| Sumario: | • Simulation-based initiatives often do not fit neatly into categories of quality improvement or research. • A reflective framework positions initiatives along two continua: contribution to practice and contribution to knowledge. • Many initiatives combine features of both traditions, creating ethical and methodological tensions. • Case examples illustrate how simulation work can be oriented differently while still crossing boundaries. • Reflecting on purpose and context can strengthen transparency, ethics, and the usefulness of findings. Simulation-based initiatives are increasingly integrated into healthcare settings, often responding to local concerns while also producing insights that contribute to wider scholarly and professional debates. In this context, the distinction between quality improvement and research is often blurred, and many projects incorporate elements of both. This paper argues that instead of treating quality improvement and research as fixed categories, it is more productive to reflect on how simulation initiatives are positioned in relation to their intended contributions to practice and knowledge. Drawing on insights from implementation science, I outline recurring challenges that arise when this reflection is absent, including difficulties with ethics, contextual transparency, and accessibility of findings. To support a more deliberate approach, the paper introduces a reflective illustration that helps situate simulation work without reducing it to predefined labels, thereby enhancing both its local value and its broader relevance.
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