The Future of Simulation in Medical Education: From Novelty to Necessity

 The Future of Simulation in Medical Education: from Novelty to Necessity

Medical education has always wrestled with the challenge of teaching complex, high-stakes skills in an environment where mistakes can carry real consequences. Historically, students learned at the bedside, often relying on apprenticeship models where experience came in unpredictable bursts. While this “see one, do one, teach one” tradition had its strengths, it also left gaps. Simulation-based training (SBT) emerged to fill those gaps, and it is no longer a niche tool—it is a core component of medical education. A recent article describes simulation-based research and innovation. The authors suggest that the next decade will transform simulation from a supplemental experience into a foundational pillar of how we prepare physicians.

Why Simulation Matters

Simulation provides a safe space where learners can make mistakes, reflect, and try again—without putting patients at risk. Elendu and colleagues’ 2024 review (1) highlights several key benefits: learners gain clinical competence more quickly, retain knowledge longer, and demonstrate improved patient safety outcomes. Equally important, simulation supports deliberate practice, structured feedback, and team-based scenarios that mirror the realities of modern healthcare. In an era where patient safety is paramount and medical knowledge is expanding faster than ever, the controlled environment of simulation offers a vital buffer between the classroom and the clinic. 

Emerging Technologies Driving Change

The next wave of simulation training will be shaped by technology. In an article posted by Education Management Solutions (2), artificial intelligence (AI) is poised to revolutionize how scenarios are created and adapted. Instead of static, one-size-fits-all cases, AI can generate patient interactions tailored to a learner’s level, performance, and even biases. Imagine a resident who consistently misses subtle diagnostic cues being repeatedly exposed to cases that hone that specific skill. Adaptive learning, powered by AI, promises to accelerate mastery and personalize education in ways we’ve only begun to imagine.

Another major trend is the improvement in simulation technology such as high-fidelity mannequins (Sim Man and Harvey), virtual endoscopy and ultrasound simulators, and surgical simulators. Virtual Reality and Augmented Reality have moved from gaming into the world of education. (3) VR headsets are smaller, more affordable, and more accessible. For medical schools committed to widening access to education and reducing disparities, portability is a game-changer. These tools allow learners to step into highly realistic, immersive scenarios. VR can recreate the chaos of a mass casualty event or the precision of an operating room, while AR overlays digital information onto the real world—imagine seeing a patient with anatomy labeled in real time. The potential for engagement and realism is enormous. Still, VR/AR must avoid becoming flashy gimmicks. Their power lies in creating experiences that are both immersive and educationally sound, rooted in clear learning objectives.

Feeling is Believing: the Role of Haptics 

Simulation has long been strong in visual and auditory fidelity, but haptics—the sense of touch—has lagged behind. That is changing. New advances in haptic feedback allow learners to “feel” the resistance of tissue during a procedure, the snap of a joint during reduction, or the subtle give of a vessel wall during cannulation. For skill-based specialties like surgery, obstetrics, and emergency medicine, this tactile realism can shorten the learning curve and increase confidence before performing procedures on patients. A recent systematic review in the Journal of Surgical Education (4) identified the challenge with surgical simulation. Feedback from the surgical instrument which is typical for minimally invasive techniques such as laparoscopy is easier to simulate than the feel of soft tissues in the body. The review identified nine studies of haptics but there is much inconsistency in the evidence.

Competency Tracking

Perhaps one of the most exciting—and potentially controversial—advances is the integration of data analytics into simulation. Systems are emerging that can measure everything from the angle of a needle insertion to the response time in a code scenario. These metrics can provide real-time feedback and generate longitudinal reports of a learner’s progress. For competency-based medical education (CBME), which emphasizes outcomes over time served, such analytics could provide the objective measures we have long struggled to capture. Of course, this raises important questions about how such data are used in assessment, promotion, and even remediation. Transparency and fairness will be critical if analytics are to fulfill their promise without creating new inequities.

