Simulation has become a pillar of health professions education. The success of this experiential learning modality has become so widespread that numerous health professions education accrediting bodies across the globe now require its implementation in training programs.1–12 As a result of this popularity, an ample literature base and dedicated peer-reviewed academic journals (eg, Simulation in Healthcare; Clinical Simulation in Nursing; Advances in Simulation; International Journal of Healthcare Simulation) have emerged.

With the increasing utilization and importance of simulation-based education (SBE), it is critical that effective, data-driven programs exist to train instructors in SBE. Understanding what interventions and approaches are currently being used to improve the knowledge, skills, and effectiveness of instructors in SBE is an integral step for carving out the future of simulation. The current study is a scoping review on the topic, to uncover what is known about faculty development (FD) for SBE. Mapping the field of FD for simulation can help elucidate what is known and what remains to be investigated, uncover common methodologies used, and identify knowledge and research gaps.13 As such, the purpose of our scoping review was to determine what is known about FD in SBE. Our aim was to uncover key features related to main content areas, methodologies and approaches used, program leaders and participants, outcomes assessed, and the conceptual and theoretical frameworks used to inform design and assessment of these programs. After mapping the terrain, we then synthesize these data and make recommendations based on input from an expert panel.

CONCEPTUAL FRAMEWORK

Scoping reviews aim to explore the contours and boundaries of knowledge in an emerging field. As noted in our previously published protocol,14 our aim with this study was to rely upon a conceptual framework describing FD approaches by Steinert15 to help with organization and sensemaking. This framework situates FD activities based on 2 axes: the approach, from formal to informal; and the context for learning, from individual to group. Moreover, to broaden our perspective and explore key features beyond approaches, we incorporated the conceptual framework of O'Sullivan and Irby16 (Fig. 1) for FD research to organize our results. According to this model, FD is embedded both within the smaller FD community as well as the larger workplace community where teaching occurs. As such, desired change requires the interaction of people (facilitators and participants), programs, and context that exist within the smaller, dynamic FD community. Each of these components is also linked to an associated process in the workplace (mentoring and coaching; relationships and networks; organizations, systems, and cultures; and tasks and activities) that defines FD within communities of teaching practice. Both models were used as organizing frameworks to explore the FD approaches present in the literature and to help elucidate and articulate gaps in the existing literature base.

FIGURE 1:

O'Sullivan and Irby's model for FD research.

METHODS Inclusion Criteria

The scoping review was conducted in accordance with our previously published scoping review protocol14 based on Joanna Briggs Institute (JBI) methodology for scoping reviews.17,18 The JBI approach was chosen given that it builds upon the original framework of Arksey and O'Malley19 and Levac et al20 and also extends their work into the analysis and results presentation stages. Studies that included participants from all of health professions education were included so that all key features, methodologies, and outcomes across contexts and learning aims could be included. The context for the review was international, with no limits, inclusive of any educational, clinical, or geographical setting and studies published in the English language.

As this scoping review was designed to explore the breadth of FD in health professions education, all literature with a focus on any aspect of FD for SBE was included. This encompassed not only skills used directly when working with learners but also included any additional knowledge and skills required to be effective simulation instructors (eg, scenario design, implementation, assessment). Research that focused on FD for health professions educators, but not FD specifically for simulation educators, was not included. In addition, any work that was purely conceptual in nature (eg, proposed FD frameworks or perspectives, with no data) was not included.

Research published in peer-reviewed journals as full manuscripts or conference abstracts or in the gray literature (eg, theses and dissertations) was included. All empirical study designs were considered, including experimental, quasi-experimental, observational, and qualitative studies. Systematic reviews and narrative reviews were excluded but their references were back searched.

