- BACKGROUND: Simulation in healthcare lacks a dedicated framework and supporting taxonomy for instructional design (ID) to assist educators in creating appropriate simulation learning experiences. AIMS: This article aims to fill the identified gap. It provides a conceptual framework for ID of healthcare simulation. METHODS: The work is based on published literature and authors' experience with simulation-based education. RESULTS: The framework for ID itself presents four progressive levels describing the educational intervention. Medium is the mode of delivery of instruction. Simulation modality is the broad description of the simulation experience and includes four modalities (computer-based simulation, simulated patient (SP), simulated clinical immersion, and procedural simulation) in addition to mixed, hybrid simulations. Instructional method describes the techniques used for learning. Presentation describes the detailed characteristics of the intervention. The choice of simulation as a learning medium is based on a matrix of simulation relating acuity (severity) to opportunity (frequency) of events, with a corresponding zone of simulation. An accompanying chart assists in the selection of appropriate media and simulation modalities based on learning outcomes. CONCLUSION: This framework should help educators incorporate simulation in their ID efforts. It also provides a taxonomy to streamline future research and ID efforts in simulation.