One Does Not Simply Walk Into Artificial Intelligence: A Distributed Leadership Framework for Healthcare Simulation.

Abstract

Artificial intelligence is entering healthcare simulation, yet implementation remains fragmented and lacking coordinated governance. This article argues that sustainable AI integration requires moving beyond tool-centric experimentation toward an ecosystem-level approach connecting governance, infrastructure, pedagogy, and evaluation. We propose a Fellowship model, drawing on Tolkien's literary framework to illustrate how distributed leadership can align strategic, clinical, technical, operational, and learner perspectives. The Fellowship metaphor captures how trust must be built across historically separate groups, how leadership emerges situationally rather than hierarchically, and how those closest to the work prove essential to success. Simulation centers, with their controlled environments and established debriefing cultures, offer natural testbeds for AI implementation. We translate these principles into practical recommendations: anchoring decisions to educational problems, embedding psychological safety in planning, conducting multidimensional evaluation, and establishing continuous governance while ensuring ethical imperatives remain foundational rather than retrofitted. This framework offers guidance relevant to educators seeking pedagogical alignment, administrators developing governance structures, clinicians ensuring clinical authenticity, operations staff validating workflow integration, and learners advocating for meaningful participation in AI implementations.