INACSL Healthcare Simulation Standards of Best Practice

International Nursing Association for Clinical Simulation and Learning (INACSL) has developed the “INACSL Standards of Best Practice: Simulation” to advance the science of simulation, share best practices, and provide evidence-based guidelines for implementation and training. The development of a set of best practices can help any healthcare simulation flourish, as these guidelines help promote successful learning and training outcomes. These Standards provide a detailed process for evaluating and improving simulation operating procedures and delivery methods that every simulation team will benefit from. This HealthySimulation.com article will provide a highlight of the INACSL Healthcare Simulation Standards of Best Practice.

INACSL Healthcare Simulation Standards of Best Practice Evolution

Adoption of the “INACSL Standards of Best Practice: Simulation” demonstrates a commitment to quality and implementation of rigorous evidence-based practices in healthcare education to improve patient care by complying with practice standards. You can find the latest Standards by INACSL here.

• 2011: 1st edition published
• 2013: 2nd edition published
• 2016: 3rd edition published
• 2021: 4th edition published and name change to Healthcare Simulation Standards of Best Practice

Professional Development

Initial and ongoing professional development supports the simulationist across their career. As the practice of simulation-based education grows, professional development allows the simulationist to stay current with new knowledge, provide high-quality simulation experiences, and meet the educational needs of the learners. The criteria necessary to meet this standard include:

1. Perform an educational needs assessment that includes a gap analysis to provide the foundational evidence for a well-designed professional development plan.
2. Participate in professional development activities that address desired learning outcomes and align with an individual’s role and the priorities of the institution.
3. Reevaluate the professional development plan on a regular basis using formative and summative methods by both the individual and the organization.

Prebriefing: Preparation and Briefing

Prebriefing information prior to simulation-based experiences is vital for learner success and may enhance debriefing and reflection. Deliberately designed preparation and prebriefing can balance the cognitive load demands of the learner and increase the effectiveness of the simulation-based experience. The high-quality simulation requires simulationists and educators who are knowledgeable in pedagogy, including the prebriefing phase.

The Universal Criteria necessary to meet this standard include:

1. Simulationist should be knowledgeable about the scenario.
2. The prebriefing is developed according to the purpose and learning objectives.
3. Consider the experience and knowledge level of the simulation learner

The Preparation Criteria necessary to meet this standard include:

1. Develop preparation materials to help learner meet objectives.
2. Help learners succeed with variety of activities.
3. Deliver prior to and on the day of the simulation-based experience to augment knowledge.

The Briefing Criteria necessary to meet this standard include:

1. Set the tone with expectations, logistics, and roles.
2. Conduct a structured orientation to simulation-based experience (SBE0 environment and modality.
3. Create a psychologically safe learning environment during the prebriefing.

Simulation Design

Simulation-based experiences are purposefully designed to meet identified objectives and optimize the achievement of expected outcomes. All simulation-based experiences require purposeful and systematic yet flexible and cyclical planning. The criteria necessary to meet this standard include:

1. Simulation-based experiences (SBE) should be designed in consultation with content experts and simulationists knowledgeable in best practices in simulation education, pedagogy, and practice.
2. Perform a needs assessment to provide the foundational evidence of the need for a well-designed simulation-based experience.
3. Construct measurable objectives that build upon the learner’s foundational knowledge.
4. Build the simulation-based experience to align the modality with the objectives.
5. Design a scenario, case, or activity to provide the context for the simulation-based experience.
6. Use various types of fidelity to create the required perception of realism.
7. Plan a learner-centered facilitative approach driven by the objectives, learners’ knowledge and level of experience, and the expected outcomes.
8. Create a prebriefing plan that includes preparation materials and briefing to guide participant success in the simulation-based experience.
9. Create a debriefing or feedback session and/or a guided reflection exercise to follow the simulation-based experience.
10. Develop a plan for evaluation of the learner and of the simulation-based experience.
11. Pilot test simulation-based experiences before full implementation.

Outcomes and Objectives

All simulation-based experiences (SBE) originate with the development of measurable objectives designed to achieve expected behaviors and outcomes. For any simulation activity the outcomes and objectives help you determine how the participant will benefit from the experience. The criteria necessary to meet this standard include:

1. Establish learner outcomes.
2. Create objectives.
3. Identify appropriate simulation modality.
4. Identify appropriate fidelity.
5. Establish guidelines for facilitation.

Facilitation

Facilitation of a simulation-based experience requires a facilitator who has the education, skill, and ability to guide, support, and seeks out ways to assist participants in achieving expected outcomes. The criteria necessary to meet this standard include:

1. Effective facilitation requires a facilitator who has 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 simulation-based experience include preparatory activities and a prebriefing to prepare participants for the simulation-based experience (Follow the Healthcare Simulation Standards of Best PracticeTM (HSSOBPTM) Prebriefing: Preparation and Briefing).
4. Facilitation methods during a simulation-based experience involve the delivery of cues (predetermined and/or unplanned) aimed to assist participants in achieving expected outcomes.
5. Facilitation after and beyond the simulation-based experience aims to support participants in achieving expected outcomes.

The Debriefing Process

Learning is dependent on the integration of experience and reflection. The evidence is clear that essential learning occurs in the debriefing phase of the simulation-based experience. Reflection is the conscious consideration of the meaning and implication of an action, which includes the assimilation of knowledge, skills, and attitudes with pre-existing knowledge. Reflection can lead to new interpretations by the participants; cognitive reframing is essential to learning. The skills of the debriefer are important to ensure the best possible learning outcomes. The criteria necessary to meet this standard include:

1. Ensure debriefing is incorporated in an appropriate manner.
2. Constructed, designed, or facilitated by a competent debriefer.
3. Promote self, team, and/or systems analysis while encouraging reflection.
4. Planned and structured in a purposeful way based on theoretical frameworks and/or evidence-based concepts.

