Wearing Hats and Blending Boundaries as a Simulation Educator

By: Victoria Brazil (@SocraticEM)

As a simulation practitioner, what ‘hat’ do you wear?

Clinician? Educator? And are these identities in conflict or are they blended?

These questions are central to Will Dace’s new model for how we think about our roles in clinical and simulation workspaces. His article Wearing hats and blending boundaries: harmonising professional identities for clinician simulation educators” takes a deep dive into theories of professional identity formation and offers a new way of thinking about making the most of being an educator and a clinician.

But his departure point is practical, drawing on an experience as a facilitator in a medical student simulation exercise. The exercise is a large-scale multiple patient simulation of an emergency department, in which doctors and nurses supervise students participating as ‘interns’. Students assess patients, order investigations, prescribe treatments and refer patients to speciality teams. Driven by strong cues in the physical environment and patient care tasks, he found himself “unconsciously don[ning] his clinician hat”. Instead of teaching about an ECG presented to him from a student, he found himself in ‘work mode’ and asked her to call the interventional cardiologist without delay. Likewise, in an end-of-life discussion with a family member he found himself intervening early to make sure the conversation went well for the family, rather than giving the student full licence to fail (or not). He recognises this as more than simply being immersed in a simulation, but rather engaging in a professional identity shift.

And Dace describes his ‘hat switching’ experience going both ways. When working in the real emergency department, he found himself using an approach learned in simulation debriefing to attempt to calm an intoxicated, behaviourally disturbed patient. Strategies like validation, paraphrasing, normalising and previewing might not be unique to healthcare simulation debriefing, but Dace’s immersion in those topics was drawn from experience there.

Figure from Wearing hats and blending boundaries: harmonising professional identities for clinician simulation educators (1), an open access article distributed under the terms of the Creative Commons CC by license

Dace proposes that more explicitly recognising when we are ‘switching hats’ might make us better clinicians and better educators. He suggests this is more than just changing behaviours, and more than just being fully immersed in simulation, but rather blending the boundaries between our dual (or more) identities. This may create opportunities; using the hats model as a reflection tool, and using frameworks developed for simulation back in clinical practice. Talking about our ‘hats’ might help create clarity for simulation novice learners about their roles in simulation and might encourage a growth mindset when talking about future clinician identities.

The article offers a theoretical deep dive with a practical application and will likely prompt reflection on how best to harmonise our professional identities. What hats do you wear? When do you change them? How do they fit?


Dace W, E Purdy and V Brazil. Wearing hats and blending boundaries: harmonising professional identities for clinician simulation educators. Adv Simul. 2022; 7 (35)

Image: Instagram: Captain Scratchy

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