Electronic Database Search

An initial limited search of MEDLINE (PubMed) was undertaken to identify articles on the topic. The text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles were used to develop the full search strategy (Appendix 1, https://links.lww.com/SIH/A980). A health sciences librarian conducted a comprehensive literature search across the following electronic databases: MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), ERIC (EBSCO), PsycInfo (Ovid), and Web of Science. The search strategy was customized appropriately for use in each database. Free-text terms were also included, considering synonyms and variants in spelling. The search was not limited by date to maximize the breadth of literature identified. In addition, seminal works identified by the team were compared with those identified through the search; this step confirmed the adequacy of the search terms in retrieving the desired literature.

Citation Searching

Reference lists of all included research studies and all relevant reviews were back searched, and Google Scholar was used for forward citation tracking to identify further studies.

Study Selection

All identified citations were collated and uploaded into EndNote 20.2.1 (Clarivate Analytics, PA) and duplicates were removed automatically and manually. After deduplication, citations were transferred to Covidence (Veritas Health Innovation, Melbourne, Australia). A pilot test was performed by screening 50 titles/abstract jointly by all researchers, in order for consensus checking of the criteria and their application. After this, titles and abstracts were independently screened against the eligibility criteria by 3 researchers (C.C., R.D., A.R.) and by one member of the 4-person review panel (A.G., D.P., G.R., S.V.). Any discrepancies were resolved by a third member of the review panel. After screening, the full text of potentially eligible studies was retrieved and screened in full to determine eligibility by three reviewers (A.R., R.D., A.G.). Any disagreements were resolved by consensus with the review panel. Full-text studies that did not meet the inclusion criteria were excluded and reasons for exclusion were documented.

Data Extraction

Data were extracted from the included articles using an iterative approach given the diversity of the identified literature. The extracted data included citation information; details about the population, content areas, and context; study methods; and key findings relevant to the review questions. A standardized data extraction instrument was used in the Covidence system (Appendix 2, https://links.lww.com/SIH/A981). This was adapted from the JBI template data extraction instrument for source details, characteristics, and results extraction, with modifications appropriate for the concept of this scoping review. The draft results extraction instrument was piloted on the first 5 articles and modified as needed. One review author extracted the data and a second review author checked extraction data.

Data Synthesis

Descriptive analysis was undertaken to organize and interpret key features of the final body of work. As mentioned previously, Steinert's15 and O'Sullivan and Irby's16 models for mapping FD approaches and research were used to organize results along the components of programs, people, and context.

RESULTS Included Studies

Figure 2 illustrates the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Scoping Reviews flow diagram. The initial scoping review identified 4733 potentially relevant articles. Removal of duplicates reduced the pool down to 3259 articles. Sixteen additional records were identified through back searching of relevant reviews. Title and abstract screening eliminated 3147, leaving 128 for full-text review. Ninety three of these were excluded after full-text review for not meeting inclusion criteria, resulting in a final pool of 35 articles9,21–55 for data extraction and analysis.

FIGURE 2:

PRISMA diagram.

As shown in Table 1, study types ranged from pre/post single-cohort designs to qualitative designs. The most common (n = 11) study type was intervention only, with a pre-post design wherein a single group of participants completed self-assessments of confidence or ability (Kirkpatrick Level 159), participated in a FD module or workshop, and then completed the same assessment of confidence or ability after the intervention. The next most common study type (n = 9) was post-only, with data collected only after an intervention. The final pool of articles included 5 mixed methods studies, in which both quantitative and qualitative data were collected after an intervention. Qualitative studies were just as common (n = 5) and included studies ranging from surveys of open-response feedback and attitudes after an intervention to interviews with educators. Four case studies were included in the final pool of articles; they described the development of single instructors (n = 2),35,48 a blog30 that tracked uptake and utilization, and development of a regional FD for simulation consortium.36

