Novice to Advanced: A Roadmap for Simulation Operations Certification Success > The Society for Simulation in Healthcare

Novice to Advanced: A Roadmap for Simulation Operations Certification Success


Adrienne D. Wilk, PhD, RN, CHSE, CNE, CHSOS-A1

1Austin Peay State University, School of Nursing, Clarksville, Tennessee

Conflict of Interest Statement

The author declares no conflict of interest.

Corresponding Author

Adrienne D. Wilk, PhD, RN, CHSE, CNE, CHSOS-A, Austin Peay State University, School of Nursing, Clarksville, Tennessee


Brief Description

The Society for Simulation in Healthcare (SSH) grants four certifications for healthcare simulation (SSH Certification, 2023). The Certified Healthcare Simulation Educator® (CHSE) and advanced CHSE (CHSE-A) are intended for simulationists assuming the educator role. The Certified Healthcare Simulation Operations Specialist® (CHSOS) and advanced CHSOS (CHSOS-A) are intended for individuals who assume a simulation operations role. This article will highlight the CHSOS and CHSOS-A credentials and present practical tips and tricks for obtaining the operations certifications.


"But you never played with dolls as a kid!" my mother exclaimed when I told her about my new fascination with healthcare simulation. She was correct; I was the child who demonstrated little to no imagination or creativity growing up. So, imagine her surprise when I told her that after working as a nursing professor, I would venture into the new-to-me world of manikins, task trainers, standardized participants, moulage, and audiovisual technology.

Like many of you reading this, I got my start in simulation operations because I found several unopened equipment boxes in the musty basement of my place of employment. The school where I was employed had a phenomenal grant writer who loved purchasing the latest and greatest simulation technology. The problem was that no one knew how to assemble or use the equipment. I knew nothing about simulation then, but decided to take on the challenge of getting the manikins and equipment up and running. Thankfully, I have come a long way since the early days, and I want to encourage others to follow my path of becoming a simulationist. This article aims to provide readers with a general roadmap for simulation operations-specific professional development and growth, ultimately leading to attaining the CHSOS-A credential.

Getting Started in Simulation Operations


When I started in simulation, I lacked a simulation mentor at my place of employment. Thankfully, there were several options for external sources of reliable information and eager encouragement. I cannot overstate how important reaching out to others will be when getting started. Thankfully, I had old ties to one of the ten study sites participating in the landmark simulation study for the National Council of State Boards of Nursing (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014). My past faculty welcomed me with open arms and mentored me as a simulationist. If you do not have connections with another facility utilizing simulation, I would urge you to pick up a phone or write an email and ask for a tour at the closest simulation center. The sim world is smaller than it may appear, and building relationships with other simulationists is vital to your success.


Much of what I learned in the early days came from old-fashioned trial and error. I would contact the various help desks and scour the forums and online social networks provided by the manikin vendors. Later, I discovered that simulation pioneers were sharing their knowledge for free on YouTube and other social media outlets. I relied heavily on YouTube channels like Simulation Tek (Simulation Tek, n.d.) and Healthy Simulation (Healthy Simulation, n.d.). Another invaluable resource is podcasts. A quick search of your favorite podcast platform will provide a robust list of options. Facebook, Instagram, LinkedIn, and Twitter also house multiple simulation operations-specific pages.

Professional Development

Attending a simulation conference is one of the best ways to expand your knowledge. SSH conducts two conferences on an annual basis. The International Meeting on Simulation in Healthcare (IMSH) is held in the winter, and SimOps is held in the summer. SimGHOSTS is another excellent conference focused on enhancing the role of the healthcare simulation operations specialist. Simulation conferences that are not healthcare-specific are also beneficial. Organizations like the National Center for Simulation conduct conferences and workshops to advance simulation and related technologies. Equipment vendors also conduct their own simulation conferences. There are also several free professional development courses available online. The University of Washington hosts free online modules on designing, facilitating, and debriefing simulations (University of Washington Center for Health Sciences Interprofessional Education Research and Practice, 2023). The modules on selecting the appropriate modality and enhancing fidelity are particularly beneficial for simulation operations specialists.

