A conceptual three-level framework is presented for understanding the aims, scope and potential outcomes of simulation in healthcare contexts. At the first level, micro-simulation aims at honing basic technical skills of individual clinicians. At the second level, meso-simulation aims to train clinicians to work more effectively and efficiently as part of a clinical team. At the third level, macro-simulation aims to assess organisational fitness for purpose at large scale. We discuss HOSPEX as an exemplar macro-simulation and argue for needs- and evidence-based implementation of simulation-based training at micro, meso and macro levels.
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