The revised IMT curriculum has a clear mandate: simulation, including human factors, is now required at every stage from IMT1 to IMT7. As enthusiastic advocates for simulation-based learning, we saw both an opportunity and a risk. The opportunity was to create meaningful, high-quality training; the risk was that simulation could become just another tick-box exercise to meet curriculum hours, rather than something of real value to learners.

Many trusts, including ours, were already struggling to provide meaningful postgraduate simulation. Resources such as physical space, technical expertise and faculty time were stretched thin between undergraduate and postgraduate programmes. Our goal was to deliver a simulation that not only met curriculum objectives but was also free to learners and genuinely useful for their development.

Getting started: from idea to action

We’d seen colleagues pour energy into simulation teaching days, only for those projects to fade when individuals moved on. Sustainability is tough, but maintaining quality and consistency is even harder, especially since debriefing skills are as important as clinical knowledge.

In summer 2022, a wider group of us ran our first simulation day for IMT2s about to step up as IMT3 registrars. The group designed six scenarios to reflect the real challenges of the medical registrar role, focusing on both clinical complexity and the communication and non-technical skills required. When we repeated the course in 2023, we faced a new challenge: most of the original team had moved on. That’s when we realised, we needed a plan for sustainability and consistency if we wanted to expand across the region.

How we built GIM-Sim

We set out to create a series of simulation courses, eventually called GIM-Sim, that would be educationally valuable, not just a tick-box for the annual review of competency progression (ARCP). We structured the courses to encourage learners to return as faculty, and we designed scenarios around human factors first, then mapped them to clinical curriculum topics. Each course targeted a different phase of training and key transition points, so the series as a whole would cover a broad curriculum. Scenario allocation and debriefs were learner-focused, ensuring that individual learning needs were met.

We took a slow, deliberate approach, prioritising quality and sustainability over rapid expansion. We piloted one course a year, only moving beyond a single trust once we had a strong base of recurring faculty. Each course took 4–6 months from planning to delivery, and we aimed for eight scenarios per course, covering different parts of the IM curriculum and avoiding repetition. Human factors were deliberately varied in type and complexity. We integrated feedback from each course into the next.

What went well

Over the past 3 years, we’ve gradually expanded. We now run three complete courses:

• GIM-Sim:1 for new IMT1 doctors
• GIM-Sim:2 for IMT2s preparing to become registrars
• GIM-Sim:3 for ST4/5 doctors.

The courses are structured so that learners can progress through them without curriculum overlap. As seniority increases, the emphasis shifts from clinical challenges to human factors.

Before piloting the third course, we noticed that observers often felt lost at the start of debriefs, asking for clarity about results or patient documentation. To address this, we developed an electronic patient record called Sim Desk, introduced in 2025. This allows learners to review results and radiology as needed, with a responsive interface for mobile devices so observers can follow along or even get ahead during scenarios.

By September 2025, we’ll have delivered 12 courses across two trusts, with 77 learners and 11 returning as faculty. Feedback has been overwhelmingly positive; learners value the realistic scenarios, the learner-centred design and the integration of human factors. To date, 100% of attendees would recommend the courses to colleagues.

Challenges and lessons learned

Expansion has been slow. Building faculty, contacts and courses takes time, especially when most of the development happens alongside clinical work and training, rather than in dedicated teaching fellow posts. Simulation resources are limited, and early on, just booking space and securing technician support required persistence and adaptability. Now that the series is established, we have better access to resources and are networking with neighbouring trusts for further expansion.

Funding remains a significant challenge. All our courses have been free to learners within the holding trust, but for sustainability, we need to define the true costs and address funding, something we probably should have tackled earlier.

Key lessons

• Reputation and relationships matter: Working with local simulation teams, medical education teams, and college tutors was key to booking and advertising each course
• Start small, build slow: Our scenarios have been repeatedly reviewed, refined and re-written based on feedback and experience
• Invest in people: Medical education often depends on goodwill, so we’ve expanded our faculty carefully, sharing responsibility and gradually spreading delivery across multiple sites
• Beyond medical expertise: Developing GIM-Sim has required input from multiple specialties. Faculty need strong simulation skills, debriefing and technical expertise are as important as clinical knowledge.

Looking ahead

We are expanding our series. In 2026, we expect to release GIM-Sim:4, a day aimed at ST6/7 registrars acting in the role of consultant. We’re also working to expand to more trusts in our region and, in time, beyond. The ACT network was vital in our first expansion, providing the contacts and enthusiasm to bring the course to a second site. The support of our college tutor has also been key, advocating for the value of GIM-Sim to both learners and faculty.

Expansion hasn’t been straightforward. Most of the development has been done in our own time, and balancing clinical training, career progression and wellbeing is difficult without dedicated time for education.

‘If we could change one thing about postgraduate medical education, we’d create the equivalent of the Academic Clinical Fellowship (ACF) for education. Research trainees can combine clinical and academic training without compromise; educators could benefit from the same opportunity.’