TABLE 1 - Summary of Included Studies (N = 35) Study: Author (Year), Country Subject Type(s) Sample Size Type of Program Description of Study and Outcomes Abulebda et al21 (2020), United States Multiprofessional faculty (physicians, nurses) 16 Workshop (4 H) Single-group precourse/postcourse study and description of 4-h workshop for novice simulation faculty who then conducted SBE course for pediatric sedation providers with a with a participant survey and instructor assessment of transfer of learning using the OSAD tool.
Pre/post self-efficacy survey showed improvements.
Postcourse OSAD evaluations by content experts tied learning to performance in course. Mean OSAD score was 31 (maximum possible score is 40) indicating learning transfer. Allvin et al22 (2017), Sweden Experienced simulation educators (physicians, registered specialist nurses, midwives) 14 — Qualitative interviews with educators examining changes in teaching practices over time.
Five themes were identified: shifting focus, from following to utilizing a structure, setting goals, application of technology, and alignment with profession.
Faculty built self-confidence in the role through experience and not just by CPD.
Affirms theoretical viewpoint that experience creates changes in understanding, similar to educators in other professions. Bentley and Seaback23 (2011), United States Nursing faculty >100 Workshop (longitudinal series of four 1- or 1.5-d workshops), Describes development of longitudinal series of workshop, each 1 or 1.5 d in duration with a single-group postcourse survey. The postcourse participant survey indicated objectives were achieved.
A separate postcourse survey of deans and academic partner programs showed increased use of simulation, increase in use of simulation as a clinical site, and increased enrollment.
Program helped reinforce or create new partnerships in the region. While not directly stated, this established the beginnings of a community of practice Brazil et al24 (2021), Australia Medical students 3 7-Week rotation in SBE Description of 7-wk medical student elective in SBE with a qualitative review of three SBE elective graduates. nformation sources were weekly reflections and logbook completed during the rotation, end-of-rotation report, and reflective paper completed one year after rotation.
Five themes were identified: development as a professional, active participation in an educator team, diverse experience in simulation skills and techniques, role models and mentoring, and rethinking feedback. Chiu et al25 (2017), Canada Simulation fellows (physicians, multiple disciplines) 32 Longitudinal simulation fellowship (multimodal) A mixed methods study which included a description of a 26-topic simulation fellowship curriculum.
Pre/post self-assessment of learning showed increased gains in knowledge and skills in all areas.
Learner evaluations of the topics showed high scores in most areas. The lowest scoring areas were audiovisual equipment, conflict resolution, and history of simulation in medical education.
Qualitative themes were faculty expertise, structure, practicality, content of the curriculum, and areas for improvement. Chung et al26 (2012), South Korea Multiprofessional faculty (physicians, nurses, paramedics, administrators) 30 Workshop (3 consecutive days) Workshop conducted in Korea but based on established course provided by the University of Miami and the University of Pittsburgh. Participants' mean experience was less than 3 yr.
Single-group, pretest/posttest design with demographics and baseline knowledge survey.
Postcourse participant self-assessment of learning identified barriers including stakeholder buy-in, insufficient resources, and high cost.
Participant survey of confidence improved from pretest to posttest.
Study highlighted need for adapting curriculum to the culture of the participants. Coleman et al27 (2011), United States Nursing faculty 43 instructor trainers, 210 instructors Workshops (2 d for instructor trainers), not specified for instructors. Descriptive report of a regional program involving 19 universities, hospitals, or other agencies. Survey of simulation programs indicated simulation utilization increased. While n specific data presented, article proposed a train-the-trainer model was effective. Dailey29* (2019), United States Multiprofessional faculty (nurses, physicians assistants, pharmacists) 30 Workshop (2 d) Single-group, precourse/postcourse self-assessment of self-efficacy, attitude, and intention, with an additional 1-mo postassessment.
