Reviews In Situ Simulation in Continuing Education for the Health Care Professions: A Systematic Review MICHAEL A. ROSEN,PHD; ELIZABETH A. HUNT, MD, MPH, PHD; PETER J. PRONOVOST, MD, PHD; MOLLY A. FEDEROWICZ, MA; SALLIE J. WEAVER,PHD Introduction: Education in the health sciences increasingly relies on simulation-based training strategies to pro- vide safe, structured, engaging, and effective practice opportunities. While this frequently occurs within a simulation center, in situ simulations occur within an actual clinical environment. This blending of learning and work environ- ments may provide a powerful method for continuing education. However, as this is a relatively new strategy, best practices for the design and delivery of in situ learning experiences have yet to be established. This article provides a systematic review of the in situ simulation literature and compares the state of the science and practice against principles of effective education and training design, delivery, and evaluation. Methods: A total of 3190 articles were identified using academic databases and screened for descriptive accounts or studies of in situ simulation programs. Of these, 29 full articles were retrieved and coded using a standard data extraction protocol (kappa = 0.90). Results: In situ simulations have been applied to foster individual, team, unit, and organizational learning across several clinical and nonclinical areas. Approaches to design, delivery, and evaluation of the simulations were highly variable across studies. The overall quality of in situ simulation studies is low. A positive impact of in situ simulation on learning and organizational performance has been demonstrated in a small number of studies. Discussion: The evidence surrounding in situ simulation efficacy is still emerging, but the existing research is promising. Practical program planning strategies are evolving to meet the complexity of a novel learning activity that engages providers in their actual work environment. Key Words: simulation, simulation-based training, in situ simulation, medical continuing education, health professions Disclosures: The authors report none. Dr. Rosen: Assistant Professor, Armstrong Institute for Patient Safety and Quality, and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine; Dr. Hunt: Associate Pro- fessor, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine; Dr. Pronovost: Professor, Direc- tor, and Senior VP for Safety and Quality, Armstrong Institute for Patient Safety and Quality, and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine; Dr. Federowicz: Senior Research Coordinator, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine; Dr. Weaver: As- sistant Professor, Armstrong Institute for Patient Safety and Quality, and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine. Correspondence: Michael A. Rosen, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 1909 Thames Street, Baltimore, MD 21231; e-mail: Mrosen44@jhmi.edu. C  2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education. Introduction Simulation is a powerful tool for learning. As an education and training strategy, the use of simulation has proven to be effective 1,2 and superior to other training delivery modalities for a broad range of skills including teamwork 3−5 and tech- nical skills. 6,7 Within the context of continuing education in the health professions, simulation has been defined by the Institute of Medicine 8 as: The act of imitating a situation or a process through some- thing analogous. Examples include using an actor to play a patient, a computerized mannequin to imitate the behavior of a patient, a computer program to imitate a case scenario, and an animation to mimic the spread of an infectious disease in a population. (IOM, 2010, p. 34) In addition, conceptual distinctions have been made be- tween the simulator (a specific technology used to represent  Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/chp.21152 JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS,32(4):243–254, 2012