By: Victoria Brazil (@SocraticEM)
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“How often do we consider the environmental impact of our simulation sessions?”
That quiet but pointed question opens Mitchell et al.’s recent article in Advances in Simulation, and it sets the tone for a paper that’s aiming to move simulation educators beyond business-as-usual — not with guilt, but with tools.
The article, Simulation-based education and sustainability: creating a bridge to action, takes on a timely and underexplored tension in health professions education: how to reconcile the environmental cost of simulation with its pedagogical value. The authors highlight what many of us have intuited but not often interrogated — that SBE is not a carbon-neutral enterprise. Energy-hungry equipment, single-use materials, and participant travel all contribute to the environmental footprint of our educational efforts.
Framing the Problem
The authors position simulation not as a villain, but as a paradox. SBE improves healthcare outcomes — potentially saving lives — but does so at a material and environmental cost. In the context of the broader healthcare sector’s 4.4% contribution to global greenhouse gas emissions, they argue simulation deserves its own critical reflection.
The paper is structured around a dual imperative: reduce the environmental impact of SBE itself, and leverage SBE as a platform for teaching and modelling sustainability in healthcare more broadly. It’s an ambitious brief, and one that aligns with current planetary health discourse and calls from bodies like AMEE and ASPiH.
The Toolkit: Pragmatism Over Polemic
The heart of the paper is its two-part toolkit. Part 1 deals with sustainable delivery – practical steps to reduce emissions through changes in energy use, materials, and waste. There’s a useful worked example of reducing cannula and glove use in routine scenarios, framed through the 9R model (Refuse, Reduce, Reuse, etc.). The authors clearly did their homework here, drawing on frameworks like ISO 14001 and NHS data to anchor their recommendations.
But while the suggestions are sensible and achievable, there’s a risk of underplaying the complexities. For instance, the idea of leaving a cannula in situ to reduce waste is a logical step environmentally, but it sidesteps potential pedagogical trade-offs. There are inevitable tensions between fidelity, safety, and sustainability. That said, this conversation reinforces the longstanding principle of rigorous reflection on alignment of our simulation design and modality choices with our objectives and within our constraints (now including our environmental footprint).
Toolkit Part 2 shifts gears – using simulation to promote sustainability as a learning outcome. This is where the article makes a more novel contribution. The examples — such as embedding environmental trade-offs into clinical decision-making scenarios — offer a compelling way to integrate planetary health into mainstream curricula. This approach could help normalise sustainability as part of clinical reasoning, not a separate ethical add-on. Whether these simulation scenarios shift behaviour in practice, or how we evaluate whether sustainability-focused scenarios are achieving both their clinical and environmental aims is future work to be done.
Between Idealism and Implementation
Mitchell et al. are not the first to call for environmental awareness in health professions education, but they are among the few to articulate what that means for simulation, specifically. This is one of the paper’s key strengths: it moves beyond rhetoric and into operational territory. The toolkit is detailed, grounded, and broadly applicable — especially valuable for programs that want to act but aren’t sure where to start.
The paper occasionally leans toward idealism. The authors argue that simulation centres can meaningfully reduce their carbon footprint through modest changes — but the data to support the scale of impact is limited. Moreover, the article assumes a degree of institutional autonomy that may not exist everywhere. Implementing the ISO 14001 framework or redesigning curriculum objectives around sustainability requires leadership buy-in, not just faculty enthusiasm.
So, does it advance our conversation and practice?
Yes — especially if you work in simulation and have ever asked (or ignored) the question: “What’s the environmental cost of this?” The article is a valuable starting point. It doesn’t have all the answers, and in some places it smooths over complexity. But it does exactly what a good simulation should do: it creates a safe space to test ideas, reflect on values, and ask difficult questions.
Our (collective) challenge now lies in local adaptation. Can we take this framework and tailor it to our context? What are the meaningful (and measurable) changes we can make without compromising educational integrity? How do we evaluate impact beyond emissions — on learning, on systems, on culture?
Thank you to the author team for this great work and encouraging our conversations about sustainability in SBE. (also reviewed on the Simulcast podcast here if audio is more your style)
Happy reading!
vb
References
- Mitchell, K., Canham, R., Hughes, K. et al. Simulation-based education and sustainability: creating a bridge to action. Adv Simul 10, 27 (2025).
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