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Characterization of the simulation technician profile in Portugal: a cross-sectional study

This cross-sectional study characterizes Portugal's heterogeneous and non-standardized simulation technician workforce, revealing a critical gap between their administrative confidence and pedagogical/technical skills that necessitates a national, hands-on training program to ensure the sustainability of simulation-based education.

Original authors: Abel Nicolau, Elaine Gonçalves, Cristina Granja, Isabel Pereira

Published 2026-06-30

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CC BY 4.0

Original authors: Abel Nicolau, Elaine Gonçalves, Cristina Granja, Isabel Pereira

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine the healthcare system as a massive, high-tech flight school. In this school, students (doctors and nurses) don't just read textbooks; they fly in sophisticated flight simulators to practice saving lives without risking real passengers.

But here's the catch: a flight simulator is useless if the person running the controls doesn't know how to fix the engine, program the weather, or manage the cockpit lights. That's where the Simulation Technician comes in. They are the "pit crew" and "control tower operators" rolled into one.

This paper is a first-ever look at the "pit crews" in Portugal. Here is what the study found, broken down simply:

1. The Team is a Mosaic, Not a Mold

The researchers asked 19 technicians from 11 different centers across Portugal to describe themselves. The result? A very mixed bag.

The Backgrounds: Some technicians have PhDs, some have master's degrees, some have bachelor's, and some only finished high school.
The Origins: They come from two main worlds: Healthcare (mostly nurses) and Engineering (mostly biomedical engineers).
The Analogy: Imagine a sports team where the players are former doctors, former mechanics, and former teachers. They all wear the same jersey, but they didn't all go to the same training camp. This makes the team talented but unstandardized.

2. The "Empty Hangar" Problem

Portugal has 23 officially recognized simulation centers. However, the study found that not all of them have a dedicated technician.

The Reality: Some centers have multiple technicians, while others have none. In those "empty hangars," the doctors and nurses have to fix the simulators themselves while trying to teach.
The Consequence: It's like asking a pilot to also be the mechanic during a flight. It adds stress and distracts them from teaching the students how to fly.

3. What They Are Good At vs. What They Struggle With

The technicians rated their own skills on a scale of 1 to 5.

The Superpowers (High Scores): They are excellent at the "logistics" of the job. They are great at scheduling appointments, managing inventory (counting supplies), and handling medical equipment. They are the ultimate organizers.
The Weak Spots (Low Scores): They feel much less confident in the "art" and "future tech" parts of the job.
- Debriefing: This is the post-flight review where the teacher and student discuss what went right and wrong. Technicians feel unsure about how to help lead these conversations.
- Moulage: This is the art of applying fake wounds and injuries to make the simulation look real. They feel shaky here.
- VR/AR: They are least confident with Virtual and Augmented Reality equipment. Since the future of training is moving toward these high-tech tools, this is a gap that needs filling.

4. The Magic of "Instructor Certification"

The study split the group into two: those who had taken a formal course to become simulation instructors, and those who hadn't.

The Result: The ones with the instructor certificate were significantly more confident in designing scenarios (creating the flight plan) and leading debriefings.
The Takeaway: When a technician understands why they are teaching (the pedagogy) and not just how to push the buttons (the technology), they become a much better partner to the educators.

5. What They Want to Learn

When asked what training they need, the technicians were clear:

Top Request: They want to learn how to design clinical scenarios (the stories and problems the students solve).
Preferred Style: They don't want long, boring online webinars. They want short, in-person workshops where they can get their hands dirty and practice.

The Bottom Line

The paper concludes that Portugal has a dedicated group of technicians who are the backbone of its medical training. However, the system is currently held together by "heroic effort" rather than a standardized plan.

To fix this, the authors argue that Portugal needs a national, hands-on training program. This isn't just about making the technicians feel better; it's about ensuring that the "flight school" runs smoothly, the "pilots" get the best training, and the "hangars" aren't left empty. The goal is to bridge the gap between having fancy equipment and having the skilled people who know how to use it to its full potential.