Challenges Ahead  

Despite its promise, simulation faces hurdles. Costs are significant—high-fidelity mannequins, VR systems, and haptic devices are expensive, and simulation centers require space, staff, and upkeep. Faculty development is another challenge: effective simulation requires skilled facilitators who can guide debriefings, not just operate the technology. Finally, while simulation improves competence, translating those skills into clinical performance is not automatic. More research, like that synthesized by Elendu et al., is needed to understand how best to integrate simulation into curricula to maximize transfer to patient care. 

Implications for Medical Education

For medical schools (and residency training programs), the message is clear: simulation is not optional. Schools that fail to invest in simulation risk graduating physicians less prepared for the realities of modern healthcare. The most forward-thinking institutions will not only build simulation centers but also embed simulation across the curriculum—from preclinical years through residency. This requires leadership willing to make strategic investments and faculty committed to weaving simulation into teaching, assessment, and remediation. It also requires attention to equity, ensuring that students across campuses and resource levels have access to the same opportunities.

Looking Forward

As simulation matures, its role will expand beyond technical training. It will increasingly serve as a platform for teaching professionalism, interprofessional teamwork, cultural humility, and even resilience. The “hidden curriculum” of medicine—the values, habits, and attitudes we pass on—can be intentionally addressed in simulated spaces. AI-driven avatars may even help address bias, exposing learners to diverse patient populations in ways that are not possible in traditional settings.

In short, the future of simulation is bright. What began as a supplemental tool is becoming the backbone of modern medical education. The convergence education and technology is creating a learning ecosystem that is safer, smarter, and more responsive to individual learners. The challenge for medical educators is not whether to adopt simulation, but how to do so thoughtfully, equitably, and in ways that truly enhance patient care.

 

References

(1)   Elendu C, Amaechi DC, Okatta AU, et al. The impact of simulation-based training in medical education: A review. Medicine  2024; 103 (27): e38813. doi: 10.1097/MD.0000000000038813. PMID: 38968472; PMCID: PMC11224887.

(2)   https://ems-works.com/blog/content/7-future-trends-in-healthcare-simulation-training/

(3)   Dhar E, Upadhyay U, Huang Y, Uddin M, Manias G, Kyriazis D, Wajid U, AlShawaf H, Syed Abdul S. A scoping review to assess the effects of virtual reality in medical education and clinical care. Digit Health. 2023; 9: 20552076231158022. doi: 10.1177/20552076231158022. PMID: 36865772; PMCID: PMC9972057.

(4)   Rangarajan K, Davis H, Pucher PH.  Systematic Review of Virtual Haptics in Surgical Simulation: A Valid Educational Tool? J of Surgical Education 2020; 77 (2); 337-347.  https://doi.org/10.1016/j.jsurg.2019.09.006

More Than a Prayer: How Chaplaincy Services Shape and Improve Patient Experience

 More Than a Prayer: How Chaplaincy Services Shape and Improve Patient Experience

By John E. Delzell Jr., MD, MSPH, MBA, FAAFP

As physicians and educators, we often talk about the patient experience as if it's only tied to clinical outcomes, nursing care, timely communication, or the cleanliness of the hospital. But a recent study in the Journal of Healthcare Management challenges us to widen that lens. White and colleagues (1) examined a less discussed—yet profoundly impactful—hospital service: the chaplaincy department. Their research poses a simple but powerful question: Does having a chaplaincy department improve hospital patient experience scores? The answer is a strong yes, and the implications are far-reaching for how we think about team-based care and holistic healing.

Study at a Glance

This was a large, multi-year observational study using American Hospital Association (AHA) data and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. The researchers looked at a sample of 1,215 hospitals between 2016 and 2019, using rigorous multivariate regression modeling to adjust for variables like hospital size, ownership, status as a teaching hospital, and patient demographics.