Precourse/postcourse self-assessment showed: increased self-efficacy from precourse to postcourse surveys that sustained for 1 mo and improved attitudes toward simulation from precourse to postcourse surveys that continued to improve at 1 mo. Intention to use simulation showed no significant difference owing to an already high baseline. Dale-Tam et al29 (2021), Canada Hospital-based nurse educators 21 for surveys, 7 for paired-testing on OSAD tool Workshop (5 H) with 2 H preworkshop self-study and postworkshop practical application Mixed methods with single-group pretest/posttest and qualitative analysis that also described the changes to the workshop curriculum over 3 PDSA cycles using participant input to modify the program.
Precourse/postcourse survey found significantly improved confidence in prebriefing and facilitation and improved but not significantly improved confidence in debriefing.
Expert rater scoring of participants using the OSAD tool indicated high quality debriefings in the postworkshop practical applications with the OSAD showing between 3.88 and 4.29 scores on a scale of 0–5.
Qualitative comments found three themes: use of a debriefing structure, instructor awareness of supporting attitude toward learners, and providing objective feedback in a positive manner. Di Delupis et al30 (2021), Italy — — Online blog Descriptive report of a case study using a nationwide (Italy) online blog as an educational too, with sections for communication, debriefing, simulation experiences, instructions for use, journal club, and psychology.
Top 3 consulted categories were as follows: (1) simulation experiences, (2) debriefing, and (3) instructions for use. The most viewed articles were as follows: (1) fidelity, realism, and simulation engagement; (2) simulation as a didactic learning method; and (3) the structured debriefing. Dieckmann and Rall31 (2006), Germany Not specified 70 Workshop (4 d) Single-group, pre/post using a self-administered questionnaire on simulation instructor competencies showing improvement in competencies in five areas evaluated: (clarity of instructor role, simulator setting overview, running a simulator course, debriefing skills, and CRM skills). Dumas et al32 (2015), United States Senior nursing students 20 Workshop (5 H) and mentoring Nonrandomized 2-group postcourse survey completed by learners taught by either senior nursing students or nursing faculty.
Senior nursing students completed 5-H workshop on simulation teaching and had nursing faculty available for mentoring. Senior nursing students and experienced faculty each taught a series of three simulation sessions to junior nursing students.
Junior nursing students' assessment of teaching effectives was equal for senior nursing student and experienced nursing faculty. Forstrønen et al33 (2020), Norway Multiprofessional faculty (physicians, nurses, midwives, radiographers) 141 Workshop (3 d with 2 consecutive days then third day 5 wk later) Qualitative study using a postevent questionnaire after a series of facilitator development courses with total of 179 participants, of which 141 completed the survey.
Five primary themes emerged with additional subthemes: in situ training in the workplace valued (participatory learning, active learning, simulation as a valuable education tool), Having resources and tools promotes self-confidence (scenario templates valuable for novice), learning from each other (interprofessional learning valuable, embodied learning connected with emotions of simulation), differentiation between facilitator and instructor, and need for “more of everything.” Greenwood and Ewell34 (2018), United States PTs 8 — Qualitative interviews with PT faculty and a descriptive report of their SBE experiences.
Four themes identified that resulted from SBE: stronger professional identify as PTs, simulation was a valuable part of their own professional development, IPE enhanced with simulation, and promoted growth as a PT educator. Gross et al35 (2021), Latvia Physicians 1 Mentoring over 8 SBE sessions in 16 mo with residents Case study of a single novice instructor who over 16 mo conducted 8 simulation sessions in conjunction with a remote-based expert instructor. Over time, responsibility for debriefing shifted from the remote expert instructor to the local novice instructor.
Expert rating of the novice instructor with the DASH-IV showed no significant change over time. Learner rating of simulation sessions decreased significantly over time as the novice instructor assumed greater role in debriefing. Jeffries et al36 (2013) United States Nursing faculty 60 Consortium development Case study on the development of a regional simulation consortium describing process, impact on SBE, and lessons learned.
Lessons learned included the following: learning curve exists, proper orientation to technology and processes improves experience, smaller groups were preferable, opportunities to participate in different simulation roles improved experience, metrics (eg, courses, participants) can show progress, and visiting other simulation programs builds support and adds to learning. Katoue et al37 (2015), United Kingdom and Kuwait Multiprofessional faculty (physicians, dentists, nurses, pharmacists) 37 Longitudinal curriculum (12 wk, multimodal) Single-group midcourse questionnaire conducted in second week of 12-wk longitudinal SBE program showed participants acquired knowledge on simulation taxonomy and concepts.
