The Updated INACSL Cornerstone Healthcare Simulation Standards of Best Practice

Research in the field of healthcare simulation continues to advance rapidly, transforming healthcare education through groundbreaking findings worldwide. In this monthly HealthySimulation.com article series, Content Manager Teresa Gore, PhD, DNP, APRN, FNP-BC, CHSE-A, FSSH, FAAN, highlights key developments in updates to the Healthcare Simulation Standards of Best Practices by the International Nursing Association for Clinical Simulation and Nursing (INACSL) Clinical Simulation in Nursing Journal. Key changes in these updates includes a refinement in prebriefing processes to emphasize cognitive readiness, expectations, and ground rules; enhanced facilitation strategies for learner needs and outcomes to offer clearer guidance; strengthened emphasis on structured debriefing to include deliberate use of feedback, reflective techniques and guided reflection; and updated guidance on ethical practice throughout the simulation experience to incorporate professional conduct, transparency, inclusivity, and psychological safety.

Preamble: Grounded in Excellence: The Cornerstone Healthcare Simulation Standards of Best Practice: This revision of the HSSOBP underscores a steadfast commitment to strengthening simulation practices, fostering interdisciplinary collaboration, and advancing healthcare education through research, integrity, and continuous improvement. The cornerstones for the HSSOBP include the following standards:

• Professional Integrity
• Prebriefing: Preparation and Briefing
• Facilitation
• Debriefing

The global simulation community serves as advocates for best practices. As such an international call-to-action to provide an exemplary approach to SBE is necessary. The action items to be considered for simulationists worldwide include:

• Continue simulation research, with rigor, expanded sample size, enhanced design, ingenuity, and creativity.
• Actively engage in scholarship by publishing, presenting, and disseminating work.
• Advocate for best practice and excellence in simulation experiences.
• Utilize the Healthcare Simulation Standards of Best Practice® (INACSL Standards Committee, 2021) and seek to integrate them into all simulation programs.

Healthcare Simulation Standards of Best Practice: The Debriefing Process: An umbrella review (UR) was conducted to inform the review of the INACSL Standards for Healthcare Simulation, The Debriefing Process using Joanna Briggs Institute (JBI) methodology . The goal of the UR was to identify “evidence-based practices related to the debriefing process to support the delivery of high-quality simulation that promotes a culture of inclusion, trust, and safety. This section provides a summary of the evidence acquired through the UR that supports the criteria necessary to meet the standard related to the debriefing process.

Criteria necessary to meet this standard include the debriefing process is:

1. Planned and incorporated into the simulation-based experience in an appropriate manner to guide the learner(s) in achieving the desired learning or evaluation outcomes.
2. Constructed, designed, and facilitated by a person(s) or technology-supported system capable and/or competent in providing appropriate feedback, debriefing, and/or guided reflection.
3. Conducted in a manner that promotes self, team, and/or systems analysis. This process should encourage reflection, exploration of knowledge, and identification of performance/system deficits while maintaining psychological safety and confidentiality.
4. Planned and structured in a purposeful way based on theoretical frameworks/models and evidence-based concepts.

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Healthcare Simulation Standards of Best Practice Facilitation: Facilitation methods are varied, and use of a specific method is dependent on the needs of the learner and expected learning outcomes. Based on a comprehensive systematic review (INACSL Committee et al., 2025b), recent studies confirm that facilitation involves guiding participants through simulation-based experiences (SBE) to ensure they achieve defined learning objectives.

Operationally, facilitation is the structure and process necessary to effectively conduct simulated-based experiences, while the facilitator is the individual who directs the learning experience that directly impacts the learner. A facilitator is the educator who assumes responsibility and oversight for managing the entire SBE.

Criteria necessary to meet this standard:

1. Effective facilitation requires a facilitator with specific skills and knowledge in simulation pedagogy.
2. The facilitative approach is appropriate to the level of learning, experience, and competency of the participants.
3. Facilitation methods before the SBE include conducting a needs assessment and a pilot test simulation before full implementation Facilitation methods also include prebriefing (preparation and briefing) activities to prepare participants for the SBE and determining participant evaluation methods. The facilitator discusses ground rules to create and maintain a safe learning and noncompetitive environment .
4. Facilitation methods during a SBE involve the delivery of cues (predetermined and/or unplanned) aimed at assisting participants in achieving expected outcomes.
5. Facilitation after and beyond the SBE aims to support participants in achieving expected outcomes.

