Strengthening Simulation Design and Cultural Safe Practice: End-User Evaluation of the Quality Simulation Assurance Framework

Background: Simulation-based learning is a core component of health professional education, yet designing simulations that are culturally responsive, educationally robust, and locally relevant remains challenging. Existing international standards reflect the cultural contexts in which they were developed and provide limited guidance for adapting simulation design for Australia and Aotearoa New Zealand, including effective inclusion of First Nations perspectives. The Quality Simulation Assurance Framework was developed to address this gap and support culturally safe, high-quality simulation design. This study explored two research questions: 1) How do participants evaluate the applicability of the framework, including its relevance and feasibility, to their simulation practice? and 2) How does the framework support users in their design and delivery of quality simulation, including perceived helpfulness, value, and educative impact? Methods: A pilot evaluation was conducted across five tertiary institutions. Twenty-six educators used the framework to benchmark an existing simulation-based learning activity, and four participated in semi-structured interviews. Quantitative data were analysed using descriptive statistics. Qualitative data were examined using reflexive thematic analysis to explore perceptions of applicability and educative value. Results: Participants reported that the framework and supporting materials were broadly applicable to their simulation practice. Most participants rated their experience positively and indicated an intention to use the framework in future design or documentation. Four themes described the framework’s perceived value: usability, promoting best practice, supporting reflection on design, and encouraging consistent learner experience. Although the consultation and co-design element of the framework received the lowest quantitative relevance rating, findings showed this element to be least understood, particularly in relation to cultural safety and First Nations inclusion. Participants suggested improvements such as a brief orientation, video walkthroughs, and an online version with embedded guidance. Limitations included a small sample, incomplete survey responses, and challenges recruiting interview participants. Conclusions: The Quality Simulation Assurance Framework appears feasible, useful, and educative, supporting more consistent and culturally responsive simulation design. Further refinement should focus on strengthening guidance for co-design with First Peoples and enhancing usability. Introduction Simulation-based learning (SBL) is a cornerstone of contemporary healthcare education, offering authentic, experiential opportunities to develop both technical, social and cognitive competencies. Despite its widespread adoption, designing simulation activities that are high-quality, culturally responsive, and pedagogically sound remains a challenge, particularly for novice educators. While the Healthcare Simulation Standards of Best Practice (HSSOBP: 1) and Association for Simulated Practice in Healthcare standards (ASPiH: 2) provide a robust evidence-based guidelines, their development is through a North American, or European (3) sociocultural lens. These standards have not been evaluated for sociocultural appropriateness in regions with different cultural, regulatory, health or education systems, limiting their applicability to the particular social, cultural, political, and economic contexts of Australia and New Zealand, especially in relation to First Nations perspectives.