlighted a lack of publications in this area, as well as a lack of studies collating and synthesizing this evidence [11]. Therefore, we are proposing a scoping review approach with an exploratory nature and systematic search to collate the literature around simulation-based education to educate nurses and physicians about cancer care.
A preliminary search of MEDLINE, Prospero, Epistemonikos, the Cochrane Database of Systematic Reviews and Joanna Briggs Institute (JBI) Evidence Synthesis was conducted, and no current or underway systematic reviews or scoping reviews on the topic were identified. In this study, we opted to use a scoping review methodology as it allows the researcher to use an iterative approach with an exploratory nature where the researcher can reflect at each step and repeat it if necessary to add new terms or look for more evidence [18]. Also, there is valuable evidence from different research paradigms in the literature approaching the topic of interest; thus, the use of a methodology that allows the researcher to include a wide range of literature with different methodologies (e.g. quantitative and qualitative evidence), such as scoping reviews, is essential. Therefore, the aim of this scoping review is to collate and synthesize the literature on how simulation has been used to educate nurses and physicians about cancer care.
This review question is proposed using the ‘PCC’ strategy as recommended by the JBI framework for scoping reviews [19], where the ‘P’ for population in this study are nurses (including nurse practitioners) and physicians, the ‘C’ for concept is simulation-based education and the ‘C’ for context is cancer care.
Overarching question: How has simulation-based education been utilized to educate nurses and physicians about cancer care?
The proposed scoping review will be conducted in accordance with the JBI methodology for scoping reviews [19].
Participants: This scoping review will consider as participants physicians from any speciality (as long as they hold an MD degree) and nurses also from any speciality, including nurse practitioners (as long as they hold an RN degree) caring for patients with cancer in any setting, including primary care, hospitals, home/community care, cancer centres or any other clinical settings with inpatient and/or outpatient services for cancer patients. Additionally, the focus is on professionals, so, if the population includes undergraduate students, the record will not be included in this review; however, if the population is graduate or post-graduate/specialization students and the students already hold a professional degree in nursing or medicine, then, we are going to include the report.
Concept: For this scoping review, the main concept of interest will be simulation-based education. We are going to consider the use of educational strategies that consists of, or is blended with, a simulation intervention (including in situ simulation and virtual simulation). We will consider simulation as being the representation of a real-life clinical experience as a model of clinical exercise to train healthcare professionals. However, if the focus of the study is on simulation modelling, which is the representation of a physical model through a digital prototype to predict performance, and/or if it does not involve the representation of a real-life clinical scenario in the educational exercise, then the report is going to be excluded. Also, if the focus in the use of simulation is only to evaluate skills and not to teach them, or if the simulation is mixed with educational strategies (other than briefing activities) and the results are reported together, the reports will be excluded.
Context: Articles will initially be considered for eligibility if they focus on the use of simulation-based education to train nurses (including nurse practitioners) or physicians about knowledge, skills and/or practices related to the care for oncologic patients, including cancer prevention, screening, treatment, diagnosis, symptom management, end of life and cancer survivorship care.
Types of sources: This scoping review will consider both experimental and quasi-experimental study designs including randomized controlled trials, non-randomized controlled trials, before and after studies and interrupted time-series studies. In addition, analytical observational studies including prospective and retrospective cohort studies, case–control studies and analytical cross-sectional studies will be considered for inclusion. This review will also consider descriptive observational study designs including case series, individual case reports and descriptive cross-sectional studies for inclusion. Qualitative studies will also be considered including, but not limited to, designs such as phenomenology, grounded theory, ethnography, qualitative description, action research and feminist research. In addition, systematic, scoping and other types of reviews that meet the inclusion criteria will also be considered; however, the review will not be included; instead, we are going to review and screen their selection of articles. Text and opinion papers will also be considered for inclusion in this scoping review. Additionally, some sources of grey literature, such as theses, dissertations, conference papers and research reports, will also be considered.
The search strategy will aim to locate both published and unpublished studies. To develop and implement the search strategy, we have the support of two Health Sciences Librarian experts. An initial limited search of MEDLINE and CINAHL was undertaken to identify articles on the topic. The words contained in the titles and abstracts of relevant articles and the index terms used to describe the articles were used to develop a full search strategy for MEDLINE (Appendix A). The search strategy, including all identified keywords and index terms, will be adapted for each included database and/or information source. The reference list of all included sources of evidence will be screened for additional studies. Studies published in any language will be included. We are not going to restrict the search to any date. The databases to be searched include Medline (Ovid), CINAHL, EMBASE and PsycINFO (Ovid). Sources of unpublished studies/grey literature to be searched include Research Gate, OpenGrey and Open Access Theses and Dissertations.
