“…Despite significant advances in educational simulation, the scientific simulation community has been slow to produce evidence for why practitioners appear to be reserved in selecting simulation as a CPD activity. While some have discussed how simulation has been underutilized in CPD [20, 21], the focus in the simulation community remains largely at the level of utility and educational mechanisms. These have included, for example, the effects of developmental strategies [22, 23], comparing effectiveness of simulation designs [24], promoting effective simulations [25–29], links to maintenance of certification [30, 31], consideration of simulation to assess performance or gaps [32], improving quality of systems of care [33, 34], clinician perspectives on changes to knowledge skills and attitudes [33, 35], and simulation uses in CPD [36, 37].…”