The Østergaard Declaration

Introduction: From Evidence to Action Simulation-based education and training (SBET) is now an essential component in anaesthesiology, intensive care, peri-operative medicine and team-based clinical practice. It enables clinicians to apply knowledge, refine procedural and social and cognitive skills, think critically, act decisively, communicate effectively and respond appropriately under pressure.1,2 Beyond individual competence, SBET strengthens team dynamics, exposes systems vulnerabilities and enhances patient safety in high-stakes environments.3-5 Despite compelling evidence, major policy reports and professional consensus,6,7 SBET remains inconsistently implemented, unevenly funded and frequently regarded as ancillary rather than integral to training. This contradiction lies at the centre of the current challenge. The question is no longer whether simulation is effective, but why healthcare and education systems have yet to integrate it systematically into routine training and clinical practice. The European Society of Anaesthesiology and Intensive Care (ESAIC) asserts that the time has come to move beyond advocacy and pilot initiatives. SBET must now be formally recognised, governed and funded as core education and healthcare infrastructure. Rationale: Why this Declaration? Why now? ESAIC has demonstrated sustained commitment to advancing SBET across Europe. The Simulation Subcommittee, which evolved from the Simulation Task Force established in 2017, has played a central role in promoting simulation through initiatives such as the Simulation Lab at Euroanaesthesia and the development of a pan-European community of simulation educators. Surveys conducted by ESAIC consistently demonstrate strong support for SBET among both trainees and educators. However, they also reveal substantial variability in access, curricular integration, faculty support and protected time across countries and institutions.8,9 Substantial progress has been achieved over the past years. In 2024, ESAIC, in collaboration with the Society for Simulation in Europe (SESAM), published a European curriculum for SBET10 providing a unified framework for specialist training in anaesthesiology across Europe and representing an important step towards harmonising educational standards. Furthermore, ESAIC-supported national initiatives have demonstrated that coordinated governance, faculty development and curricular integration can foster scalable, sustainable training programmes.11 However, these achievements also underscore the limitations of incremental change and emphasise the critical role of ESAIC.12 Such examples remain exceptions rather than the norm. Across Europe, SBET remains influenced by local priorities, budgetary constraints and workforce pressures. This results in a persistent gap between established best practices in education and training and the realities of healthcare system delivery. Ensuring equitable access to high-quality SBET should therefore be established as a policy priority, given the substantial variation in resources and training structures across Europe. Without intentional coordination, differences in training quality, patient safety and workforce resilience are likely to increase. In the current European Journal of Anaesthesiology (EJA) issue, an evidence-based expert review examines SBET across the entire professional lifespan – from initial training to high-stakes assessments and continuing professional development – moving beyond individual learning to demonstrate its broader value.13 The authors highlight that SBET not only improves knowledge, procedural, social and cognitive skills, and team performance, but also drives organisational learning and redesign through translational and transformative simulation. Increasingly, SBET is recognised not merely as an educational tool but as a system-critical intervention: it tests clinical processes, validates new environments, prepares organisations for crises and identifies latent safety threats, therefore making risks visible before patients are harmed. Recognising SBET as a strategic infrastructure, rather than an optional adjunct, carries significant implications; infrastructure must be planned, funded, managed and evaluated based on outcomes that benefit patients, healthcare professionals, teams and organisations. It redefines expectations for individuals, teams, organisations, regulatory bodies and professional societies. The primary challenge: Implementation, not Innovation The priority must now shift towards embedding SBET sustainably within regulatory frameworks, funding structures and organisational strategies, supported by leadership and implementation science.7,14,15 This requires integrating simulation throughout the professional life cycle – from initial training and certification to high-stakes assessment and continuing professional development – to ensure continuous competence, adaptability and safety in an evolving healthcare environment. Simulation educators must also be recognised as key contributors to quality improvement, with protected time, professional recognition and defined career pathways that reflect their roles in debriefing, human factors and systems-level learning.7,15 Crucially, success must be measured not by learner satisfaction alone but by meaningful outcomes, including individual competencies, team performance and crises preparedness, patient safety outcomes and quality of care indicators, system reliability, workforce resilience and equitable access to high-quality care. The professional consensus on the value of SBET is already clear; the decisive issue is whether healthcare systems will demonstrate the strategic commitment, accountability and coordinated action necessary to implement it effectively and sustain its impact. Key Statements defining the European Society of Anaesthesiology and Intensive Care vision for simulation-based education and training In response to the clear and urgent direction SBET must take, the current Declaration reflects areas of shared agreement that emerged through collective deliberation among a Core Working Group, comprising 12 simulation experts (ESAIC Simulation Sub-Committee members, n = 9; invited external experts, n = 3), together with an Advisory Working Group composed of representatives from the ESAIC Board and the European Board of Anaesthesiology (EBA). The Core Working Group engaged in iterative discussions in early 2025, leading to an initial proposal approved by the ESAIC Board in April 2025. The Core Working Group continued to meet online throughout 2025, informing the development of an expert review of the current evidence.13 This process culminated in a hybrid (face-to-face and online) structured meeting in January 2026 (n = 9 participants), during which 10 key statements, derived from the evidence review, were formulated, reflecting the collective judgement of the expert panel following structured discussion and iterative refinement. The Advisory Working Group reviewed and approved the final statements. Ten Key Consensus Statements have been identified to articulate the ESAIC vision for the future of simulation-based education (Table 1). Table 1 - To guide the transition from advocacy to implementation, European Society of Anaesthesiology and Intensive Care has defined 10 priority statements that articulate a clear vision for the future of simulation-based education and training ESAIC Vision: Key Consensus Statements 1. The effectiveness of simulation in all domains of anaesthesiology, peri-operative medicine and intensive care has been firmly established; it is time to turn evidence into action through implementation. The central challenge has shifted from evidence generation to governance, integration and sustainability. Implementation science should be used to facilitate simulation. 