From leadership research to district action: Developing a faculty simulation-based education strategy: a Delphi study to build consensus and aid decision making

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Background Simulation-based education (SBE) improves learner competence, patient safety and workforce readiness. Yet, existing frameworks such as INACSL and ASPiH provide limited guidance on developing sustainable, institution-wide strategies, particularly in decentralised, multidisciplinary contexts. This study aimed to create a faculty-wide SBE strategy using the e-Delphi method to build consensus among diverse stakeholders. Method The study was conducted at a UK higher education institution without a centralised simulation centre. An e-Delphi process was used to refine strategic statements across three survey rounds. Panellists were purposively sampled and included internal and external academics, postgraduate and undergraduate students, and international contributors from 7 countries and 15 healthcare-related professions. Initial statements were derived from established SBE frameworks and refined based on quantitative agreement (≥ 80% consensus) and thematic analysis of free-text feedback. Result Of 111 invited participants, 41 completed Round 1, increasing to 43 in Rounds 2 and 3. The process produced 39 final strategic statements grouped under eight strategic priorities: (1) Leadership and governance; (2) Communication and networking; (3) Training and development; (4) Standards and quality assurance; (5) Research and evaluation; (6) Accessibility; (7) Preparation and planning; and (8) Finance. These priorities map to three overarching themes—Connectivity, collaboration and partnership; Promoting quality; and Stability, sustainability and growth of SBE. The strategy embeds SBE into institutional processes, aligning it with budgeting, infrastructure planning, workforce development, and digital transformation. It emphasises multi-level governance, sustainability planning, technology integration and inclusivity through student patient and public involvement and engagement (PPIE) representation. Conclusion The e-Delphi method effectively built consensus on a comprehensive SBE strategy tailored to a decentralised, multidisciplinary faculty. The strategy goes beyond existing frameworks by integrating sustainability, multi-level governance, and structured technology planning, while embedding student and PPIE perspectives. It offers a scalable, replicable model for institutions seeking to align simulation provision with strategic priorities, accreditation standards and equitable access. Future research should examine the strategy’s impact on educational outcomes, workforce readiness and its adaptability across disciplines and institutional contexts.

Study methods

The E-Delphi method, an evolution of the traditional Delphi technique developed by Dalkey and Helmer [24], is widely adopted in health and educational research to enhance decision-making by achieving consensus on healthcare standards and strategic initiatives [22, 25, 26]. E-Delphi offers a more cost-effective and efficient alternative, allowing participants to contribute from any location and at any time [20]. E-Delphi follows the Delphi principles of anonymity, controlled feedback, iterative rounds and statistical aggregation, ensuring consensus while minimising social pressures [21]. The study adhered to the DELPHISTAR guidelines for reporting [27], reinforcing transparency, credibility and reproducibility in the Delphi process. By using at least two iterative rounds, anonymity and equal participant status is maintained, preventing dominant voices from influencing outcomes [19, 28, 29]. Ultimately, the E-Delphi method enhances the validity and quality of consensus-driven research, contributing to best practices in healthcare and education.

Limitations

The panel was disproportionately composed of medicine and nursing participants, with relatively low numbers from disciplines such as audiology, social work and dentistry. While no evidence suggests that equal representation across professions improves outcomes and no maximum panel size has been defined [18, 26], some professions were underrepresented, potentially limiting the breadth of perspectives. This study brought together a large number of diverse panel from 7 countries and a broad spectrum of 15 disciplines from diverse professional backgrounds enriched the study, providing a comprehensive range of perspectives essential for developing a robust, equitable and inclusive education strategy which fosters reliability and dependability by including a large group of a wide range and a representative sample [26, 49]. This imbalance may have weighted judgements toward dominant professions and reduced discipline-specific nuance [18, 26]. Response rates declined in rounds 2 and 3, falling below the pre-specified 70% target. Reminder emails were issued to improve retention; nevertheless, attrition, typical in Delphi studies [51, 52], may have narrowed perspectives in later rounds. Non-responders were distributed across professions rather than clustered within a single discipline, reducing the risk of systematic bias influencing consensus outcomes [20]. Importantly, consensus thresholds (≥ 80%) were achieved, supporting the stability of the final statements despite lower participation. Finally, although conducted within a single institution, organisational differences (structure, culture, resources) may affect direct applicability elsewhere. However, contributions from 7 countries and 15 disciplines support transferability to comparable settings [18, 26].

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one school improvement question with teachers. Protect a short shared planning cycle, agree an instructional change and use a common rubric for examining student work. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Review implementation fidelity, teacher time and independently scored student work against a recorded baseline. Examine access differences and competing explanations before attributing changes to leadership. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Nebras Alghanaim; Samantha Rogers; Jo Hart; Gabrielle Finn. Developing a faculty simulation-based education strategy: a Delphi study to build consensus and aid decision making. Advances in Simulation (2025-12-09). https://doi.org/10.1186/s41077-025-00393-9

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.