Video reviews of participants teaching with simulation demonstrated participants opted for teaching procedural skills rather than scenario-based sessions. When doing so, they often used a simulator that was not the most appropriate for the procedural skill (using a high-technology simulator when a low-technology or other simulation modality would have been more optimal) and during critiques most were unable to explain their simulation selection. Kinnear et al38 (2015), United Kingdom Faculty (simulation physician leads) 13 None Descriptive report of a consensus process using modified Delphi method that included 13 simulation lead faculty to produce a topic outline for a faculty course on teaching with simulation.
Highest ranking topics in order of importance were scenario design, creating a supportive learning environment, structured debriefing formats, human factors, educational feedback, and communication Kolbe and Rudolph39 (2018), United States Multiprofessional faculty 25 Workshop (4 d) Qualitative analysis of written reflections from 25 participants in an advanced simulation instructor course.
Thematic analysis revealed the following 5 primary themes: understanding one's own learning process, evaluation of learning activities, balancing emotions, anticipating future application, and “notes to self,” which included concepts that participants felt important to recall and apply. Lee-Jayaram et al40 (2019), United States Multiprofessional faculty (medicine, nursing, paramedicine, social work, simulation specialist. athletic trainer) 65 Workshop (2 d) Mixed methods single-group posttest study with qualitative comments analysis that reported on a portion of the 2-d workshop focusing on scenario development.
There were 4 qualitative themes for scenario development identified and additional subthemes: realism (props, patient, timing, clinical), protocols (clinical, sequence, information, students, timing), introductions (objectives, specific, general), and roles. Lemoine et al9 (2015), United States Multiprofessional faculty (physicians, nurses, respiratory therapists, PTs, physician assistants) 194 Longitudinal curriculum (multimodal), community of practice Single-group, precourse/postcourse study and a detailed description of program development for a 12-module simulation FD curriculum. Development process included statewide collaboration
Pre−/post–course survey reported significant improvement in participants' self-reported learning and self-efficacy across the first 4 modules of the program. McNeill et al41 (2012), United States Nurse faculty, nursing teaching assistants 53 experienced instructors, 14 novice instructors Workshops (4 H for experienced and 32–48 H spread over 4 to 6 wk for novices) Descriptive report with single-group postevent satisfactions survey. Satisfaction scores ranged 4–5 (5 being highest satisfaction for experienced, and 4.5–5 for novices). Nestel et al42 (2016), Australia Multiprofessional faculty (physicians, nurses, PTs, paramedics, midwives) 303 Workshop (3 d, plus 4- to 8-H eLearning) Mixed methods single-group, postcourse survey, expert observers' notes, qualitative comments analysis, and a description of development of a 10-module curriculum for simulator educators and technicians.
Participant ratings of the program were consistently high across all modules and topic areas. Qualitative content analysis reported the top five things learned from a focused review of one module were practical skills including feedback and debriefing, development process for SBE including learning objectives and testing scenarios, access to resources such as templates, theory applied to simulation, and processes that enhance learning such as managing group dynamics, interacting with a wide range of learners, and co-facilitation. Oikawa et al43 (2021), United States Faculty 28 Longitudinal simulation fellowship (multimodal) Single-group postcourse survey and a brief descriptive report of the development and outcomes of a simulation fellowship program with 28 graduates and average length of fellowship of 13.7 mo. Postgraduation survey reported 3 most useful content areas were debriefing, simulation operations, and learning theory. Least useful were research and administration. Paige et al44 (2015), United States Surgical educators conference attendees Not reported Workshop (3 H) Single-group pre/postcourse assessment after a conference-based workshop including didactic content based on the OSAD tool and immersive simulation experiences. Participants reported significantly increased self-efficacy in 7 