Simulated practice-based learning: Creating the opportunity for the profession to learn

Simulation is a learning modality that supports development through experiential learning by replicating real-life situations. It provides a safe environment where participants can learn from mistakes, enabling individuals to analyse and respond to realistic scenarios, with the aim of developing or enhancing skills and behaviours (Hawker et al., 2022). Simulation has been integrated into curricula globally to support learning across diverse contexts, including interprofessional education (Diaz-Navarro et al., 2024).

Within pre-registration occupational therapy (OT) education, simulation has become both established and valued. It is well received by learners and is commonly used to support preparation for practice-based learning (also referred to as placement). Simulation represents one modality that can contribute to practice-based learning and the evidence underpinning its use is still evolving.

In Spring 2026, the Royal College of Occupational Therapist’s (RCOT) Learning and Development Standards for Pre-Registration Education: Revised 2026 (‘the Standards’; Royal College of Occupational Therapists [RCOT], 2026) came into force. A change within the revised Standards is the opportunity for up to 20% (around 200 hours) of the minimum 1000 practice-based learning hours to be delivered via simulation, representing an increase from the previous maximum of 40 hours (RCOT, 2019). This editorial considers the opportunities and challenges this change presents for the profession. It aims to prompt professional dialogue and reassure stakeholders that simulation is not a compromise, but a strategic enhancement, one that must be grounded in authenticity and clearly defined learning outcomes.

As we look to the future of OT pre-registration education and practice, it is time to embrace the use of simulation as a medium for practice-based learning. The literature lacks any agreed definition, so through the process of the Standards review the following definition has been adopted: ‘Simulated practice-based learning is the purposeful and authentic use of simulation, designed, delivered and assessed to meet the defined learning outcomes of a practice-based learning module’ (RCOT, 2026).

While simulation is accepted as a teaching modality within pre-registration OT education, implemented in a wide range of ways, its role within practice-based learning remains unclear. Following Imms et al.’s (2018) groundbreaking randomised controlled trial, which demonstrated that students could achieve equal learning outcomes in a simulated placement to a traditional placement experience, RCOT (2019) introduced that up to 40 hours of simulation that could be counted towards the mandated minimum of 1000 placement hours (World Federation of Occupational Therapists, 2026). This was met with a mixed response, with some wary of any simulation at all and others arguing that the permitted number of hours was insufficient – but no other research existed, then or now, to support a different number of hours.

The updated Standards enable programmes to use simulation to deliver up to 20% of practice-based learning hours (approximately 200 hours), aligning the United Kingdom with Australia, where Imms et al.’s (2018) research took place, and New Zealand. With this change, OT sits between nursing and midwifery, which permit up to 26% simulated placement learning hours, and many allied health and social care professions where allowances remain smaller or more flexible. In the 8 years since that research, the evidence base for simulated placements has not significantly changed, but the world has and so has RCOT. We need to embrace being bold leaders of our profession and create safe, well-defined opportunities for innovation and learning.

It is clear within the revised Standards that there is no requirement to use any of the available hours for simulated practice-based learning. For programmes that can meet the definition outlined in the Standards, then a simulated placement experience is one of the options available to ensure that a breadth of experiences are undertaken.

Success will be measured, and ideally researched, through the design of the placement. The risk that universities may seek to label all simulation as placement-replacement, thus reducing the range of opportunities afforded to our learners has been heeded, and the Standards are clear about the intention and authentic design of the placement, assessed by defined learning outcomes. We are advocating for practice-based learning delivered via simulation, not a series of simulation experiences labelled as practice-based learning. A scoping review by Grant et al. (2021) emphasises that educators should take care to align the simulated placement constructively with intended learning outcomes, a point particularly relevant when focusing on professional competencies.

With increasing numbers of education providers offering OT pre-registration courses, we have a challenge in securing sufficient placement opportunities. Where there are concerns about the use of simulation, OTs should use their significant innovation, creative problem-solving, and research skills to fully understand the learning achieved through simulation, and to create more quality practice-based learning opportunities with local employers. Like any practice-based learning, simulated placements must be authentic and outcome-driven. The move to permit 20% of hours to be simulated is not a strategy to manage shortages. Instead, it offers a safe, structured environment where learners can engage meaningfully with complex scenarios, develop clinical reasoning, and build confidence as part of their overall placement profile.

The evidence remains limited, but in the years since the 40 hours were introduced, researchers have challenged how to create the evidence if we do not provide the safe environment and authentic opportunities to conduct the research? We already know that simulation offers a safe, structured environment for skill development. Could it be possible that this makes it an ideal first placement experience, in turn both preparing learners more effectively for their first real-world placement and reducing the burden on practice educators?

Grant et al. (2021) and recent global guidance (Sangster Jokić et al., 2025) provide practical tools for implementing simulation effectively, while also highlighting the diversity of simulation used within the United Kingdom, distinguishing between interactive and non-interactive forms. The tools to enable us to build suitable, sustainable, simulated practice-based learning are developing at pace.

OT must embrace new ways of working while ensuring graduates are fit for practice. By increasing the allowance for simulated practice-based learning hours and providing clear guidance, we empower education providers to design authentic, outcomes-driven experiences. We also create the conditions necessary to build the evidence base that will reassure stakeholders and support innovation.

Let us lead the profession shaping the future of practice-based learning: creating opportunities that are flexible, digitally confident, evidence-driven and responsive to the evolving needs of learners, placement providers, employers and the people who use our services. Together we have a unique opportunity to strengthen education and research, ensuring our profession remains innovative, relevant and ready for the opportunities ahead.