As the use of simulation has grown, so have the options for certificates and degrees. Several institutions of higher learning offer certificates in simulation and undergraduate, graduate, and doctoral degrees. If you are not ready to commit to a certificate or degree program, I encourage you to consider purchasing and reading one of the many textbooks and comprehensive guides on healthcare simulation offered in stores. They are even available as audiobooks! Professional journals are another great way to gain new knowledge. Periodicals like STORM, Human Factors in Healthcare, Clinical Simulation in Nursing, Simulation in Healthcare, Journal of Interprofessional Education & Practice, and Advances in Simulation are all reputable information sources that translate to the simulation operations role.

Simulation Organizations 

Becoming a member of an international simulation organization such as SSH will provide you with reliable information about the history of simulation and its future. An SSH membership will unlock access to tools like SimConnect, SSH's online network that allows for resource-sharing, networking, and problem-solving. Membership also allows you access to Simulation in Healthcare and STORM, peer-reviewed journals dedicated to healthcare simulation. Another perk to SSH membership is access to the Live Learning Center, with over 200 accredited simulation courses (Society for Simulation in Healthcare, 2023). You will rely heavily on the Live Learning Center when you renew your CHSOS certification, discussed further in the next section.

The International Association for Clinical Simulation and Learning (INACSL) also has valuable resources. Most notable is the Healthcare Simulation Standards of Best Practice, which provides an evidence-based foundation for simulation education and operations (Society for Simulation in Healthcare Council for Certification, 2019). The National League for Nursing also hosts a Simulation Innovation Resource Center (SIRC) online forum. Lastly, the Association of SP Educators (ASPE) is another resource for information regarding the use of standardized patients in healthcare simulation.

There are several regional, state, and local simulation collaboratives or consortiums to join. These groups typically meet virtually once a month to share resources that enhance simulation quality. A few of my favorites include the Interprofessional Education Collaborative, California Simulation Alliance, and Simulation Canada. Another collaborative that assists simulation operations specialists in excelling in their role in the Higher Education Makerspaces Initiatives. This collaborative is responsible for the annual International Symposium on Academic Makerspaces (ISAM), where attendees can share knowledge and inspiration for improving education.

CHSOS Certification

One of the many things I love about healthcare simulation is that there is always an opportunity to develop new knowledge. During the pandemic, I pursued my CHSOS certification. I had already obtained my CHSE certification but felt that obtaining the CHSOS would legitimize my simulation operations role and demonstrate value in its operations functions. CHSOS eligibility criteria stipulate that a simulationist must have two years of simulation experience in a simulation operations role and possess a bachelor's degree to take the exam. If you do not have a bachelor's degree, you can apply for a waiver with an equivalent combination of education and experience (Society for Simulation in Healthcare, 2018).


The CHSOS exam application is online, open year-round, and quick and easy to complete. For the application, you will be asked to describe your simulation-based operations experience, advocacy for healthcare simulation, and any activities you have participated in that assist in expanding the field of simulation. You must provide two professional references who will receive an online reference request.


I thoroughly reviewed the CHSOS Handbook, Examination Blueprint, and Exam Preparation Guide to prepare for the exam (Society for Simulation in Healthcare, n.d.b; Society for Simulation in Healthcare, 2018; Society for Simulation in Healthcare, 2019a). I then completed the CHSOS Professional Development Worksheet (Society for Simulation in Healthcare, 2022d). All four resources are free to access on the SSH website. The Professional Development Worksheet helped me to identify gaps in my knowledge. From there, I took the Practice Examination provided by SSH and reviewed specific content related to the practice exam questions I missed. I did not utilize a review course in my preparatory activities, but I would encourage others who feel they may benefit to do so. SSH offers live and online CHSOS review courses covering major content areas from the exam blueprint.