of 8 areas. Robertson and Bradley45 (2017), United States Multiprofessional faculty (physicians, nurses, physician assistants, researchers) 51 Workshop (1.5 H) Single-group post–course survey of learners' self-competence and a detailed description of program development. Post–course survey reported increased self-described competence. A second iteration of the course surveyed 80 individuals and showed improved self-reported competence. Surveys also indicated desire for more time in workshop. Robinson et al46 (2020), Uganda Multiprofessional faculty (physicians, nurses, midwives, and other independent healthcare practitioners) 13 2-Day workshop followed by 1-d refresher one year after Single-group observer ratings using the OSAD precourse and postcourse plus 1 yr after the course. Intervention was a workshop focused on design, execution, briefing, and debriefing with customization for local cultural attributes and emphasis on delivery in low-resource settings. OSAD scores indicated significant improvement from precourse to postcourse and participant capabilities were sustained at the 1-yr review. Rojas et al47 (2017), Canada Nursing faculty 30 Workshop (4 H) Single-group postcourse assessment using the DASH tool and a description of workshop development and implementation based on INACSL Standards. Participants' DASH scores ranged from 5.2 to 7, with 7 as the maximum, indicating participants were functioning at the satisfactory level or higher. Rudolph et al48 (2013), United States RN simulation instructor 1 Case study Case study on a single simulation educator navigating through difficult decisions in SBE. Presents 2 tools to enhance reflection, 2-Column Case and The Learning Pathways Grid, and uses case study to demonstrate use. Seethamraju et al49 (2021), India Multiprofessional faculty (physicians, nurse, simulation facilitator) 11 Workshop (2 d) Qualitative interviews with 11 participants of a 2-d workshop that focused on adult learning, simulation operations, curriculum and scenario design, and debriefing. Interviews concluded positive impacts on Kirkpatrick levels for reaction, learning, and behavior (application in work setting). Sigalet et al50 (2016), Qatar Multiprofessional faculty (physician, nurses, nurse practitioners, allied health providers) 40 2-Day workshop with precourse eLearning Single-group, pretest/posttest scores from 12-question MCQ on course content showed significant improvement in areas covered by eLearning rather than hands-on portion of workshop. Stephenson et al51 (2019), United States Multiprofessional faculty from 9 professions including physicians, nurses, and paramedics 87 5-Module instructor development program (nonconsecutive half days per module) Single-group postcourse survey with qualitative comments after development a 5-stage approach to simulation FD with introduction to simulation education; scenario development; running a simulation; debriefing; and assessment, research, and sustainability. Used tiered approach with sequential progression through modules.
Postevent surveys indicated high degree of satisfaction and applicability for participants. Among the qualitative comments was desire for more hands-on practice and additional strategies for beginning simulation educators. Taibi and Kardong-Engren52 (2014), United States Nursing faculty, chiropractor, dentist hygienist, other nonspecified health professions 66 Online education curriculum Descriptive survey data that served as needs analysis for development of a 7-module online learning program for simulation FD, including modules for basic and advanced faculty with modules ranging from 12 to 30 min. Topics included the following: basic—introduction to clinical simulation, Pedagogical approaches in simulation for developing critical thinking, Designing and writing a simulation scenario, Briefing and debriefing and Advanced—How to evaluate learning using simulation, Matching human patient simulators to clinical learning outcomes, and Bringing realism to simulation. Wong et al53 (2020), United States Multiprofessional simulation educators 15 Remote virtual FD program Single-group postcourse survey with qualitative comments and description of development and implementation of an online avatar-based virtual debriefing course. End-of-course evaluation reported high degree of satisfaction with course content and delivery model. Qualitative comments indicated feedback provided through the course using the OSAD tool was valuable for participant development. Woolfrey et al54† (2017), Canada Emergency medicine physician faculty 21 1-Day workshop with prior online content Single-group precourse/postcourse survey after using a flipped-classroom approach with self-regulated learning before a 1-day workshop. Postevent survey showed improvement in participants' self-efficacy conducting postsimulation debriefing.