Evaluation of Learning and Performance

Simulation requires some form of learner evaluation. See the Healthcare Simulation Dictionary for definitions of the evaluation terms. The criteria necessary to meet this standard include:

1. Determine the method of learner evaluation before the simulation-based experience (SBE).
2. May be used for formative evaluation.
3. May be used for summative evaluation.
4. May be used for high-stakes evaluation.

Professional Integrity

Professional integrity is demonstrated and upheld by all involved in simulation-based experiences. Professional integrity refers to the ethical behaviors and conduct that are expected of all involved throughout simulation-based experiences (SBE); facilitators, learners, and participants. The criteria necessary to meet this standard include:

1. Honor and uphold the Healthcare Simulationist Code of Ethics.
2. Follow standards of practice, guidelines, principles, and ethics of one’s profession.
3. Create and maintain a safe learning environment (Follow the HSSOBPTM Facilitation)
4. Practice inclusion by respecting equity, diversity, and inclusivity among all involved and in all aspects of SBE.
5. Require confidentiality of the performances and scenario content based on institution policy and procedures.

Simulation-Enhanced-IPE

Simulation-enhanced interprofessional education (Sim- IPE) enables learners from different healthcare professions to engage in a simulation-based experience to achieve linked or shared objectives and outcomes. The criteria necessary to meet this standard include:

1. Conduct Sim-IPE based on a theoretical or conceptual framework.
2. Utilize best practices in the design and development of Sim-IPE.
3. Recognize and address potential barriers to Sim-IPE.
4. Devise an appropriate evaluation plan for Sim-IPE.

Operations

Simulation operations encompass the infrastructure, people, and processes necessary for the implementation of an effective and efficient simulation-based education (SBE) program. The interactions of these pieces must form a system that integrates with larger educational and healthcare entities to realize the goals of SBE. SBE is no longer an adjunct to health care training and/or professional development programs but an all-inclusive integrated program requiring business acumen and technically knowledgeable personnel that serve as team members providing leadership and support in the delivery of SBE. The criteria necessary to meet this standard include:

1. Implement a strategic plan that coordinates and aligns the resources of the SBE program to achieve its goals.
2. Provide personnel with appropriate expertise to support and sustain the SBE program.
3. Use a system to manage space, equipment, and personnel resources.
4. Maintain and manage the financial resources to support stability, sustainability, and growth of the SBE program’s goals and outcomes.
5. Use a formal process for effective systems integration.
6. Create policies and procedures to support and sustain the SBE program.

Research to Support Continued Evolution of the Standards of Best Practice

The INACSL Healthcare Simulation Standards of Best Practice are living documents and will continue to evolve as the science of healthcare simulation grows. The Standards are updated and developed regularly. In the Healthcare Simulation Research Update April 2025, an overview of published reviews was highlighted prior to revision of the Standards. The Standards are published and downloadable in INACSL’s official journal, Clinical Simulation in Nursing.

View the new HealthySimulation.com Community Scenario Design Group to discuss this topic with your Global Healthcare Simulation peers!

INACSL Endorsement Program

In 2022, INACSL established a Core IV Healthcare Simulation Standards Endorsement to recognize healthcare institutions and practices that have demonstrated excellence in applying all four clinical simulation standards from the Healthcare Simulation Standards of Best Practice (HSSOBP) in their educational simulation programs. The four standards include Prebriefing: Preparation and Briefing, Facilitation, Professional Integrity, and Debriefing.

HealthySimulation.com Standards of Best Practice Webinars:

Introducing INACSL’s New Simulation Standard: Professional Development: In August of 2021 the new and updated Healthcare Simulation Standards of Best Practice (formerly known as the International Nursing Association of Clinical and Simulation Learning standards) were published. Included in this publication was a new standard: Professional Development. This webinar will describe the evidence behind the new standard, review the criteria and discuss how the simulationist can meet these described criteria. In addition, there will be a review of the changes made to the previously published standards and the additional new standards.

Introducing INACSL’s New Simulation Standard: Prebriefing: Prebriefing ensures that learners are prepared for the educational content of a simulation and are also informed about their expectations of them during the simulation-based experience. Because the current literature refers to prebriefing as both preparatory activities and briefing activities, this new standard incorporates both as pre-simulation activities. Historically, the terminology related to prebriefing has varied and included numerous terms. The lack of consistency in terminology can create confusion for educators and simulationists. Standardization of terminology and methodology can help to create more standardization in future use.

How to Implement INACSL’s Healthcare Simulation Standards of Best Practice Into Your Program: This CE presentation provides an overview of the ten Healthcare Simulation Standards of Best Practice(TM) and describes opportunities for application in the areas of writing outcomes and objectives, prebriefing, facilitation, debriefing, simulation design, operations, professional development, professional integrity, simulation-enhanced interprofessional education, and evaluation of learning and performance. We will highlight exemplars from academic and practice settings who have operationalized the Standards successfully, and discuss a stepwise approach to using the Standards to improve simulation quality.

More About INACSL

The International Nursing Association for Clinical Simulation and Learning (INACSL) is the global leader in transforming practice to improve patient safety through excellence in healthcare simulation. INACSL is a community of practice for simulation where members can network with simulation leaders, educators, researchers, and industry partners. INACSL also provides the INACSL Standards of Best Practice: Simulation, an evidence-based framework to guide simulation design, implementation, debriefing, evaluation, and research. Learn more about the organization‘s Standards of Best Practice on the INACSL website or by reading the articles below.

Learn More About INACSL’s Healthcare Simulation Standards of Best Practice