Understanding disparities in simulation through minority stress theory: a conceptual framework

Despite growing attention to equity in healthcare simulation, persistent disparities in participation and learning outcomes among learners from minoritized backgrounds remain insufficiently explained. Existing simulation-based education frameworks describe how learning occurs but offer limited insight into how inequitable learning conditions shape learners’ experiences. We propose minority stress theory (MST) as a conceptual framework for understanding how stress related to minoritized identity operates within healthcare simulation environments. Originally developed to explain health disparities among sexual minorities, MST conceptualizes stress as arising from both structurally embedded conditions (distal stressors) and internalized vigilance and self-monitoring (proximal stressors). Through conceptual analysis, we map MST constructs onto core features of healthcare simulation, including its performance-based, socially intensive, evaluative, and immersive characteristics. We illustrate how minority stress processes may operate through education-relevant mechanisms, such as cognitive load, psychological safety, engagement, and help-seeking, to shape learning experiences and performance. By applying MST to simulation-based education, this paper offers an equity-informed framework for examining learning-environment mechanisms and informing inclusive simulation design, facilitation, and assessment practices.