When we think of simulation and gaming, one thing triggered in the minds of many educators may be the thought of how it can and has been used as a tool for educating segments of the population. From a research standpoint, these segments are sometimes united and expand in the form of multi-site studies with large sample sizes that help us justify what we do (or not). It is of little surprise that we have witnessed an increase in the use of gaming and simulation-based education across multiple professions. At Simulation & Gaming, our editorial team is proud of the fact that for 50 years we have produced several issues that unite communities and professions (Harviainen, 2018). We welcome research that highlights the growth that is occurring across the professions so we can learn more about our unique positions in our multidisciplinary community of simulationists. In part, I hope that this editorial serves as a call for research exploring the amount of growth that is occurring in each profession. We know that the use of simulation is reaching deep into several professions and that the healthcare community has likely seen the greatest expansion over the past 15-20 years. Games and simulations can be used to address concepts and skills including immunizations, stroke management, and patient handoff, but may also be used to learn about root-cause analysis and how errors occur (Aebersold, 2018). It has been integrated in undergraduate nursing courses to improve knowledge and care in such subjects as mental health, basic anatomy, end-of-life care and communication (Aebersold, 2018). We can find evidence in the literature that these same areas and many more are being addressed by the use of simulation-based education in multiple healthcare professions. However, it appears that research in many cases is still isolated to the first two levels of Kirkpatrick's (1994) educational outcomes (Table 1). That is not to say that the third and fourth levels are not being achieved by some simulationists. I suspect that educators are reaching the higher levels, but too often, research protocols are limited to studying knowledge acquisition. We need more research results that depict those observed changes in behavior to study whether or not learners are transferring the knowledge, skills, and procedures to practice in their own settings. Just reflect for example on the areas noted above affected by simulationbased education in undergraduate nursing education. Nurses are responsible for the full care of their patients from basic care to end of life procedures and everything in 870930S AGXXX10.