Deception and simulation education: issues, concepts, and commentary.

STATEMENT: The use of deceptive methodology in simulation education is an emerging ethical controversy. At the 2014 International Meeting on Simulation in Healthcare, arguments for and against its use were debated by simulation experts. What emerged from this discussion was an apparent disconnect between current practice and existing empiric research on this subject. At present, no framework exists to guide the simulation community's exploration of this issue of deception.After reviewing the relevant psychological literature, we propose a framework delineating discrete elements and important relationships, which enables a comprehensive view of the factors germane to simulations that use deception. We further comment on key pedagogical and psychological issues in the context of this framework and define an agenda for further research. Educators are encouraged to use this framework when determining whether, when, and how deception might be used and, if used, how it can be ethically justified and carefully implemented.