Coloniality in Simulation-Based Medical Education.

Simulation-based medical education (SBME) has emerged as a dominant pedagogical tool globally, yet its diffusion into low- and middle-income countries (LMICs) frequently occurs through uncritical transfer from high-income country (HIC) contexts. This viewpoint examines how coloniality, the enduring structures of power, knowledge and cultural hierarchy inherited from colonialism continue to shape SBME in LMICs. Drawing on the author's experiences as a simulationist in Sri Lanka and the United Kingdom, the paper explores how colonial assumptions manifest across three phases of simulation practice: design and planning, execution and facilitation and evaluation. In the planning stage, imported educational theories and faculty-development models often neglect local learning cultures and social hierarchies, resulting in pedagogical dissonance. In execution, simulation activities are frequently delivered in colonial languages and rely on equipment designed for Western physiologies, producing artificial learning encounters and limiting psychological safety. Evaluation processes, meanwhile, depend on HIC-derived metrics and standards that marginalise Indigenous perspectives and reinforce epistemic dependency. These practices collectively reproduce inequities that privilege Western frameworks while silencing local innovation and contextual adaptation. Decolonising SBME therefore requires deliberate awareness, reflection and re-design-through multilingual instruction, co-creation of contextually relevant scenarios and development of locally led faculty and research ecosystems. By reframing simulation not as a technology to be imported but as a relational, culturally situated educational practice, educators can create more authentic and equitable learning environments. This article calls on simulationists, educators and policymakers in both HICs and LMICs to recognise colonial legacies in SBME and to pursue inclusive, locally grounded approaches that enhance patient safety and learning outcomes without perpetuating dependency. Confronting coloniality within simulation is thus a necessary step towards the broader decolonisation of global medical education.