Table 3.

Themes for recommendations captured during the consultation process

Theme	Considerations
Adoption into everyday learning and practice	Advocate for the use of simulation in patient safety initiatives Advance the institutional use of simulation for the improvement of adaptation to new challenges, productivity and burn out prevention Promote the “Return on experience”: the value of well trained healthcare providers Low cost simulation options may provide suitable and accessible learning experiences Foster the use of simulation throughout the training continuum, including CME and certification/recertification Simulation facilitation skills can support everyday training in any setting Emphasize the need for interprofessional education and team training Prioritize participant and patient safety Nurture simulation literacy Engage in and encourage collaboration
Integration into curricula	Harmonization between undergraduate and postgraduate simulation curricula Development of interprofessional learning opportunities Integration should follow a collaborative, wise and prudent approach, following best practice Simulation curricula should be aligned
Quality Assurance (QA)	Simulation is only good if used correctly: promote and develop standards for best practice Faculty development is crucial Evaluate all simulation activity Promote the inclusion of the patient’s perspective Embed risk assessment in simulation-based practice Certification of simulation devices Consider QA during the development and early adoption of emerging technologies QA is the responsibility all simulation practitioners, managers, healthcare and education organizations and policy makers Develop Internationally agreed frameworks for mapping of socio-cognitive skills Develop and adopt practical and standardized quality assurance tools Develop quality assured approaches for accreditation, credentialing, certification/recertification
Equitable access	High quality simulation learning opportunities should be equitably accessible and appropriate to each context and learning needs High impact low cost simulation and telesimulation may facilitate accessibility - Across the spectrum of professions and practice - To low income areas - To rural or remote environments Develop outreach programmes Facilitate participation of individuals from low income areas to international learning events Commitment to equity, diversity and inclusion both within and via simulation
Fostering research and scholarship	Promotion of simulation-based research focused on patient outcomes Simulation curricular alignment could facilitate educational research
Collaboration	Collaborate with patient safety associations or institutions and quality improvement agencies Foster networking
Societal expectations	“Your first attempt should never be on a live patient” “Everybody should be a master” “Failure is not an option” Pressure to perform Public engagement: - Potential of simulation to help shift patient perspectives, responsibilities and behaviors - Sharing what we do everyday with the public
Sustainability	Environmental sustainability of simulation facilities, considering structural designs, resource consumption and reutilisation, environmentally friendly materials, and awareness of the carbon footprint - telemedicine/telesimulation might support diminishing our carbon footprint Sustainability of high quality simulation programmes, simulation staff and the wider workforce across the globe
Enablers	Political and strategic support Practical support including staffing and other resources Societies Networks
Policy	Institutional and government level Appropriate prioritization of investment in educational resources (people over technology) Support to the sustainability of simulation facilities and programmes Explicit guidance for substitution of clinical placements with simulation practice (proportion and quality assurance)