The online certification exam must be taken within 90 days of eligibility of your application approval. You may take the exam at either an approved computer-based testing site or remotely at your chosen location. The test consists of 115 questions, of which 100 are counted towards determining the achievement of the certification. The other 15 questions are being pilot tested for use in future exams. The exam consists of questions from 5 domains (Society for Simulation in Healthcare, n.d.b).

The CHSOS exam has a cumulative total pass rate of 77.48% (Society for Simulation in Healthcare, 2019b). The exam results will be made available immediately, electronically on the screen or on a printed result sheet. A results report for a successful exam will only report the passing result. An unsuccessful exam report will include an overall score and data for the performance on questions from each of the five domains. If unsuccessful, candidates may retake the exam in 90 days.


A CHSOS certification is active for three years. Renewal of the CHSOS credential may be accomplished by retesting or demonstrating the achievement of 45 continuing professional development credits over the three-year recertification cycle. Professional development activities must be correlated to one of the five domains covered in the exam. Renewal candidates will need a minimum of one professional development activity for each of the five domains. For example, all 45 professional development credits may not fall under domains I through IV, leaving domain V without an activity. All continuing professional development credits must be documented on the online Candidate Management System. Accurate records must be maintained, as random audits are conducted to verify the validity of the documented continuing professional development credits. The CHSOS Renewal Handbook, available for free on the SSH website, takes you through the renewal process (Society for Simulation in Healthcare, n.d.c).

CHSOS-A Certification

In Fall 2020, SSH announced it would add the Certified Healthcare Simulation Operations Specialist – Advanced® (CHSOS-A) certification. The CHSOS-A credential is reserved for leaders in simulation operations who serve as mentors to others in the field. On March 30, 2021, I received notification that my CHSOS-A application was accepted! I was one of 25 CHSOS-As designated during the first application cycle. At present, there are 33 individuals certified as CHSOS-As (Society for Simulation in Healthcare, 2019b).

I take the mentor role required for the CHSOS-A credential very seriously. If it were not for mentors who supported me in my simulation operations infancy, I would not have been able to accomplish my professional goals. I felt drawn to this new certification as it would push me further into discomfort for growth in my career. I also felt strongly that I wanted to show that women can excel in technology-related fields. Since obtaining my advanced certification, I have become a CHSOS-A application reviewer. It is a privilege to participate in the expansion of the CHSOS-A certification. I want to encourage any eligible individual to consider applying. Hopefully, you will find the following tips helpful when submitting your CHSOS-A application.


To be eligible for the CHSOS-A, you must be a CHSOS, have five or more years of experience in simulation operations, possess a bachelor's degree, or have been granted an education equivalency. Thankfully, SSH assists you in distinguishing whether you operate at the CHSOS or CHSOS-A level by publishing the CHSOS-A Standards and Suggested Evidence, CHSOS-A Handbook, and the Application Worksheet (Society for Simulation in Healthcare, 2020; Society for Simulation in Healthcare, 2022a; Society for Simulation in Healthcare, n.d.a). I encourage you to use these documents as a needs assessment to determine your eligibility. These tools also assist in outlining your professional strengths and areas for growth.


Preparing for the CHSOS-A differs from preparing for the CHSOS, as there is no examination, and applications are only accepted twice a year. The CHSOS-A certification process consists of three components. The first component is an exemplar. The exemplar is where the candidate demonstrates their advanced simulation operations talent by providing an example of their work. The second component is an online application with multiple open-ended questions requiring a narrative response. The third component is a simulation-specific CV/resume.


The CHSOS-A application's first and possibly most crucial portion is the exemplar. In this section, the applicant must provide an example of an innovation, activity, or project demonstrating their advanced practice. The specific type of exemplar is not prescribed and may cover various topics. The only requirement is that the applicant must have served as the primary contributor.

