Abstract
Background: Simulation-based education (SBE) is widely used in postgraduate healthcare
education but is resource-intensive, requiring participant travel, multidisciplinary staffing,
specialist facilities and consumable resources. Digital simulation offers opportunities to
improve accessibility and scalability while potentially reducing environmental and financial
impacts. However, evidence evaluating these sustainability outcomes remains limited
Objective: To evaluate the educational, environmental and financial outcomes of digital
simulation within a postgraduate maternal medicine module.
Methods: A multi-method educational evaluation was undertaken using participant
questionnaires, narrative comments, travel information and comparative environmental and
financial modelling. Educational outcomes were analysed descriptively using Likert-scale
responses and content analysis of narrative comments. Environmental evaluation compared the
operational carbon emissions associated with equivalent face-to-face and digital simulation
delivery using predefined system boundaries, while financial evaluation compared the
recurrent costs of face-to-face delivery with the one-off production costs of digital simulation.
The study was conducted within a national postgraduate maternal medicine module delivered
by the University of Greater Manchester in partnership with the Northwest Maternal Medicine
Network. All fifteen enrolled healthcare professionals participated.
Results: Participants reported consistently positive educational experiences, with all
respondents agreeing or strongly agreeing that the digital simulations supported clinical
decision making, realism, interprofessional learning and application to practice. Nine
participants (60%) reported that they would not have been able to attend an equivalent face-to
face simulation. For the remaining six participants, estimated participant travel related
emissions associated with equivalent face-to-face attendance total 135.45 kg CO₂e. Production
of the digital simulation required one return rail journey, generating an estimated 25.67kg
CO₂e. The estimated recurrent cost of delivering an equivalent face-to-face simulation was
£2,702,04 per session, whereas the digital simulation required an estimated one-off commercial
production cost of approximately £4,500 with no ongoing hosting costs reported by the
platform provider.
Conclusion:
Digital simulation was perceived as educationally valuable while substantially improving
access for a geographically dispersed postgraduate cohort. Compared with repeated face-to
face delivery, digital simulation reduced participant related-travel emissions and eliminated
recurrent deliver costs, although production required an initial environmental and financial
investment. These findings demonstrate the importance of evaluating educational innovation
beyond learner outcomes by incorporating environmental and financial considerations
alongside educational effectiveness.