2. Simulation is a patient safety intervention that improves individual learning, addresses human factors, strengthens teams and healthcare systems. Its value lies in developing competence for individuals and teams, thus preventing patients’ harm. 3. Equitable access to high-quality simulation should be a priority. There is an equity issue in access to simulation. Fragmented implementation risks widening disparities between institutions, regions and countries. 4. Psychological safety, feedback and debriefing are core components of simulation. Simulation relies on structured reflection during debriefing, enabling individuals and teams to learn from experience, explore errors openly and transfer into practice to improve care. 5. Simulation must be embedded across the entire professional lifespan. From initial specialist training to continuing professional development, simulation should be used regularly, shifting from passive to experiential, interactive and interprofessional learning throughout a professional's career. 6. Faculty development and professional recognition of simulation-related roles are prerequisites for sustainable simulation programmes. Simulation requires expertise in educational theories, simulation design, facilitation, debriefing, human factors and systems thinking. 7. Simulation necessitates protected time for learners and trainers. Simulation-based training needs careful planning of activities, as well as prepared learners and faculty. Simulation should not be seen as an add on, but as a substitute for other less efficient activities. Activities should be delivered within normal working time. 8. Simulation should be evaluated by its contribution to safety, quality and resilience, not by cost-effectiveness alone. Value-based approaches are needed to move beyond narrow return-on-investment models. Educational and healthcare institutions should support simulation activities given the positive effects. 9. In addition to being an educational approach, simulation-based education in anaesthesiology is now an essential and strategic healthcare infrastructure. It underpins patient safety, quality improvement, workforce resilience and system performance by enabling both transformational learning at the individual and team levels and transformative change at the organisational and system levels. 10. European anaesthesiology has a unique opportunity to lead through coordination rather than uniformity. Shared principles, adaptable frameworks, research networks and collaborative implementation can strengthen anaesthesiology, peri-operative medicine and critical care across diverse healthcare systems. Together, these statements provide a policy-relevant framework for integrating simulation as essential infrastructure across healthcare systems. These statements are intended to support a transition from advocacy to coordinated implementation, outlining the principles, structures and commitments required to embed SBET as a core, integrated approach across the education and clinical practice of anaesthesiology, intensive care and peri-operative medicine. Together, they position simulation as a means to support lifelong learning, team performance, organisational growth and preparation for emerging clinical and technological challenges. These statements extend beyond outlining best practices; they reflect the profession's core values of quality, safety and resilience. They also deliver a stark message: if simulation is essential to safe, high-quality, equitable and sustainable care, then its fragmented implementation constitutes a systemic failure that demands coordinated action across institutions, professional bodies and healthcare systems.. European Society of Anaesthesiology and Intensive Care's leadership role and Call for Action Professional societies, regulators, educators and healthcare systems all share responsibility for advancing SBET yet ESAIC holds a particularly influential role within this ecosystem. ESAIC is uniquely positioned to serve as a catalyst, steward and convener, aligning evidence, education, policy and national implementation. While leadership must be collaborative, ESAIC's contributions in setting standards, supporting National Anaesthesiology Societies, facilitating faculty development and promoting cross-national learning are pivotal. Ensuring equitable access to high-quality SBET should be established as a policy priority, particularly given the significant variation in resources and training structures across Europe. To advance SBET in anaesthesiology, intensive care and peri-operative medicine, ESAIC has identified four Strategic Actionable Objectives (Table 2). These priorities aim to drive consistent, high-quality and impactful SBET across European educational and healthcare institutions by aligning curricula, fostering collaboration and strengthening faculty and institutional standards. Table 2 - To advance simulation-based education and training in anaesthesiology, intensive care and peri-operative medicine, European Society of Anaesthesiology and Intensive Care has identified the following key areas for strategic action ESAIC Strategic Actionable Objectives 1. Adoption of the European simulation curriculum for anaesthesiology specialist training across National Anaesthesiology Societies to ensure uniform excellence in SBET, underpinned by thoughtful adaptation to the specific context, healthcare systems and cultural frameworks of individual jurisdictions. 2. Alignment of the simulation curriculum with the domains and competencies of the European Training Requirements creating a seamless integration of training and certification standards. 3. Foster collaboration and exchange including sharing of resources between institutions, such as programmes outline, content, simulation scenarios and faculty, to avoid duplication, maximise efficiency and build networks of excellence. 4. Support simulation faculty training and development to ensure expert facilitation and sustainable educational leadership. Conclusion: A Professional and Ethical Imperative The effectiveness of SBET is no longer in question. It is one of the most powerful tools available for strengthening patient safety, professional competence and healthcare system resilience. The limiting factor is no longer evidence or innovation, but the willingness to implement, govern and sustain simulation at scale. ESAIC has laid the foundation through curriculum development, faculty initiatives and strategic leadership. The next phase requires coordinated implementation and sustained commitment across institutions, regulators, and healthcare systems. Moving from evidence to action is no longer aspirational. It is a professional, organisational and ethical obligation.