Single-group studies included studies that had cohorts from different periods who were aggregated into the survey result.

All others are peer-reviewed journal manuscripts.

*Denotes dissertation.

†Denotes published abstract.

CPD, continuing professional development; DASH, Debriefing Assessment for Simulation in Healthcare (Simon et al56); DASH-SV, Debriefing Assessment for Simulation in Healthcare-Student Version (Simon et al57); INACS, International Nursing Association for Clinical Simulation and Learning; MCQ, multiple-choice questionnaire; OSAD, Observational Structured Assessment of Debriefing (Arora et al58); PT, physical therapist.
Programs

The content and activities of the FD offering are displayed in Table 2. As shown, the main content areas included debriefing (included in 75% of studies), curriculum design (66%), conducting simulation activities (47%), self-reflection (38%), evaluation of program and outcomes (25%), and education theory (22%).

TABLE 2 - Content Areas in the Included Studies Topic % Cited Debriefing9,20–31,33,34,37,39,40,42,44–47,49–52 77% Curriculum design (all areas up to implementation including needs analysis, learner analysis, content analysis, goals and objectives development, modality selection, curricular content development, and pilot testing)8,11,13,16–18,20–26,29–32,59 66% Conducting simulation activities (the simulation event itself, not postevent activity. Could include briefing, creating safe learning space, learner orientation to the sim environment, initiating the simulation, running the simulation, concluding simulation, etc)9,21–23,27,28,30,31,34,38–40,44,47,49,50 46% Reflection on own performance22,23,31–35,37,42,46,47,59 34% Educational theory9,23,26,29,40,42,43,48,50 26% Evaluating simulation programs/outcomes20,21,23,24,26,39,48,50 23% Feedback20,27,37,39,40,46,48 20% Interprofessional education/team training23,24,39,47,49,50 17% Developing simulation-based research21,23,24,39,49 14% Technical operations (programming, simulator operations, moulage, etc)9,21,23,24,34 14% Learner assessment24,26,30,49,50 14% General teaching and learning strategies26,40,50,59 11% Simulation educator FD (eg, teaching how to teach)25,40–42 11% Using other adjuncts/technology to support simulation9,23 6% Simulation center operations (creating buy-in, obtaining resources, hiring staff, etc)23 3% Curriculum integration21 3%

Methods of delivery for these content areas widely varied. The majority (n = 17, 53%) were single-event workshops, which ranged from 1.5 to 8 hours each. Nine studies (28%) described longitudinal events that occurred over multiple episodes, ranging from several weeks to a year. Only 3 programs were delivered entirely online,30,52,53 and 2 reports described delivery of hybrid programs.42,50

These FD programs referenced a vast array of theoretical and conceptual foundations. Fewer than a third (11/35) of studies reported reliance on any theoretical or conceptual foundation for design, delivery, or assessment. Of these, Kolb's experiential learning theory was referenced most frequently (5/10; 50%), whereas other theories and models were only referenced once each. Some interventions, such as the workshop described in Daily's dissertation,28 reported reliance on multiple theoretical and conceptual foundations from the social psychology and education literature.

Program evaluation also varied widely. More than half (22/35, 63%) of studies described program evaluation. Most often, however, these program evaluations were limited to participant ratings of overall course satisfaction, the extent to which the course and facilitators met stated learning objectives, and/or solicited suggestions for improvement via open-response feedback.

People (Participants and Facilitators)

Nearly all studies reported on the characteristics of participants to some degree. Almost all FD programs were directed toward faculty-level educators, with the exception of the following 3 learner groups: senior nursing students,32 medical students,24 and an undefined population (via an online blog).30 Most programs involved participants from multiple specialties (22/35, 63%). Eight studies (23%) included only nursing participants. The remaining four studies were delivered to educators within a single discipline, including emergency medicine, pediatrics, physical therapy, and surgery. One study did not provide information on participant specialty. The number of participants in each study ranged from 1 to 303, with an average of 53 (SD, 69) participants.