The story goes as follows: Two friends are walking along a riverbank when they notice a child in the water, struggling to stay afloat. The two friends jump in and rescue the child. As soon as they have carried the child out of the water they notice another child in the river, also in difficulty. While they are back in the water they notice another child further upstream floating towards them. One of the friends then swims towards the shore and starts walking up along the riverbank. The person left in the water says: “Where are you going? There’s more kids drifting down towards us.” To which the person walking away replies: “I’m going to see who’s throwing these kids in the water.”

Moving upstream then is moving from the proximal to the distal, from treating symptoms to treating causes. Much of simulation-based education today is focused on training of individuals. Of course, individuals do need training. However, with limited time and money, one has to consider whether using simulation to make the system safer for the people to work in would be a more effective use of resources. Where is our current focus in simulation-based education and where should it be?

The 2021 ASPiH Conference theme is therefore focused on how simulation can be used to improve systems. Improving processes, procedures, guidelines, layout, equipment, checklists, etc. may have wider and longer-lasting effects than a focus on training individuals.