Coloniality in Simulation-Based Medical Education.

Area of Science:

• Medical Education
• Global Health Equity
• Postcolonial Studies

Background:

• Simulation-based medical education (SBME) is widely adopted globally.
• SBME diffusion into low- and middle-income countries (LMICs) often involves uncritical transfer from high-income country (HIC) contexts.
• Coloniality, the legacy of colonial power structures, influences SBME in LMICs.

Purpose of the Study:

• To examine how coloniality shapes SBME in LMICs across design, execution, and evaluation phases.
• To highlight the inequities perpetuated by uncritical adoption of HIC SBME models.
• To advocate for decolonizing SBME through culturally relevant and locally grounded approaches.

Main Methods:

• Viewpoint analysis drawing on author's experiences in Sri Lanka and the UK.
• Exploration of colonial assumptions in SBME planning, execution, and evaluation.
• Critical examination of imported educational theories, language use, equipment design, and evaluation metrics.

Main Results:

• Imported SBME models neglect local learning cultures and social hierarchies, causing pedagogical dissonance.
• Use of colonial languages and Western-centric equipment creates artificial learning encounters and limits psychological safety.
• HIC-derived evaluation metrics marginalize Indigenous perspectives, reinforcing epistemic dependency and inequities.

Conclusions:

• Decolonizing SBME necessitates awareness, reflection, and redesign, including multilingual instruction and co-creation of scenarios.
• Reframing simulation as a relational, culturally situated practice promotes authentic and equitable learning.
• Recognizing and addressing colonial legacies in SBME is crucial for enhancing patient safety and learning outcomes globally.