Tag Archives: design

Soooooo, first off. Happy 2026 to you! I trust it is going well so far. I have been doing some studying about some of the learning theories and educational principles associated with simulation and higher education recently. As such, I have been making many new connections in my mind about the ways that healthcare simulation deeply connects to evidence and theory regarding higher education, and surprisingly to the K-12 education world. So this post is a bit more theoretical than usual, but it is representative of some of the course work that I am currently enjoying! I hope you share the same enthusiasm.

If you have worked in healthcare simulation for any length of time, you may have heard the phrase “guide on the side, not sage on the stage” which comes from Alison Kings 1993 publication (1) that suggested college level teaching move toward a constructivist theory design. Some argue she set the stage for the flipped classroom, where lecture content is moved outside the classroom to make room for active, guided learning during class time. It is often repeated, but do we truly practice it? In the rush to employ high-technology manikins or arrange the perfect clinical fidelity, it is easy to focus on the teaching rather than the learning.

To truly maximize the potential of our simulation center education programs, we need to shift our perspective toward Student-Centered Learning Environments (SCLEs) as described by Jonassen & Land (2). According to the learning sciences, SCLEs are not just about letting learners “figure it out” on their own; they are grounded designs where learners negotiate meaning, engage in authentic problems, and utilize scaffolding to bridge the gap between novice and expert where we serve as facilitators.

So then, how do we ensure our healthcare simulations function as true student-centered environments? Here are a few approaches that blend educational theory with practical simulation design.

1. Respect the “Learner’s Scenario”

In a previous post, I discussed how the word “scenario” means different things to different people. To the educator, it is a blueprint; to the operations specialist, it is a technical playbook. But to the learner, the scenario is the experience.

A core assumption of SCLEs is the “centrality of the learner”. While we may set external goals, the learner ultimately determines how to proceed based on their individual needs and the questions they generate. To support this, we must design scenarios that allow for agency. We must move away from linear, step-by-step exercises, which behaviorist theories might favor, and toward open-ended inquiry where learners identify gaps in their own knowledge and seek evidence to resolve them. After all, such design mimics the real-world practice of medicine and diagnostic processes in all of healthcare.

2. Recognize Scenarios as “Practice Fields” (But Mind the Cognitive Load!)

We often strive for realism, but we must be careful. Student-centered learning is rooted in “situated cognition,” meaning knowledge is inextricably tied to the context in which it is used. We want our simulations to act as “practice fields”, or environments where learners can engage in the authentic work of professionals. Think diagnosing a condition, managing a code, displaying empathy, or any other aspect of healthcare that we wish our learners to show us their abilities.

However, authenticity does not mean clutter. As I have written before, cognitive load is a currency that must be spent wisely. If we overload a scenario with irrelevant noise or “too much stuff” in the name of realism, we risk overwhelming the learner. A true student-centered design simplifies the authentic practice just enough to make it accessible, reducing the complexity without removing the core challenge. This allows the learner to focus on the learning objectives rather than processing extraneous details.

3. Anchor Learning in Prior Experience

You cannot center a curriculum on a student if you do not know where they are starting. Learners come to us with tacit, often naive beliefs rooted in their everyday experiences. Effective SCLEs use “anchored instruction” to connect new concepts to these familiar contexts.

In the absence of harboring true expertise in the needs of your intended learners, a robust needs assessment is the cornerstone of simulation design. As I have discussed in previous posts there are many pathways by which this can be accomplished. By gathering data through surveys or interviews, we identify the specific gaps between current outcomes and desired goals. This allows us to tailor the simulation to the learner’s “Zone of Proximal Development” ensuring the challenge is neither too boring nor too overwhelming. When we validate a learner’s prior experience, we empower them to take ownership of the inquiry.

4. Scaffolding: The Art of Optimal Guidance

There is a misconception that student-centered learning means “minimal guidance.” In reality, it requires optimal guidance. In the simulation world, we often provide this through scaffolding, or constructing the learner journey in a building block adventure that ultimately help learners manage the complexity of the task.

Scaffolding in simulation takes many forms:

• Pre-Simulation Learning Assignments: Helps learners activate prior knowledge, identify gaps, and form initial mental models before entering the simulation. By establishing a shared baseline of concepts, terminology, and expectations, these assignments help level the playing field among participants, allowing the simulation itself to focus on higher-order reasoning,  and sensemaking rather than uneven content familiarity.
• Conceptual Guidance: Helping learners organize their thoughts, perhaps through “argument structuring tools” or specific prompts that help them distinguish between conflicting ideas.
• Debriefing: This is perhaps our most powerful scaffold. Using the HUMBLE approach (Humility, Understanding, Mindfulness, Balance, Learning, Engagement), we can guide learners to reflect on their performance. Reflection allows students to compare their internal ideas with the evidence generated during the simulation, leading to a more coherent understanding.

5. Leverage Multiple Perspectives

Deep understanding rarely emerges from a single point of view. It develops when learners are exposed to, and must reconcile, multiple perspectives. Well-designed simulation environments are uniquely positioned to support this kind of learning.

In healthcare simulation, perspective-taking happens at several levels. Within a single discipline, learners are often exposed to differing clinical interpretations, prioritization strategies, or communication styles. Two clinicians may look at the same evolving scenario and arrive at different conclusions about what matters most in that moment. Simulation creates a safe space for these differences to surface, be examined, and be discussed, without the risk of patient harm and through the operative lens of a safe learning environment. This kind of cognitive diversity encourages learners to move beyond “the right answer” and toward deeper clinical reasoning and judgment.

Interprofessional simulation amplifies this effect even further. When nurses, physicians, pharmacists, respiratory therapists, and other professionals train together, learners gain direct insight into how roles, responsibilities, and mental models differ across the care team. What one profession sees as a priority may not align with another’s perspective, and simulation makes those differences visible. Rather than flattening these viewpoints, effective SCLEs use them as learning assets.

From a student-centered perspective, the power of simulation lies in shifting knowledge construction from the individual to the group. Learners are not simply absorbing expert explanations; they are actively negotiating meaning with peers who bring different training backgrounds, experiences, and assumptions to the scenario. Over time, this shared sensemaking helps build a true learning community, one in which understanding is co-constructed and collective competence exceeds what any single learner could achieve alone.

Importantly, structured debriefing plays a critical role in solidifying this learning. When facilitators intentionally invite multiple voices into the conversation, asking “What were you seeing?” or “How did your role shape that decision?”, learners begin to appreciate not only what decisions were made, but why they differed. This reflective dialogue reinforces perspective-taking as a core professional skill, not an optional add-on.

In this way, simulation-based SCLEs mirror the realities of clinical practice itself: complex, collaborative, and shaped by multiple viewpoints. By embracing, not minimizing, these differences, simulation helps learners develop the adaptability, empathy, and team-based reasoning required for real-world patient care.

Conclusion

Transforming a simulation program into a student-centered learning environment (SCLE) requires more than just high-tech equipment. It requires a shift in mindset from the outset of the design. We must view the simulation ecosystem through the lens of the learner. By balancing authentic practice with cognitive load management, respecting prior experience, and providing robust scaffolding, we empower our learners to become autonomous, lifelong problem solvers.

Until next time, Happy Simulating!

• (1) King, A. (1993). From sage on the stage to guide on the side. College Teaching, 41(1), 30–35.
• (2) Jonassen, D. H., & Land, S. M. (2012). Student-centered learning environments (pp. 3–25). In D. H. Jonassen & S. M. Land (Eds.), Theoretical foundations of learning environments (2nd ed.). Routledge.