Following the search, all identified citations will be collated and uploaded into Convidence® and duplicates removed. After that, and following a pilot test, titles and abstracts will be screened by two independent reviewers for assessment against the inclusion criteria. Then the full text of selected citations will be assessed in detail against the inclusion criteria by two independent reviewers. Reasons for exclusion of sources of evidence at full text that do not meet the inclusion criteria will be recorded and reported in the scoping review. Any disagreements between the reviewers at each stage of the selection process will be resolved through discussion or with the input of a third reviewer. The results of the search and the study inclusion process will be reported in full in the final scoping review report and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) flow diagram [20].
Data will be extracted from reports included in the scoping review by two or more independent reviewers using a data extraction tool adapted from JBI by the researchers. The data extracted will include specific details about the participants, concept, context, study methods and key findings relevant to the review question. A draft of the data extraction form is provided in Appendix B. The draft of the data extraction tool will be modified and revised as needed during the process of extracting data from each included evidence source, and modifications will be detailed in the scoping review final report. Any disagreements between the reviewers will be resolved through discussion or via consultation with a third reviewer. If appropriate, authors of papers will be contacted to request missing or additional data, where required.
The data extracted from this scoping review will be assessed through a content analysis and simple numerical count to find the majority consensus across the data. Results will be assembled and summarized qualitatively (using content analysis) and quantitatively (using a simple numerical count) to respond to the review question. The qualitative and quantitative summary will be presented in tabular form and accompanied by a narrative summary to answer the review question by describing how simulation has been used to educate nurses (including nurse practitioners) and physicians about cancer care, identifying possible gaps in the literature and providing guidance for future studies and policies.
Results from this scoping review will map the literature around the use of simulation-based educational strategies to educate nurses and physicians about cancer care. We expect that these findings will highlight the different types of simulation used, key aspects for successful implementation of simulation and aspects that need to be further developed and/or investigated. Also, our results can generate a solid underpinning for nursing and medical community to empower evidenced innovation through the further development of simulation-based educational interventions. Lastly, results from this scoping review will be used to guide the development of an interventional study to educate nurses and physicians working in the continuum of cancer care.
All authors have contributed to the ideas, design and writing of this scoping review research protocol.
This scoping review is part of a PhD thesis research study funded by a Canadian Association of Nurses in Oncology (CANO) Research Grant and an International Nursing Association for Clinical Simulation and Learning (INACSL) Debra Spunt Research Grant.
The data supporting the findings of this study are available within the article.
None declared.
There is no conflict of interest in this project.
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| # | Query | Results from 27 May 2021 |
|---|---|---|
| 1 | exp nurses/ or exp physicians/ | 234,389 |
| 2 | exp Nursing Staff/ | 67,547 |
| 3 | (nurse* or physician* or doctor*).ab,ti,kw. | 772,593 |
| 4 | exp Simulation Training/ | 10,007 |
| 5 | simulat*.ab,ti,kw. | 571,820 |
| 6 | virtual patient*.mp. | 1,149 |
| 7 | computer simulation/ or augmented reality/ or patient-specific modeling/ or virtual reality/ | 198,433 |
| 8 | exp Neoplasms/ | 3,471,247 |
| 9 | (neoplasm* or cancer* or oncolog*).ab,ti,kw. | 2,112,337 |
| 10 | or/1–3 | 913,525 |
| 11 | or/4–7 | 677,932 |
| 12 | or/8–9 | 4,064,963 |
| 13 | 10 and 11 and 12 | 969 |
| Evidence source details and characteristics | |
| Authors | |
| Date | |
| Title of the report | |
| Type of publication (e.g. thesis, manuscript and webpage) | |
| Local of publication (journal, including volume, issue and page) | |
| Methodology and methods | |
| Methodology (design adopted, e.g. random control trial) | |
| Country of publication | |
| Sample (if applicable) | |
| Procedures (e.g. interviews, tools and institutional indicators) | |
| Data analysis performed | |
| Study data | |
| Aim/purpose | |
| Healthcare professional target (e.g. nurse and physician) | |
| Type of cancer (if applicable, e.g. breast and brain) | |
| Type of simulation (e.g. virtual, high-fidelity) | |
| Focus on the use of simulation (e.g. communication skills) | |
| Results from the use of simulation (if measured) | |
| Challenges identified by the authors in the use of simulation (if applicable) | |
| Benefits identified by the authors in the use of simulation (if applicable) | |
| Study/report limitations stated by the author(s) | |
| Author’s overall suggestion for future studies | |
| Other notes | |
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