Beyond pen and paper: Simulation as a transformative training ground for guideline methodologists.

OBJECTIVE: Simulation of guideline panel meetings has been used to increase panelists knowledge and familiarity with the process. However, a gap remains in understanding how this pedagogical design strengthens capabilities in guideline processes and methods among those facilitating the simulation. This paper explores how simulation-based training of a guideline panel meeting strengthens preparedness, confidence, and competence in guideline processes and methods among both simulation participants (panelists) and facilitators (prospective or active methodologists and chairs). STUDY DESIGN AND SETTING: We conducted a qualitative study using semi-structured interviews and focus groups with simulation panelists and facilitators involved in guideline simulations globally. Eleven study participants (five facilitators, six panelists) were purposively sampled across South Africa, Malawi, Namibia, Nigeria, and Norway. Data were analysed using a reflexive thematic approach guided by Kolb's experiential learning theory. RESULTS: In these simulations, facilitators took on the roles of guideline methodologists and chairs, while the simulation participants played the role of panelists. Study participants indicated that the purpose of simulations could be flipped from training panelists to training guideline methodologists and chairs, effectively positioning the simulation facilitator as the primary learner. Simulation strengthened participants (panelists) understanding of transparent decision-making and the management of uncertainty during panel deliberations. By learning by doing, simulation provided an active practice ground to build confidence in an experiential, authentic, and safe environment for methodologists and chairs (the facilitators) and demystified the guideline development process for panelists. Simulations addressed critical missing competencies for those in the methods and chairs roles, specifically cross-cutting interpersonal skills such as facilitation, communication, and conflict resolution. CONCLUSION: Guideline panel simulation addresses a significant gap in professional development for prospective, current and future methodologists, chairs and panelists. This practical approach offers an experiential, authentic mechanism to build confidence and competencies in a safe, low-risk environment. Our work suggests that simulation humanises the teaching of guideline development, moving pedagogy beyond traditional theoretical methods toward a transformative process. Prospective, current and future guideline methodologists, chairs and panelists, seeking to strengthen their competencies and confidence, can consider simulation as an ideal practice ground for the real-world.