Twelve steps to design meta-simulation game worlds to foster the next generation of healthcare practitioners: the example of ‘The Carthage Codex’

This article introduces the concept of ‘meta-simulation game world design’ for healthcare education. This innovative approach integrates multiple evidence-informed instructional strategies into a curated series of integrated and progressively complex simulation experiences (a meta-simulation) set within an immersive game world – a simulated, fictional universe governed by its own rules. Drawing on our experience designing The Carthage Codex, a meta-simulation game world for long-term care specialization, we outline our method and detail the 12 design steps, from initial planning to evaluation. Each step is illustrated with practical examples to guide and inspire readers in developing their own meta-simulation game worlds. Additionally, we emphasize the importance of ethical, cost-effective and reusable design practices to maximize educational impact and sustainability. This article aims to advance the integration of simulation, game-based learning and storytelling by presenting a flexible 12-step approach for designing immersive and impactful healthcare learning experiences.