In the world of healthcare simulation, structured frameworks help educators deliver effective training tailored to learners’ needs and experience levels. One such framework is the SimZones model, originally designed for clinical professionals. But what happens when we apply this model to undergraduate nursing education? Can students benefit in the same way, or are adjustments needed?
A SIMZINE exclusive based on the SIMShot webinar hosted by Álvaro Trampal Ramos featuring Belén González Tejerina
In the first episode of SimShot, a new series of short, focused webinars on simulation and innovation, host Álvaro Trampal sits down with Belén González Tejerina, a nurse, clinical educator, and advanced simulation instructor at Fundación Jiménez Díaz and the Autonomous University of Madrid. Through this engaging conversation, Belén walks us through her hands-on experience with SimZones, her challenges in implementing simulation for undergraduate students, and her proposal for a new “Zone 2 Plus” to bridge existing gaps.
SimShot: A New Learning Format for Simulation Conversations
Before diving into the content, let’s take a moment to appreciate the format. SimShot is designed as a short, impactful shot of knowledge—like a quick espresso of expertise. Each episode brings an expert voice to discuss timely topics in simulation, aiming to foster open debate and collective learning.For the premiere episode, Belén shares her perspective on structuring simulation programs for nursing students, an audience often overlooked in frameworks tailored for experienced clinicians. And here lies the core of her message: we need to rethink how SimZones are applied in undergraduate education.
SimZones: A Quick Refresher
Belén begins by outlining the SimZones model, introduced by Peter Weinstock and colleagues. This hierarchical structure provides a roadmap for aligning simulation-based education with learners’ competencies, institutional goals, and expected outcomes. Although widely adopted in postgraduate training, the model’s application in undergraduate settings, particularly for nursing students, reveals a few misalignments.
Zone 0 involves orientation and familiarization.
Zone 1 focuses on isolated skills and basic procedures.
Zone 2 emphasizes integrated skills in low-fidelity environments.
Zone 3 introduces full clinical roles in complex, realistic scenarios.
Zone 4, often overlooked, involves reflection and learning from real-world clinical practice.
For many educators, it’s tempting to jump straight to Zone 3, believing that high-fidelity, high-stakes simulation equals better learning. But Belén challenges this assumption, especially when working with novice learners.
The Undergraduate Simulation Dilemma
Belén shares an important realization: when she began facilitating simulation for nursing students, she assumed she was delivering Zone 3 experiences. But soon, she asked herself a fundamental question: “Are my students actually ready for this?”
The answer, she found, was often no. Students lacked the clinical judgment and theoretical grounding required for Zone 3. Pushing them into complex simulations without adequate preparation risked confusion, frustration, and superficial learning.
Instead, Belén advocates for a programmatic approach to simulation, one that is coherent, longitudinal, and aligned with clearly defined learning outcomes. This means mapping national competency frameworks to simulation objectives and placing them appropriately within the SimZones structure.
Competency Translation and Curriculum Integration
One of the major challenges in nursing education is translating competencies into actionable learning objectives. Belén describes the educator’s role as a sort of translator—bridging national regulatory frameworks with day-to-day learning experiences.
Once this translation is done, the next step is determining where these objectives best fit across the SimZones. Not all skills are best taught in Zone 3. For instance, a student learning about childbirth for the first time would benefit more from a Zone 1 or 2 experience, gradually building the knowledge and confidence needed for more complex scenarios.
Balancing Theory, Simulation, and Clinical Practice
Another recurring theme in Belén’s discussion is the balancing act between theoretical coursework, simulation hours, and clinical rotations. Simulation requires significant time and resources—trained facilitators, dedicated spaces, equipment—and must be integrated thoughtfully to avoid displacing other essential components of education.
Moreover, faculty must manage students’ perceived roles. When the same instructors alternate between assessors, lecturers, and facilitators, students may struggle to let go of their evaluative mindset and embrace the reflective, non-judgmental nature of simulation. Creating a safe learning environment becomes paramount.
Zone 3: An Elusive Fit?
Belén raises a bold but honest question: “Does Zone 3 even exist in undergraduate nursing education?”
Zone 3 requires learners to act within their real clinical role and to engage in deep reflective debriefings focused on their mental models. But undergraduate students—by definition—lack autonomy in clinical settings. They cannot act independently, and in real life, are always supervised by a preceptor. Translating this into a simulation scenario without violating realism or overextending students’ capacity becomes a complex challenge.
Furthermore, students’ mental models are still forming. Without enough real-life exposure, there may not be enough clinical judgment to reflect upon. Instructors often find themselves switching roles—from facilitator to content expert—to fill knowledge gaps during debriefings. This further distances the experience from the ideal structure of Zone 3.
A New Proposal: Zone 2 Plus
To address this, Belén and her colleagues propose an intermediate simulation zone, one that blends the benefits of Zones 2 and 3 while adapting to the realities of undergraduate learners. They call it Zone 2 Plus.
This zone incorporates:
- Role-play, allowing students to “act as” professionals they are training to become.
- Selective debriefing, where instructors explore mental models while still offering expert content correction.
- Realistic complexity, introducing noise and distractions without overwhelming cognitive load.
- Dynamic instructor roles, allowing educators to shift between facilitation and instruction based on student needs.
Zone 2 Plus is a pragmatic solution, grounded in the belief that simulation must meet learners where they are—not where the framework expects them to be.
The Role of Zone 4: Debriefing Real-Life Practice
Near the end of the conversation, Álvaro raises a great point: What about Zone 4?
Belén agrees that Zone 4, often underutilized, holds immense potential. At her institution, they implement clinical debriefing, using students’ real-life clinical experiences as reflective learning opportunities. These are powerful moments, filled with emotional and cognitive learning, especially when handled with care and structure.
Such debriefings help students internalize their experiences and reinforce safe practice—without needing expensive simulation infrastructure.
Final Advice: Start with Needs, Not Frameworks
As a parting message, Belén offers some advice to educators eager to implement SimZones:
“Don’t start with the zones. Start with your learners’ needs.”
Understand your students’ competencies, your institutional context, and your teaching goals. Then align these needs with the SimZones—or adapt the framework to better serve your context. Simulation is a flexible tool. The magic lies in how we use it.
Conclusion
The SimZones model is a powerful framework, but as Belén González Tejerina reminds us, it is not a one-size-fits-all solution. Undergraduate nursing education demands flexibility, creativity, and a willingness to adapt. Whether it’s through Zone 2 Plus or clinical debriefings, the ultimate goal remains the same: preparing future nurses with competence, confidence, and compassion.
With initiatives like SimShot, the conversation around innovation in simulation continues—short, sharp, and insightful, just like a well-poured shot.
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