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Over the past two decades, there has been an exponential and enthusiastic adoption of simulation in healthcare education internationally. Medicine has learned much from professions that have established programs in simulation for training, such as aviation, the military and space exploration. Increased demands on training hours, limited patient encounters, and a focus on patient safety have led to a new paradigm of education in healthcare that increasingly involves technology and innovative ways to provide a standardized curriculum. A robust body of literature is growing, seeking to answer the question of how best to use simulation in healthcare education. Building on the groundwork of the Best Evidence in Medical Education (BEME) Guide on the features of simulators that lead to effective learning, this current Guide provides practical guidance to aid educators in effectively using simulation for training. It is a selective review to describe best practices and illustrative case studies. This Guide is the second part of a two-part AMEE Guide on simulation in healthcare education. The first Guide focuses on building a simulation program, and discusses more operational topics such as types of simulators, simulation center structure and set-up, fidelity management, and scenario engineering, as well as faculty preparation. This Guide will focus on the educational principles that lead to effective learning, and include topics such as feedback and debriefing, deliberate practice, and curriculum integration – all central to simulation efficacy. The important subjects of mastery learning, range of difficulty, capturing clinical variation, and individualized learning are also examined. Finally, we discuss approaches to team training and suggest future directions. Each section follows a framework of background and definition, its importance to effective use of simulation, practical points with examples, and challenges generally encountered. Simulation-based healthcare education has great potential for use throughout the healthcare education continuum, from undergraduate to continuing education. It can also be used to train a variety of healthcare providers in different disciplines from novices to experts. This Guide aims to equip healthcare educators with the tools to use this learning modality to its full capability. Introduction and background A confluence of recent events has led to increased growth in the use of clinical simulation across the healthcare education continuum. These factors include an increased focus on patient safety, the call for a new training model not based solely on apprenticeship, a desire for standardized educational opportunities that are available on-demand, and a need to practice and hone skills in a controlled environment. In addition, the benefits of clinical simulation are increasingly reported in the literature, adding further validity to its use in healthcare education (Issenberg et al. 2005; McGaghie et al. 2010a). The effectiveness of simulation, like all educational modalities, depends on how well it is used. Simulation should be utilized as an adjunct to patient care experiences, and its integration into the curriculum should be well-planned and outcome driven. Purpose/Guide overview This Guide is meant to be a practical handbook for educators about the effective use of simulation for healthcare education. The goal is to discuss, in an evidence-based manner, the Practice points . Simulation is increasingly being used in healthcare education to teach cognitive, psychomotor, and affective skills to individuals and teams. . It is important to first determine the outcomes of using simulation and utilize these to guide its integration into the curriculum. . Feedback is critical to effective learning using simulation, and should be guided by individual learning needs. . Simulation allows for training in a controlled environment, with opportunities for deliberate practice and assessment. . Simulation-based mastery learning, or SBML, significantly improves skills for all participants, and also leads to skill retention. . Further research is needed in the areas of instructional design, outcomes measurement, and translational and implementation sciences in the context of simulation. Correspondence: Dr Ivette Motola, University of Miami Miller School of Medicine, Michael S. Gordon Center for Research in Medical Education, 1120 N.W. 14th Street, Miami, FL 33136, USA. Tel: 305-243-6491; fax: 305-243-6832; email: [email protected] ISSN 0142–159X print/ISSN 1466–187X online/13/101511–2