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In artistic fields, like graphic design and architecture, designers often experience tension between highlighting a product’s appearance (form) and creating a product that meets the intended purpose (function). Traditionally, simulation educators and champions have valued form: the expensive “high-fidelity” manikin or standardized patient is discussed more often than the “low-fidelity” task trainer. That preoccupation has jeopardized and de-emphasized the importance of the functions (i.e., educational objectives) the simulation is supposed to address [1–3]. With the availability today of a vast array of simulation techniques and innovations, there is clearly an obligation to use simulation resources wisely and to develop an evidence-base that meaningfully connects simulation form (i.e., simulator, simulation actors/confederates, simulation technique, and location) and simulation function (e.g., for education, for assessment, for evaluating systems). As an analogy, high-quality research arises first from a focused research question and second from methods chosen to best answer that question. Similarly, we suggest a simulation session must begin with a clear statement of the session’s objective, which ultimately dictates the session’s form. We believe this principle applies to any form of simulation, be it a task trainer in the simulation center or a large-scale multi-disciplinary team-based event in the clinical environment. Considering the latter, while our community has made strides in de-emphasizing “fidelity” and is focusing on educational objectives in the simulation center, we wonder if the same thinking applies when conducting simulations in the workplace, commonly referred to as in situ simulation (ISS). A recent paper proposes shifting away from typical simulation descriptors (e.g., high-fidelity) to using a more applicable term, translational simulation, to highlight the importance of a functional connection with healthcare priorities and patient outcomes [4]. We agree with Posner et al. [5] that the hallmark of ISS is that it enables the study of “how the clinical environment responds in its natural state, including the personnel, equipment, and systems responsible for care in that environment.” Observing team members in their typical role using their actual equipment and following their processes likely supports a systems-thinking approach not entirely realized with simulation at off-site centers [6]. Numerous studies support applying ISS to identify latent safety threats (LSTs) [7], to test newly designed clinical environments [8], and to teach and practice communication and teamwork skills [9]. Educators often use ISS as a crash test for personnel, equipment, and systems, offering important insights into patient safety threats and potential mitigation strategies. Here, the function is to improve patient safety, and the form making it possible is ISS. Despite this potential, however, the literature still lacks evidence to help educators and administrators decide which forms of ISS to implement and which functions ISS best serves [10]. As we strive to support healthcare professionals in continuous, lifelong learning, we need evidence to clarify which simulation environment allows us to achieve our specific objectives effectively and efficiently. In producing that evidence, we discourage comparing ISS to a center-based simulation, as the two represent different * Correspondence: ryan.brydges@utoronto.ca Department of Medicine, University of Toronto, Toronto, ON, Canada Allan Waters Family Simulation Centre, St. Michael’s Hospital, Toronto, Canada Full list of author information is available at the end of the article

Adapting form to function: can simulation serve our healthcare system and educational needs?