Simulation in medical training is an evidence-based, cost-effective tool for doctors at every level to take part in patient care scenarios in a protected environment. From small group “megacode” practice to procedural mastery, using a hospital-based simulation center can add tremendous value. Hospitalists can use the simulation center to focus on quality initiatives, improve communication skills, practice team-based scenarios, and develop diagnostic ultrasound and procedural skills. Simulation can take the form of standardized patients, high-fidelity mannequins with realistic anatomy, simulated cardiac rhythms, and virtual and augmented reality.
Interested trainees and faculty have opportunities to pursue careers in simulation education and to help healthcare systems develop curricula and modules to enhance education, maintain skills, create a dynamic learner environment, and advance clinical practice.
Incorporating Simulation into Training
Historically, medical training has been an apprenticeship model with a mantra of “see one, do one, teach one.” Simulation was developed to allow training in real-world scenarios where mistakes do not have significant consequences and has been integrated into medical education for decades. Major uses in training have included teaching learners how to have difficult conversations, place central lines, and participate in hands-on opportunities to practice high-stakes scenarios in the hospital setting.
Internal medicine and pediatric residency programs frequently incorporate simulation in education.1-3 Finding opportunities to incorporate simulation beyond the common standards must address overall curricular gaps and have a deliberate purpose for students. One example is the University of Chicago’s incorporation of rapid response and cross-cover simulation into the fourth-year medical student sub-internship (acting intern) curriculum. Sub-interns in the program have responded positively to the opportunity to practice these low-volume, high-stakes situations, and confidence in responding to decompensating patients and intense cross-cover has improved dramatically.
For residency programs, simulation periods should be structured to fit within the curriculum, whether through ambulatory blocks, half days protected for simulation, or direct electives. Senior and chief residents may serve as preceptors for interns to obtain exposure to procedures or challenging scenarios when faculty are less available. Surgical residencies have incorporated virtual reality and augmented reality environments to practice surgical techniques. Simulation serves to build both confidence and competence for trainees to build proficiency in a risk-free environment. Successful programs add some didactics to simulation and provide immediate feedback with post-simulation debriefing. They have direct learning objectives and a variety of clinical scenarios, and make the most of available technology.
Ongoing Use of Simulation After Training
While simulation is widely used during training, it plays an increasing role in continuing medical education. Advanced cardiovascular life support remains the most common interaction with simulation after training; however, there is ample room for ongoing simulation, including learning new skills that weren’t available during training, maintaining competence when there is less exposure, and accessing training in areas with fewer resources.
Point-of-care ultrasound (POCUS) training is a prime example of simulation use for ongoing training and learning advanced skills. As an increasingly utilized tool in hospital medicine, it has largely become integrated into residency training. However, clinicians who have been out of residency for five to 10 years likely have had limited exposure to POCUS. To address this gap, formal training programs through organizations like SHM and the American College of Chest Physicians offer comprehensive certification in POCUS. These programs offer in-person training sessions and require the participant to upload a portfolio of images that can be reviewed and verified, culminating in a formal certification exam. These programs can be intensive, often taking two to three years to complete.
While certification programs are ideal for practitioners who would like to become experts in ultrasound, there has also been a push to make introductory training more approachable. To this end, institutions have initiated smaller, workshop-based internal training and certification programs for POCUS. During the workshops, clinicians rotate through the simulation center, practicing cardiac, pulmonary, vascular, and abdominal ultrasound techniques on standardized patients, wherein the primary objective is to shorten learning curves and enhance competency in bedside ultrasound.
Smaller simulation centers in community hospital settings often do not have the faculty bandwidth to develop formal certification programs for hospitalists or simulation educators. There are some comprehensive but achievable curricula that programs can adopt to start building skills in the simulation and POCUS space. The Montefiore 10 curriculum is just one example of a user-friendly basic curriculum that is well-suited to cover the bedside ultrasound needs of a variety of learners.4
Simulation is key for more remote areas where practitioners must stretch their training despite a lack of frequent exposure to events. Simulated codes may be necessary at smaller institutions for multidisciplinary teams to maintain critical skills that may be necessary at a moment’s notice. Globally, simulation can help train providers where advanced training and fellowship options are limited.