The key variable of interest? Whether a hospital had a chaplaincy department according to their answer on the AHA Annual survey. The dependent variables were from the HCAHPS report in patient experience domains, specifically global hospital rating of 9 or 10 and the percentage of patients who would definitely recommend the hospital. These variables roll up many of the things that patients (and families) care about and include those related to communication, emotional support, and nursing care. These are the types of things patients remember after discharge, even when they forget the name of their antibiotic.

What Did They Find

Hospitals with chaplaincy departments consistently scored higher across the two primary outcome measures. The differences were small but statistically significant. In bivariate analysis, the hospitals who had a chaplaincy department had 1.6% more patients that were likely to give a top box score of a 9 or 10 (t = –5.04, P < 0.001) than those without a chaplaincy department. 3.1% more respondents would definitely recommend a hospital with a chaplaincy department than those without one (t = –8.91, P < 0.001). When the multiple variable regression model was applied, the results were still statistically significant. Hospitals who had a chaplaincy department had 1.5% (standard error [SE] = 0.58, P < 0.05) more patients giving a top box ranking than hospitals without a chaplaincy department. And 2.2% (SE=0.66, P <0.001) more patients that would definitely recommend the hospital.

They also found that chaplaincy presence was associated with a more significant impact in nonprofit and teaching hospitals, where patient acuity and complexity tend to be higher. This nuance adds an important layer to the conversation: chaplaincy services may be especially beneficial in the very environments where patients are most vulnerable.

Why Does It Matter

This study adds quantitative muscle to what many of us have long known anecdotally—that spiritual care is more than a “nice to have” in the hospital setting. It’s part of the fabric of compassionate, patient-centered care. In a former role, I had the privilege of having administrative oversight for our chaplaincy program, the VC &Mary Puckett Center for Spiritual Care (https://www.nghs.com/spiritual-care). The Center includes hospital chaplain services, pastoral care education for chaplain interns and chaplain residents, a live therapeutic music program, and a center for clinical bioethics. A busy and amazing group.  

As someone who has spent years in academic medicine and hospital leadership, I’ve seen how easily chaplains can be overlooked during strategic planning or budget decisions. They often operate in the background, providing emotional and spiritual care, facilitating difficult family conversations, or simply sitting with a patient in silence when nothing else seems to help. But this research tells us that those seemingly quiet contributions reverberate in powerful ways. Chaplains may not prescribe medications or write orders, but their presence has measurable effects on how patients feel about their care. And in a healthcare environment increasingly focused on value-based metrics, that matters.

Implications for Medical Education

One area where I think this research really resonates is in how we prepare students and residents to think about interprofessional care. We train them in evidence-based medicine, population health, and systems-based practice. But how often do we talk about spiritual care as an evidenced-based part of the clinical care team?

This study opens the door to that conversation. If chaplaincy departments contribute to a better patient experience—and therefore better outcomes, clinically and financially—then students and residents should be taught how to collaborate with chaplains just like they learn to work with pharmacists or nurses or case managers. Incorporating chaplain shadowing, discussions of spiritual assessments, and interprofessional simulations into our curricula could make a real difference. It’s not just about preparing future physicians to treat disease—it’s about preparing them to treat people.

Budget vs. Benefit

Of course, none of this comes without cost. Many hospitals, especially smaller, for profit, and rural hospitals, have cut back on “non-essential” services like a chaplaincy department. (2) But this research challenges that decision. If chaplaincy services drive improvements in HCAHPS scores, then investment in these programs may actually support hospital finances through higher reimbursement rates tied to value-based purchasing. Hospital leaders and CFOs may want to reframe how they see chaplaincy—less as a soft service and more as a strategic investment. This is especially true in teaching hospitals, where patients often face extended stays, complex illnesses, and existential crises that stretch beyond the reach of medicine.

A Broader View of Healing

In the end, this study reminds us that healing isn’t confined to the body. The hospital is not just a place of procedures and prescriptions; it’s also a place of fear, hope, grief, and meaning. Chaplains walk with patients through all of that, often in moments when medical interventions have nothing left to offer. So, the next time you see a chaplain walking the halls—or hear their name mentioned during a family meeting—take a moment to recognize the vital role they play. And maybe even ask yourself: Are we doing enough to support this essential part of our care team?