Technical Summary: Characterization of the Simulation Technician Profile in Portugal

Problem Statement
Simulation-based education (SBE) is critical for improving patient outcomes in healthcare, yet its efficacy relies heavily on specialized technical expertise to manage complex equipment. While simulation technicians are recognized globally as vital to high-quality programs, their roles remain poorly defined internationally and are entirely uncharacterized within the Portuguese healthcare context. Despite the existence of a network of 23 formally constituted simulation centers in Portugal, there is a lack of data regarding the specific academic backgrounds, daily tasks, self-assessed skills, and professional development needs of the technicians who operate these facilities. This study addresses the gap between the physical infrastructure of simulation centers and the human resources required to sustain them.

Methodology
This research employs a cross-sectional study design conducted in Portugal. The study utilized a voluntary online survey developed by a focus group and distributed through the network of the Portuguese Society for Simulation in Health Sciences (SPSim).

Participants: The study included a convenience sample of 19 active simulation technicians from 11 distinct centers across Portugal.
Data Collection: The survey captured sociodemographic data, a 5-point Likert scale self-assessment of skills across various simulation tasks, and preferences for training modalities.
Statistical Analysis: Data were analyzed using IBM SPSS Statistics (version 30.0). Descriptive measures were used for general characterization. For subgroup analysis, non-parametric Mann-Whitney U tests were employed to compare continuous variables between technicians with and without instructor course certification. Effect sizes were calculated using Glass's delta, with findings considered robust only if they met both statistical significance ( $p < 0.05$ ) and a large effect size ( $\ge 0.8$ ).

Key Results

Demographics and Background: The workforce is heterogeneous, with an average age of 41.4 years and an average of 7.05 years of simulation experience. Academic backgrounds range from high school diplomas (31.6%) to doctoral degrees (10.5%), with primary fields of study in healthcare (mainly nursing) and engineering (mainly biomedical). Notably, only 36.8% of participants held a simulation instructor certification.
Task Distribution: The most frequently executed tasks are administrative and logistical, specifically room setup (94.7%), simulator operation (84.2%), and equipment maintenance (78.9%). Conversely, research involvement (5.3%) and undergraduate instruction (26.3%) are the least performed tasks.
Skills Self-Assessment: Technicians reported high confidence in administrative areas such as scheduling (4.47/5) and inventory management (4.21/5). However, confidence dropped significantly in pedagogical and advanced technical domains, specifically debriefing (2.79/5), moulage (2.79/5), and the use/maintenance of virtual/augmented reality equipment (2.42/5).
Impact of Certification: Subgroup analysis revealed that technicians with instructor certification demonstrated significantly higher confidence in "Support for the Development of Clinical Scenarios" ( $p=0.028$ ) and "Debriefing" ( $p=0.017$ ) compared to non-certified peers.
Training Needs: The most requested training area was clinical scenario development (31.58%), followed by virtual/augmented reality and simulator operation/maintenance (15.79% each). There is a strong preference for short, in-person courses and workshops (68.4%) over webinars.
Infrastructure Gaps: The study identified a discrepancy between the number of known simulation centers (23) and the number of participating centers (11), suggesting that a subset of centers operates without dedicated technical staff.

Significance and Claims
The paper claims to provide the first comprehensive cross-sectional analysis of simulation technicians in Portugal. Its primary significance lies in revealing a "critical disconnect" between the physical infrastructure of simulation centers and the personnel required to operate them. The authors argue that while the role is recognized as essential, the lack of standardized nomenclature and educational pathways has resulted in a fragmented workforce with variable competencies.

The study concludes that Portuguese simulation technicians constitute a dedicated but non-standardized professional group. It posits that a "confidence-competence gap" exists, particularly in pedagogical tasks and emerging technologies like VR/AR. The authors assert that establishing a national, hands-on training program is essential to bridge this gap. Such a program would not only professionalize the role but also ensure the long-term sustainability of simulation-based education in Portugal by shifting investment focus from purely physical equipment to the professional development of the human resources that operate it. The findings suggest that formal instructor training transforms technicians from mere equipment operators into pedagogical partners capable of enhancing the realism and efficacy of simulation cases.