Creating a simulation facility in a single institution is not a simple feat. The political, logistical, and fiscal issues often mire a project down. Now, magnify that to not just one institution, but an entire state. The need for simulation-based education is widespread. However, it is the need for infrastructure and operational expertise that far outstrips the supply of money or manufactured simulation devices. The statewide approach is not magical, but is just a means to an end. It is a method that will be applicable to some states but not others. It is a model that can be used locally or nationally-the concepts are remarkably similar, just the scope differs. However, the larger the scale, the greater the consequences and implications. It is commonly accepted that a functional team will outperform a single individual. The notion of a statewide implementation can take various forms, which may include a centralized governing structure. This is not absolute, and in fact may not be desirable. Models could include a body that acts as a resource to develop the infrastructure skill set required for maximal access to simulation in the state. There are a number of core elements that are critical to implementing clinical simulation at any scale: interested parties getting together; a common consensus and the need to develop a common goal; a more formal group is formed to act on the need and to develop a mechanism to meet the need and goal(s); and so on.
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