Healthcare Simulation Standards of Best Practice Professional Integrity: The World Health Organization defines integrity in its 2023 Code of Ethics as being committed to “act in good faith in all matters…. driven by the qualities of honesty, truthfulness, impartiality, and incorruptibility”. The role of the professional integrity standard within Healthcare Simulation Standards of Best Practice (HSSOBP) is to ensure the prioritization of upholding ethical standards and professional conduct in simulation-based education by all participants, both facilitators and learners. A recent exhaustive systematic review of the literature was conducted which reaffirmed the need for intentional implementation of the professional integrity criteria listed below when designing simulation experiences. The standard highlights the importance of each participant following their own profession’s standards of practice, guidelines, and ethical codes, and it does this within the larger framework of healthcare simulation with its own relevant ethical principles, values, and codes of conduct.

Criteria necessary to meet this standard:

1. Foster and exemplify attributes of integrity in all interactions, adhering to established standards, guidelines, and ethical principles of clinical simulation and professional integrity.
2. Establish and maintain a safe learning environment in alignment with the HSSOBP prebriefing: Preparation and Briefing, Facilitation, and The Debriefing Process.
3. Establish an inclusive environment by fostering trust and respect among all participants involved with the development and execution of the SBE.
4. All participants are required to maintain confidentiality of simulation activities and scenario content based on individual institutions’ policies and procedures.

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Healthcare Simulation Standard of Best Practice Prebriefing: Preparation and briefing: Prebriefing is an overarching term used to describe the activities of briefing and preparation in healthcare simulation. Briefing and preparation occur before a simulated clinical encounter, providing learners with the fundamental knowledge and assumptions of the simulation-based experience (SBE). Previously, learner preparation was included in the original INACSL Standards of Best Practice: Simulation Design. Yet in 2021, learner preparation was determined to be an essential component of prebrief and, therefore, became part of the INACSL Healthcare Simulation Standards of Best Practice Prebriefing: Preparation and Briefing.

Following an exhaustive systematic review, the current literature reaffirmed that simulation prebriefing includes activities that prepare the learners and brief them for participation in an SBE. Preparation typically precedes a briefing, is conducted before the SBE, and often includes activities such as lectures, video reviews, skill-building exercises, and assigned readings. Briefing activities typically occur preceding the SBE and may include, but are not limited to, technology orientation and orientation to the environment.

This Standard upholds that prebriefing, briefing, and preparation are activities that simulation participants engage in before initiating the simulated clinical encounter and are intended to provide transparency regarding the SBE objectives and performance expectations. Prebriefing sets the stage for learning; ensuring learners fully possess the knowledge, skills, and attitudes to engage in the SBE. Guidelines for this standard specific to preparation and briefing will be addressed, and criteria will be outlined to meet this standard.

The criteria necessary to meet the prebriefing standard are divided into three categories: General prebriefing criteria, Preparation criteria, and Briefing criteria. Each category consists of three criteria with corresponding required elements. These criteria provide a structured framework for prebriefing: preparation and briefing consistency, clarity, and effectiveness.

General criteria:

• The simulationist should be knowledgeable about the scenario and competent in concepts related to prebriefing.
• Prebriefing should be designed based on learning needs, experience level, and the purpose, objectives, and outcomes of the SBE.
• The experience and knowledge level of the simulation learner should be considered when planning the prebriefing.

Preparation criteria:

• Based on the needs assessment and purpose of the experience, preparatory materials are developed to ensure learners are equipped for the experience and can meet the scenario objectives.
• Preparatory materials should be developed according to the purpose and learning objectives of the SBE.
• Plan the delivery of preparatory materials both prior to, and on the day of, the simulation-based experience.

Briefing criteria

• Prior to participating in the simulation-based experience, the simulationist conveys important information to learners regarding expectations, the agenda, and the logistics for the experience.
• Conduct a structured orientation to the simulation-based learning environment, including the modality.
• Establish a psychologically safe learning environment during the prebriefing.

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