To begin brainstorming ideas for your exemplar, I suggest speaking with those you work beside to gather your thoughts about what to include in your application. Ask others about your most significant accomplishments, how you influence change, and the most remarkable thing you have done as a simulation operation expert to enhance learning. We often forget the incredible work we do to advance the field of healthcare simulation. Again, reviewing the preparation documents on the SSH website will help you to develop ideas for your exemplar.

Your narrative responses that describe the exemplar aim to create a clear, comprehensive picture of the project for the reviewers (Society for Simulation in Healthcare, 2022c). If you have created or redesigned equipment or technology, provide the plans and photos of the final product and any iterations of the design process. If you designed or implemented a new process within your program, include evidence of the action and outcome. While most applicants do a great job explaining the exemplar and how it supports or improves simulation, a common stumbling block is a lack of a comprehensive description of the needs assessment and evaluation of the effectiveness of the exemplar. Be sure to adequately describe the needs assessment you conducted to determine the necessity of your exemplar. You also need to include a discussion of how you evaluated the implementation of the exemplar. Be prepared to speak to the complete process of implementing your exemplar, not just the innovation itself.


The CHSOS-A application is like that of the CHSOS (Society for Simulation in Healthcare, 2022a). You must submit two professional references who are familiar with your work and can articulate how you meet the domains of the CHSOS-A. The initial demographic questions are followed by a series of questions requiring a narrative response (Society for Simulation in Healthcare, n.d.a). At first, I was relieved to notice that the required word count for each question was relatively small. However, that later posed a challenge when articulating how I met each prompt without exceeding the word limit.

As mentioned above, the most challenging part about this component is thoroughly demonstrating competence while being succinct. It is also essential to remember the example of your work that you plan to describe in your exemplar and reference that exemplar in your responses. Be sure to review the guiding questions located in the CHSOS-A Application Information document (Society for Simulation in Healthcare, 2022b). The standards and suggested evidence will help you determine if you answer the question with the intended response.

Simulation-Specific CV/Resume

The third and final component of the application is the simulation-specific CV/resume. Most reviewers will begin examining the CHSOS-A candidate by reviewing the CV/resume for key insights supporting the CHSOS-A. Ensure that the CV/resume is simulation-specific and only contains information pertinent to your simulation role. Highlight your work experience in simulation operations, focusing on responsibilities, accomplishments, and your impact on your simulation program and its learners. Describe the projects or initiatives in which you have led or made a significant contribution. Include a detailed list of skills, including technical skills and the soft skills required to succeed in a simulation operations role. Document professional memberships and any leadership roles held within those organizations. If you have formally or informally disseminated information, document the endeavor to demonstrate scholarship. It is also vital to check for consistency in your CV/resume's dates, titles, and details and the application question responses.


Prior to submitting your completed application, be sure to have others review your work. I would encourage you to have seasoned simulationists and those outside the simulation world read your application, exemplar, and resume. You must sufficiently describe your experience and exemplar in a way that is comprehensive and easy to understand. Lastly, review the CHSOS-A Standards and Elements for a final time to ensure you have addressed each standard.


Like the CHSOS, a CHSOS-A certification is active for three years. The CHSOS-A credential may be renewed by achieving 45 continuing professional development credits over the three-year recertification cycle. Professional development activities must be correlated to one of the five domains covered in the exam. Renewal candidates will need a minimum of one professional development activity for each of the five domains. The CHSOS-A Renewal Handbook, available for free on the SSH website, takes you through the renewal process (Society for Simulation in Healthcare, 2022b). SSH will randomly audit professional development credits used for recertification. Keeping copies of the professional development documents for three years is suggested.

Concluding Remarks

It is an honor to be recognized for our impact as simulation operations specialists. My goal is for everyone who meets the CHSOS or CHSOS-A eligibility qualifications to pursue certification. There are numerous study resources and mentors available to help you. Please never hesitate to contact me or any other CHSOS-A for assistance in achieving your goals.


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