Introduction: Fundamental Simulation Instructional Methods (FunSim) is an international simulation faculty development course for Japanese healthcare educators, with English and Japanese language versions. The objectives of this study were to assess post-course outcomes of international "FunSim" , and identify barriers to the implementation of simulation-based education (SBE) for Japanese simulation educators.

Methods: Using a 73-item web-based questionnaire, FunSim course outcomes were assessed at Kirkpatrick model level one (Reaction) ; two (Learning) ; and three (Behavior) . A Likert-type rating scale (1-7) was used for course evaluation (level one) , and for confidence and competency (level two) ; four different types of Yes-No question were used for level three. A Likert-type rating scale (1-5) was used to rate twelve pre-defined potential barriers to the implementation of SBE methods.

Results: A total of 178 (63%) of 283 participants responded; FunSim language was 47.8% English (E) and 57.3% Japanese (J) , with no differences between (E) and (J) "language barrier" responses. Eighty-eight percent of ratings for the 7-course evaluation items were > 4. Confidence and competency scores decreased "at the time of the survey" compared to "at the end of the course" (P<0.05) . Pre/Post-course participants who were active simulation faculty members increased from 68 to 112 (P<0.001) . Human factors such as "Simulation specialist availability" , " Time for teaching and faculty development" , " Number of trained faculty" , "Faculty development availability" , and "Faculty skill" were predominant barriers compared to other issues.

Conclusion: FunSim participants reported positive course feedback and no critical language barriers. Barriers to the implementation of SBE are primarily human factors. Work release, hiring simulation specialists, and faculty development must be addressed to establish effective SBE systems.