Because healing doesn’t happen in isolation. It happens in community. And chaplains, it turns out, are part of the reason patients feel seen, heard, and cared for.

 

(1) White KB, McClelland LE, Jennings JAC, Karimi S, Fitchett G. The Impact of Chaplaincy Departments on Hospital Patient Experience Scores. Journal of Healthcare Management 2025; 70 (3): 220-234. DOI: 10.1097/JHM-D-24-00143

(2) White KB, Lee SYD, Jennings JAC, Karimi S, Johnson CE, Fitchett G. Provision of chaplaincy services in U.S. hospitals: A strategic conformity perspective. Health Care Management Review 2023: 48 (4): 342-351. DOI: 10.1097/HMR.0000000000000382

Expanding the Pipeline: how do we get more physicians into underserved areas?

 

Expanding the Pipeline: how do we get more physicians into underserved areas?

John E Delzell Jr MD MSPH MBA FAAFP

In the face of ongoing primary‑care workforce shortages, it is important to identify ways to expand the number of physicians who choose practice in health professions shortage areas. This also means that more graduates will need to choose primary care specialties as many rural and underserved communities cannot easily support subspecialty practice. Several recent articles enrich this discussion and illustrate some of the challenges and successes.

Targeted Admissions Strategy

A study by Evans and colleagues (1) from 2020 looked at the medical school admissions process by surveying all 185 US Allopathic and Osteopathic medical schools. Their premise was that there is an inherent social mission of all medical schools to meet the health needs of the public. I am not sure that all medical schools would agree with that statement, but it led to the authors questioning how each school targeted applicants. Specifically, the school’s admission strategy.

The authors had an impressive 72% response rate. Schools were grouped by their targeting strategy-69% used a rural targeting strategy and 67% used an urban-underserved targeting strategy. The strategies used characteristics such as graduation from rural high school, growing up in rural community, growing up in an underserved area, and stated interest in practicing in an underserved area. Interestingly, only 20% of the schools reserved admission slots for students with these characteristics.

Holistic Review for Admissions

Ballejos and colleagues (2) in an article published in 2025 looked at data from a single medical school (the University of New Mexico School of Medicine) over a period of eight years from 2006 to 2013. In this study, the authors looked at all the students matriculating each year and used practice data to identify their post-residency practice location. They were trying to identify objective attributes that might predict in-state practice location. The admissions committee at UNM SOM uses a holistic review to consider objective data (MCAT, GPA), personal attributes (gender, ethnicity), goals (practice plans), and experiences (graduating from rural high school). This is done, at least in part, to assess whether a given applicant is likely to practice in New Mexico and advance the school’s mission.

They performed univariate and multiple regression analyses to compare the graduates. The authors used in-state versus out-of-state practice location identified by NPI number and medical licensure data. They found that only 41.7% of graduates during that time period practiced in New Mexico. Older students and those who graduated from an urban high school were more likely to practice in-state after training. Importantly, most of the variables that they looked at were not significant and the three that were significant only explained 6.4% of the variance.

Not much help to inform the Admissions process.

Admissions impact on Primary Care choice?

Raleigh and colleagues (3) undertook a narrative synthesis to systematically evaluate existing literature on how various medical school admissions practices, including prematriculation programs, are associated with graduates eventually entering primary care specialties. The purpose of their study was to review literature that describes admissions practices and try to determine the impact on the number and percentage of graduates entering primary care. The performed a comprehensive search of English-language peer-reviewed research with outcomes related to primary care choice and identified 34 qualifying articles — mainly single-institution, observational studies. They used narrative synthesis as their evaluation method for two reasons: it allowed them to evaluate and summarize data from a wide variety of methodologies, and it allowed them to provide a narrative description of the identified studies.

