Barriers and enablers of simulation

what are the barriers to simulation?

Unfortunately, when attempting to deliver simulations in healthcare there are some common barriers people may come across before being able to do so:

  • Lacking Time and Resources - a key challenge for simulation is that it requires a good amount of investment in developing the resources required and take time to deliver at a sufficient standard. A rushed simulation is as ineffective as a rushed PowerPoint, or clinical encounters.

  • Fear of the technology / manikins - many people are put off by the complexity of the manikins, their software and the inherent challenges of programming scenarios. Many people also just plain and simple dislike manikins and would rather practice on patients / each other than step foot in a simulation suite.

  • Limitations of environment, space & equipment - often, many simulation environments are set up to be adaptable and made to look like several clinical areas, in that sense they equally fail to look like any setting, let alone one which the learner is familiar or comfortable in. Spaces can be limited, particularly in situ where ward staff may not wish to be visible to patients, or where clinical need supersedes availability for teaching. Equally, equipment can sometimes be the equivalent of gold dust, either the kit is out of date, donated by wards from old stock, or adopted from in situ scenarios. The concern of using equipment from a clinical area is the lack of re-usability of many elements and the generation of 'waste', particularly from an environmental consideration with single use plastics.

  • Finances - departmental, manikin & faculty - everything has a cost, brick and mortar of running a building, purchase of equipment and subsequent maintenance, limitations of kit necessitating newer models, and the ongoing training and up-skilling of staff.

  • Lack of trained faculty to support programme - probably the single most significant and ongoing limitation of any facility is the lack of interest to maintain a training programme. There is often a desire for training to happen, but a lack of willingness to provide support and long term investment to ensure success and returns on investment.

  • Misuse of simulation - GIGO (garbage in, garbage out) - potentially the next worse element, using simulation inappropriately to teaching a topic, or support an innovation, when another modality may have been as effective, or more so. Many teaching interventions; PowerPoint, small-group discussions, e-learning, videos, etc... are as effective as each other with single interventions - See Mastery Learning & Intervention Effectiveness pages.

A full review of scenario design considerations is available here.

What are the enablers of simulation?

Simulation programmes work well when the above are addressed and a department is designed with rigour and appropriate support. Ideally, there should be administrative support, with a dedicated manager/simulation coordinator, appropriate technology support - typically in the form of a simulation technician. In addition, a regular faculty development programme with evidence of return on investment, with clear instructor characteristics and preferred teaching strategies.

More learning resources are available below:


  1. Barriers and Enablers to the Use of High-Fidelity Patient Simulation Manikins in Nurse Education: An Integrative Review -