On simulation, artificial intelligence, and the spirit of the Shokunin

The healthcare simulation community has rapidly embraced artificial intelligence (AI) and large language models (LLMs) for scenario design, delivery, and debriefing. While discussions have largely centred on efficiency and academic integrity, less attention has been paid to the philosophical and humanistic costs of this integration. This commentary explores the potential erosion of identity, expertise, and craftsmanship within simulation as cognitive labour is increasingly outsourced to machines.

Drawing on the Japanese concept of the Shokunin-the devoted artisan in lifelong pursuit of mastery-the commentary contrasts the Western drive for efficiency with the intrinsic value of patient diligence and deliberate practice. Using the life and reflections of artist Katsushika Hokusai as a metaphor for the simulationist's path, the author argues that expertise is cultivated through repetition, reflection and time-qualities at risk when AI automates creative and cognitive processes. The concept of cognitive debt is introduced to describe the deferred mental cost of repeated reliance on AI, including diminished critical inquiry and weakened creative ownership. To preserve the spirit of the Shokunin, three guiding principles are proposed: (1) Know the grain of your wood before you carve-protect formative manual and reflective work early in one's career; (2) Paint first with your own brush-prioritise original human creation before seeking AI feedback; and (3) Strive for personal growth-maintain curiosity and continuous growth as enduring antidotes to automation's complacency. These principles urge simulationists to use AI as a supportive partner, not a surrogate for expertise.

AI will undoubtedly enhance simulation's technical capabilities, yet it also challenges our professional identity. To sustain meaning and mastery, simulation educators must intentionally preserve spaces for imperfection, repetition, and human creativity. The spirit of the Shokunin-humble, diligent, and ever-striving-offers a moral compass for navigating the evolving partnership between simulation and artificial intelligence.