Professional integrity is demonstrated and upheld by all involved in simulation-based experiences. Background Professional integrity refers to the ethical behaviors and conduct that are expected of all involved throughout simulation-based experiences. Professional integrity is a person's internal system of principles encompassing a number of additional interrelated attributes such as confidentiality, compassion, honesty, commitment, collaboration, mutual respect, and engagement in the learning process. 1-4 Professional integrity is doing what is right in the face of strong countervailing temptation or pressure and regardless of who is or is not watching and continues indefinitely even after the conclusion of the simulation-based experience. 5 Despite one's role in a simulation-based experience, whether as a participant, facilitator, debriefer, faculty, operator, or other role, all involved with the simulationbased experience are responsible for acting with professional integrity and developing self-awareness of how one's personal and professional behavior affects those around him or her. 3 All involved in the simulation-based experience need to discuss the attributes of professional integrity especially that of confidentiality. The level or degree of confidentiality is dependent on the policy established by the institution. Organizations must have established methods of sharing student performances. 6,7 There may be a duty to report inappropriate behaviors dictated by legal, ethical, and/or institutional regulations. 8,9 Everyone becomes vulnerable to a certain extent when they are placed within a simulation-based experience; it is therefore imperative that an unequal power balance be recognized and professional boundaries maintained so the knowledge obtained from the simulation learning outcomes are not compromised. 10 Boundary crossings may be inadvertent, thoughtless, or purposeful but these judgments can affect grades, relationships, jobs, positions, and careers.