Journal article
Strengthening simulation design and cultural safe practice: end-user evaluation of the quality simulation assurance framework
Advances in simulation, Vol.Advanced Access
12-Jun-2026
PMID: 42277888
Abstract
Background
Simulation-based learning is a core component of health professional education, yet designing simulations that are culturally responsive, educationally robust, and locally relevant remains challenging. Existing international standards reflect the cultural contexts in which they were developed and provide limited guidance for adapting simulation design for Australia and Aotearoa New Zealand, including effective inclusion of Australian First Nations and New Zealand Māori perspectives. The Quality Simulation Assurance Framework (QSAFe) was developed to address this gap and support culturally safe, high-quality simulation design. This study explored two research questions: (1) How do participants evaluate the applicability of the framework, including its relevance and feasibility, to their simulation practice? and (2) How does the framework support users in their design and delivery of quality simulation, including perceived helpfulness, value, and educative impact?
Methods
A pilot evaluation was conducted across five tertiary institutions. Twenty-six educators used the framework to benchmark an existing simulation-based learning activity, and four participated in semi-structured interviews. Quantitative data were analysed using descriptive statistics. Qualitative data were examined using reflexive thematic analysis to explore perceptions of applicability and educative value.
Results
Participants reported that the framework and supporting materials were broadly applicable to their simulation practice. Most participants rated their experience positively and indicated an intention to use the framework in future design or documentation. Four themes described the framework’s perceived value: usability, promoting best practice, supporting reflection on design, and encouraging consistent learner experience. Although the consultation and co-design element of the framework received the lowest quantitative relevance rating, findings showed this element to be least understood, particularly in relation to cultural safety and Australian First Nations and New Zealand Māori inclusion. Participants suggested improvements such as a brief orientation, video walkthroughs, and an online version with embedded guidance. Limitations included a small sample, incomplete survey responses, and challenges recruiting interview participants.
Conclusions
The Quality Simulation Assurance Framework appears feasible, useful, and educative, supporting more consistent and culturally responsive simulation design. Further refinement should focus on strengthening guidance for co-design with Australian First Nations and New Zealand Māori and enhancing usability.
Details
- Title
- Strengthening simulation design and cultural safe practice: end-user evaluation of the quality simulation assurance framework
- Authors
- Melanie Barlow (Corresponding Author) - Australian Catholic UniversityYoriko Kikkawa - Australian Catholic UniversityColleen Ryan - Central Queensland UniversityTerri Downer - University of the Sunshine CoastRobyn Dickie - Australian Catholic UniversityChanchal Kurup - Central Queensland UniversityKerry Reid-Searl - University of TasmaniaAimee Lamb - Western Sydney UniversityAlexandra Wordworth - Whitireia New ZealandNatasha Eaton - Queensland HealthLeeanne Heaton - Western Sydney UniversityStephen Guinea - Australian Catholic University
- Publication details
- Advances in simulation, Vol.Advanced Access
- Publisher
- BioMed Central Ltd.
- DOI
- 10.1186/s41077-026-00454-7
- ISSN
- 2059-0628
- PMID
- 42277888
- Copyright note
- © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
- Data Availability
- The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
- Grant note
- This research was supported by The Australian Catholic University’s Faculty of Health Sciences Teaching and Learning and the Centre for Education Innovation Teaching Development grants.
- Organisation Unit
- School of Health - Midwifery
- Language
- English
- Record Identifier
- 991240800002621
- Output Type
- Journal article
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