Introduction Clinical simulations enable experiential learning. Their use provides learners with a safe environment conducive to learning without fear of personal failure or compromising client welfare. In addition, they promote control over learning so facilitating independence and skill development (Conrick et al. 1996, Roberts et al. 1992). Nurse educators and researchers, however, have indicated they need further understanding of the development of clinical simulations (Mailloux 1998, Roberts 2000). This paper presents both a conceptual and applied approach to simulation development and validation. Simulations and learning Simulations can facilitate a learning process that is active and mimics clinical reality. In this learning process the learner has the opportunity to experience dimensions of clinical practice vicariously. Hence, simulations bridge the reality gap bringing miniaturized versions of some sphere of real life activity into the learning environment (Inbar & Stoll 1972). Such applications can be considered a foundation for learning that is deep (Ramsden 1992) and transformative (Bains 1994). Higgs (1992) argues simulations promote learning for understanding and meaning rather than rote learning of facts and principles. This does not replace real clinical experience but it does extend the subject matter to equip learners with some skills that can be directly transferred into the ‘real’ clinical setting (Edwards et al. 1995). Practice situations created by simulations can result in learners gaining increased self-confidence and improved clinical judgement (Thiele et al. 1991). A structured focus on the learning process in this way encourages learner self-monitoring, has the potential to be integrated into clinical tasks and can promote deliberation about specific aspects of practice. Learning situations involving simulations can be accompanied by other strategies such as ‘thinking aloud’ (Cocoran et al. 1988) and critical Article © 2001 Harcourt Publishers Ltd Nurse Education Today (2001) 21, 477–486 477 Clinical simulations: development and validation Jane Cioffi Jane Cioffi RN, BApp Sc, (Adv Nsg), Grad Dip Ed, MApp Sc (Nsg) PhD. Faculty of Health, University of Western Sydney, Locked Bag #1, PO Richmond 2753, Australia. E-mail: j.cioffi@uws.edu.au Fax: 0245701420; Tel.: 0245701929 Manuscript accepted: 13 March 2001 Published online: 15 June 2001 Simulations used as an educational strategy can mimic clinical reality bringing real life activity into the learning environment. This paper presents a conceptual approach to simulation development and validation that is applied to develop assessment simulations for both childbirth and triage situations. A process-based method of presenting information to the learner in the assessment phase is incorporated in simulations developed from actual clinical cases. The uncertain conditions of assessment are recognized as mirroring practice reality and validation of this construct and that of expertise are considered. Use of these simulations has the potential to provide learners with the opportunity to experience dimensions of simulated practice reality and educators with an experiential strategy that can be used to prepare students and also clinicians who are unfamiliar with new clinical practice areas. © 2001 Harcourt Publishers Ltd doi:10.1054/nedt.2001.0584, available online at http://www.idealibrary.com on