The integration of simulation-based training offers a promising avenue for continuous professional development among hospitalists, ensuring they remain adept with the latest medical technologies and techniques and maintain the confidence to continue learning, champion ultrasound at the bedside, and ultimately begin to teach others these valuable skills.
Making a Career Out of Sim
With simulation now playing such a large role in hospital medicine and training, careers in medical education with a focus on simulation-based practice are a commodity at large academic institutions and community hospitals alike. Because simulation training has become increasingly integrated into medical school training and residency, many young hospitalists have had exposure to simulation training and bring novel ideas for its application in continuing medical education. Physicians with a strong background in simulation education can serve in medical directorship for simulation in centers of all sizes and can build both academic and community careers around its use.
The Society for Simulation in Healthcare (SSIH), in addition to SHM, is a national organization that can supplement a career in simulation and allow centers to pursue partial or full simulation-center accreditation pathways. Along with SHM Converge, SSIH also has a large international conference each year that draws experts and industry superstars from all over the world to share their scholarly work and innovations in the simulation realm.
Working with your hospital system to demonstrate the value of simulation can sometimes prove difficult. Depending on the levels of buy-in from leaders within your system, you may need to strategize the best way to show the alliance between the goals of the hospital and the role of a simulation center. Using the ample research available supporting simulation training, emphasis on the value of improving the patient experience, decreasing length of stay, improving patient care outcomes, or increasing revenue from physician billing may help to elicit buy-in from the institution.1,5-7
Conclusion
Simulation utilization can be varied and integrated into any hospital system. As a champion for simulation, your goals may be to educate and improve the learner experience at your institution or enhance patient care with procedural, POCUS-based, or low-volume, high-stakes scenario practice. Hospital system goals may be to start small or expand to build large-scale competency programs for hospitalists. Simulation is an efficient and cost-effective tool for trainees and continuing medical education. It can become a career niche in hospital medicine, no matter the location of practice.
Dr. Sansbury
Dr. Tewari
Dr. Molitch-Hou
Dr. Sansbury is the program director for the internal medicine residency program at Grand Strand Health and the medical director for the Grand Strand Health Education and Simulation Center in Myrtle Beach, S.C. Dr. Tewari is an assistant professor of medicine at the University of Chicago, where she serves as the director of off-hours care and chair of the ultrasound and procedures committee. Dr. Molitch-Hou is an assistant professor, the director of hospital medicine sub-internship, core faculty for the internal medicine residency program, and co-director of the Care Transition Clinic at the University of Chicago Medical Center in Chicago.
References
- Dversdal RK, et al. A 5-day intensive curriculum for interns utilizing simulation and active-learning techniques: addressing domains important across internal medicine practice. BMC Res Notes. 2018;11(1):916. https://doi.org/10.1186/s13104-018-4011-4.
- Shanks D, et al. Use of simulator-based medical procedural curriculum: the learner’s perspectives. BMC Med Educ. 2010;10:77. https://doi.org/10.1186/1472-6920-10-77.
- Frey-Vogel A, et al. Taking the pulse on pediatric simulation: a national survey of pediatric residency programs’ simulation practices and challenges. Pediatr Emerg Care. 2021;37(12):e1303-e7. https://doi.org/10.1097/PEC.0000000000002013.
- Galen BT and Conigliaro RL. The Montefiore 10: a pilot curriculum in point-of-care ultrasound for internal medicine residency training. J Grad Med Educ. 2018;10(1):110-1. https://doi.org/10.4300/JGME-D-17-00683.1.
- Mohanty S, et al. Evaluation of outpatient procedures simulation curriculum for internal medicine residents. J Gen Intern Med. 2025;40(8):1782-8. https://doi.org/10.1007/s11606-025-09394-w.
- Elendu C, et al. The impact of simulation-based training in medical education: A review. Medicine (Baltimore). 2024;103(27):e38813. https://doi.org/10.1097/MD.0000000000038813.
- Marker S, Mohr M, Østergaard D. Simulation-based training of junior doctors in handling critically ill patients facilitates the transition to clinical practice: an interview study. BMC Med Educ. 2019;19(1):11. https://doi.org/10.1186/s12909-018-1447-0.