The authors found that pre-matriculation programs were consistently associated with higher rates of graduates entering primary care compared to peers. Other predictive factors included self-identified interest in primary care, rural background, and being older at matriculation. They found that not very many schools explicitly prioritize primary care in their admissions criteria. The authors did note that some of the studies looked at primary care in rural environments, and those results were consistent with the overall group of studies.

Raleigh et al. argue that medical schools should consider pre-matriculation programs targeting students already oriented toward primary care. They also emphasize active recruitment of applicants expressing a primary care commitment and call for more rigorous prospective research. These results suggest that structured prematriculation programs can influence specialty choice outcomes, beyond self-selection effects. The program’s design elements — mentorship, academic support, and clear pathways — likely contributed to success.

There are some great programs out there that target students who come from rural and underserved areas, get them into medical school, and then encourage them to pursue practice in underserved areas typically in primary care. Let’s look at a couple of these programs…

University of Missouri—Columbia: Bryant Scholars Pre-Admissions Program

The Bryant Scholars Program (4) guarantees medical school admission to qualified rural students committed to primary care and rural practice. Students must be from Missouri and from a rural county. The program targets rural and under‑resourced applicants, offering tailored support and conditional admission pathways. Students are committed to the MU Rural Scholars Program after matriculation into the medical school.

University of Kansas School of Medicine: Scholars in Health

The Scholars in Health program (5) has two tracks for students interested in underserved practice areas-Rural and Urban. This is an early‑admit conditional acceptance program targeting students who come from rural and underserved backgrounds and intend to return to practice in those areas after graduation. The program offers academic and career mentoring, with guaranteed admission contingent on performance milestones.

Florida State University College of Medicine: Bridge to Clinical Medicine

The Bridge Program (6) is designed to expand the pool of successful medical school applicants who come from rural and urban underserved areas. FSU COM’s Bridge Program is a 12‑month Master’s in Biomedical Sciences for applicants selected from those not initially admitted to FSU COM. Completion with a B or higher and meeting professionalism standards leads to direct consideration for admission.

Common Threads and Best Practices

Across MU’s Bryant Scholars, KU SOM’s Scholars in Health, and FSU COM’s Bridge Program:
1. Targeted recruitment of students from rural and underrepresented backgrounds
2. Conditional admission or master’s bridging with performance thresholds.
3. Integrated academic and clinical exposure.
4. Ongoing mentorship and professionalism assessment.

Prematriculation programs like MU’s Bryant Scholars, KU SOM’s Scholars in Health, and FSU COM’s Bridge Program embody the strategies highlighted in the literature as high impact. They identify likely applicants, reduce barriers, support readiness, foster diversity, and strengthen the rural and underserved practice pipeline. Expanding these models nationally offers a promising route to a more effective, equitable physician workforce.

References

(1)   Evans DV, Jopson AD, Andrilla CA, Longenecker RL, Patterson DG. Targeted Medical School Admissions: A Strategic Process for Meeting Our Social Mission. Fam Med. 2020;52(7):474-482. https://doi.org/10.22454/FamMed.2020.470334.

(2)   Ballejos MP, Riera J, Williams R, Sapién RE. Objective Admissions Data and In-State Practice: What Can We Really Predict? Fam Med. 2025;57(6):435-438. https://doi.org/10.22454/FamMed.2025.503525.

(3)   Raleigh MF, Seehusen DA, Phillips JP, Prunuske J, Morley CP, Polverento ME, Kovar-Gough I, Wendling AL. Influences of Medical School Admissions Practices on Primary Care Career Choice. Fam Med. 2022; 54 (7): 536-541. https://doi.org/10.22454/FamMed.2022.260434. 

(4)   https://medicine.missouri.edu/offices-programs/admissions/bryant-pre-admissions-program

(5)   https://www.kumc.edu/school-of-medicine/academics/premedical-programs/scholars-in-health.html

(6)   https://med.fsu.edu/outreach/masters-bridge-program