Injury by Instruction: Training Scars in Simulation

In EMS education, simulation is a powerful tool for building critical thinking, teamwork, and hands-on skills, but it also carries the risk of creating “training scars”—behaviors unintentionally taught that fail to translate into safe, effective prehospital practice. These scars often emerge from shortcuts, unrealistic constraints, over-cueing, or habitual practices built into scenarios that don't reflect real-world environments. As educators, every instruction we give—whether explicit or implied—can profoundly influence how learners perform under stress. This presentation examines how training scars develop, how they manifest in field performance, and how we as instructors can redesign simulation to prevent them. By recognizing these pitfalls and integrating strategies that enhance realism, accountability, and critical reflection, we can ensure that the habits formed in training truly prepare our learners for safe, competent, confident patient care in the field.