Reframing simulation as an implementation strategy: a call for conceptual integration across two scientific communities.

backgroundSimulation is an established evidence-based tool in healthcare. It is widely used for medical education (simulation-based medical education [SBME]), quality improvement, capacity building, audit and feedback, and probing healthcare systems for latent safety threats. Implementation science (IS) currently subsumes these functions under broad taxonomy categories such as "conduct ongoing training" or "cyclical tests of change." This framing fails to capture simulation's distinct mechanisms and its unique potential to close the evidence-to-practice gap. We argue that the time has come for implementation scientists and the healthcare simulation community to come together around a shared question: does simulation, as it is already practiced in healthcare, meet the criteria for a discrete, named implementation strategy within taxonomies such as the Expert Recommendations for Implementing Change (ERIC)? MAIN BODY: Drawing on the ERIC definition of an implementation strategy as "methods or techniques used to enhance the adoption, implementation, and sustainability of a clinical program or practice," we argue that simulation in healthcare already functions in this role across at least three distinct domains: developing individual and team competencies (SBME); probing healthcare systems for latent hazards and driving quality improvement; and operationalizing evidence-based interventions (EBIs) and clinical decision supports (CDS) under realistic conditions. We specify simulation using established IS frameworks-including the Consolidated Framework for Implementation Research (CFIR), the EPIS framework (Exploration, Preparation, Implementation, Sustainment), and the PRISM (Practical, Robust Implementation and Sustainability Model)-and propose a research agenda at the intersection of these two fields. High-reliability industries including aviation, astronautics, and nuclear power provide useful analogies, but the healthcare simulation literature has developed a robust and distinct evidence base in its own right, exemplified by translational simulation paradigms.

conclusionSimulation is not simply a training technique. It is a multi-mechanism, multi-level strategy with proven applications in healthcare education, QI, and systems change. Formally recognizing simulation within IS strategy taxonomies would sharpen conceptual clarity, enable more precise evaluation, and open a productive dialogue between two scientific communities whose work is more convergent than current frameworks suggest.