This study indicated several perceived gaps in knowledge, skills and behaviours of user groups identified in this research. These gaps pertain to the areas of ongoing training and education, research and application of simulation to areas other than education. There was confluence between the qualitative and quantitative findings, although because of the nature of the survey, some themes were explored in more significant detail in the interviews and focus groups.
Findings of this study identified three user groups including simulation users, new adopters and technically focused users. However, it was clear from the findings that there are no definitive boundaries between user groups, as many participants fulfilled several roles in simulation including facilitating, coordinating and managing as well as being a participant or actor in simulations and running audio-visual equipment. As evidenced by the quote:
We’re having to be our own technicians, we’re having to be our own educational experts, we have to be able to debrief, we have to do it all, and in fact it’s actually really hard to do all that well, or at all, without the appropriate support. (FG-P1)
Similarly, Crawford, Monks, Bailey, and Fernandez  identify the multiplicity required in simulation staff roles. Therefore, education and training programmes need to consider the diversity present in roles related to simulation and cater for the specific membership of the group. Additionally, position descriptions need to be flexible to be able to be modified for different contexts and requirements an organisation may have.
The demographic data specifies that most participants have 3-5 years of experience as a facilitator. Interestingly, the second highest years of experience were related to being a simulated participant or actor in the simulation activities. These findings reinforce previous literature affirming the multiple roles of simulation faculty ; however, it also presents an interesting discovery regarding the relevance of this experience in participating in simulations to developing expertise as simulation faculty. This finding has not previously been identified in simulation literature. Further research is required to investigate if and how experience as a simulated participant or actor in the simulation activity develops faculty expertise.
As expected for new users, there were significant perceived gaps in knowledge and skill that appear to stem from limited time for innovation, a lack of resources and expert support to implement these approaches in education programmes which aligns with elements in the qualitative findings. There was a gap in areas focused on higher technology simulation, such as virtual reality and high technology manikins, and simulated patient methodology. Challenges arose due to the conflict caused by the lack of awareness of simulation and gaps in basic training and education, and mandated simulation-based assessments in some programmes, as evidenced by:
People employed in education, in RTOs [Registered Training Organisation] that do not have the skills to develop scenarios yet scenarios to be used as assessment or an accrediting process, they’re falling very short. They’re inadequate and not well-planned scenarios that are actually having adverse effects on the staff that are involved in them, the learners and they’re not outcomes focused and so they’re not actually looking at what was needing to be measured in the first place. (FG-P5)
Adopting technologically advanced teaching requires commitment and competence . To support new adopters to engage with simulation, contextualised exemplars could be provided that demonstrate expert performance in quality simulation scenarios using various simulation approaches across the learning continuum.
Technically focused users
There was substantial diversity amongst the technically focused user group and a standardised term such as ‘technician’ had little unification as evidenced by:
My feeling is that our title sim technician or sim technologist is not descriptive of what we do … We all have so many different various backgrounds and roles … (FG-P6)
Survey results indicated that over 50% of technically focused users adopted support roles and worked directly with students in simulation. Additionally, over 40% of technically focused users reported collaborating with faculty to develop scenarios and 30% orientated participants to the environment. Bailey et al.  similarly documented a wide variation in technical staff tasks. These findings are supported in the qualitative data.
[On] the technical side I often play the patient behind the mike, I’ll be the voice of the patient for simulations … working through the scenarios and working out what's working well and taking a part in the whole simulation scenario activity … If the educator … is new to simulation … I’ll just sort of try and take them through, tell them where some information is, guide them … (FG-P2)
For technically focused users, survey data revealed eight knowledge and skill gaps, with respondents identifying areas aligning with elements in the qualitative data such as audio-visual equipment knowledge and running simulator and audio-visual simultaneously in simulation activities, with other areas aligning to business cases, budget development, maintenance schedules and asset registers. However, all technical users surveyed were confident in all aspects of preparing simulation environments. These findings suggest that technically focused users would benefit from education and training related to business and management courses.
While simulation users reported using and feeling confident with simulation approaches, when applying approaches to their work, 13 knowledge and skill gaps were identified as problematic by the participants. Additionally, simulation users reported gaps in basic education skills such as learning needs analyses, assessment and integrating simulation in curricula. Positively, these findings indicate fundamental training and education programmes are utilised with over 62% of respondents undertaking identified simulation training programmes (National Health Education and Training in Simulation (NHETSim) and the Australian Simulation Educator and Technician Training (AUSETT) Program). However, ongoing perceived gaps suggest existing training packages may not cater for or penetrate to new adopters from areas outside traditional healthcare, such as the emerging users from community services including disability support and youth workers. Additionally, as simulation-based education is only one component of learning and teaching, a sound knowledge of pedagogy, design for learning including assessments, is required . Moreover, without ongoing learning, fundamental knowledge and skills related to simulation may not be reinforced, embedded or extended . Therefore, future programmes should enable contextualisation to specific work areas and support the application of knowledge and skills in practice and consolidation of learning via mentorship.
These study results indicate a perceived gap as identified by participants may exist in knowledge and skills pertaining to research in Victorian simulation communities of practice, as evidence by statistically significant findings and supported by a theme and elements in qualitative data.
I think research is a huge area for us that’s a gap. We’re very concerned operationally, but we’re not really spending time writing about what we’re doing and what we’re learning, and that’s the thing, that’s an important area. (I2)
As a result, simulation innovation and research being done in local communities of practice are not being disseminated to the wider simulation community. There are significant risks that the Victorian simulation community will fall behind in research, innovation and simulation quality. Suggestions to redress these barriers include developing partnerships across stakeholders to develop research collaboratives, and local opportunities for dissemination of research activities . While research training programmes may be useful to develop novice researchers, the better impact may be felt from enticements to undertake graduate research study such as scholarships for higher degrees.
Strengths and limitations
Strengths of this research relate to data collection across a variety of stakeholder groups. Use of interviews and focus groups enabled detailed information to be obtained. Themes and elements were jointly constructed with supporting data examined for coherency, consistency and fit, and conflicts were resolved through consensus. The cross-sectional survey was piloted, with feedback enabling revision, to ensure question clarity and face and content validity. Additionally, the systematic nature of the research and the level of detail articulated present opportunities for the research to be replicated. It is important to note that the researchers knew many participants which may have influenced data obtained.
While findings present insight into the Victorian simulation communities of practice, caution must be exercised as findings may differ if other stakeholder groups were involved. However, the methods used in this research are transferable. Additionally, most respondents in the survey were Victorian based; the influence of widening the survey to other locations nationally may impact findings. The short time frame for collecting survey responses, 3 weeks, undoubtedly impacted on the response rate. The length and complexity of questions in the survey could be considered as a limitation; however, the comprehensive survey enabled a significant level of detail and granularity.