Strategies for overcoming challenges in implementing simulation in medical education: A qualitative leadership perspective

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Abstract
Implementing simulation-based education in medical curricula presents distinct challenges, especially for educators newly assuming leadership roles. This study aimed to explore the lived experiences of medical educators who are simulation center leaders to understand the nature of the challenges they encountered and to offer strategic insights for other leaders navigating similar transitions. A qualitative, phenomenological research design was employed. Data were collected from 4 simulation leaders through semi-structured interviews, reflective writings, and institutional documents. Interpretative phenomenological analysis was used to explore how participants made sense of their experiences. An external qualitative expert contributed to the coding and analysis process to ensure trustworthiness. Three major themes emerged: First, the role of the medical educator as a leader: participants reported shifting from being content experts to reflective leaders, emphasizing strategic vision, emotional intelligence, and educational theory. Second, team spirit: the presence of a dedicated team and shared moral purpose supported resilience and collaboration. Communication strategies and informal advocacy strengthened engagement. Third, understanding the challenges: faculty resistance, institutional inertia, and limited resources were viewed through an empathetic lens. Participants addressed resistance via faculty development, research collaboration, and ongoing feedback mechanisms. Finally, institutional support and leadership alignment: administrative support was pivotal in legitimizing efforts and sustaining initiatives. Leadership continuity, policy alignment, and access to decision-making platforms shaped the success of simulation integration. Leadership in health professions education, particularly in simulation-based implementation, requires more than subject expertise; it demands emotional resilience, strategic communication, and relationship-building. Findings suggest that simulation-based change requires not only technical knowledge but also adaptive leadership grounded in context and collaboration. Leaders navigated resistance not as defiance, but as a sign of systemic gaps in understanding and preparation. The study emphasizes the importance of aligning simulation efforts with institutional structures and culture to achieve lasting transformation in medical education.

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