Do virtual simulations count as hands-on?

Do virtual simulations count as hands-on hours? In allied health education the answer depends on the accreditor, and it ranges from a written cap with a conversion rate to an explicit prohibition. Programs comparing hands-on kits with online labs are often asking a narrower question than the standards answer: whether the hours can be credited toward required clinical or practical experience. This article reports only what seven accrediting bodies' published documents say, including where they are silent.

Hands-on hours, lab hours and clinical hours are different things

The phrase hands-on covers three separate categories in accreditation documents. Laboratory or preclinical instruction is supervised campus practice on models, manikins or other simulation methods. Clinical education is patient care in real facilities under supervision. Simulation is a technique that can sit in either category depending on the accreditor.

A simulation hour that strengthens a skill before a placement is an instructional decision. A simulation hour counted in place of a placement hour is a substitution, and substitution is what accreditors regulate.

What each accreditor says

The table summarizes the published language reviewed, as in force in October 2026 plus one standard effective January 1, 2027. Programs should read the current document for their own discipline.

Respiratory therapy: a written cap and a conversion rate

The CoARC 2027 entry standards were approved on March 21, 2026 and take effect on January 1, 2027. They are specific. Up to 25% of the program-required clinical clock hours, with the associated clinical competency evaluation, may be completed through simulation, and one simulation hour may be counted as two clinical hours.

As an illustration (ours, not CoARC's), a program requiring 400 clinical hours could credit at most 100 of them to simulation, which would take 50 simulation hours at the two-to-one rate.

Simulation must include pre-briefing, the structured activity, theory-based debriefing and evaluation. Hours used as clinical substitution may not also be counted as laboratory hours, and the student-to-instructor ratio cannot exceed 6:1. A virtual simulation without facilitation and debriefing would not meet this description.

Paramedic and EMS: encouraged, but a program decision

The joint CoAEMSP and NREMT guidance, revised in 2026, describes simulation as appropriate for learning and competency evaluation, and says entry-level competency is determined using simulation, clinical and field assessments. It also says simulation is not a replacement for all live patient experiences, and that there is no recommendation for how many simulations can replace a live encounter.

The document states that it does not define requirements. It leaves any ratio to the program and says simulation used in lieu of a live encounter should be high fidelity, a term it applies to any mode, including virtual reality, manikins and task trainers. The binding minimums are in the CAAHEP standards, which this article did not review.

Sonography and surgical technology: live patients required

The JRC-DMS standards allow some scan proficiencies, such as abdominal vascular Doppler assessment, to be demonstrated in a clinical setting or a simulated environment. The same standards say clinical competency must be assessed in a diagnostic clinical affiliate. The interpretive guide is direct: simulation of sonographic examination competence, at this time, is not an option for programs to fulfill clinical competency requirements.

ARC/STSA is equally direct for surgical technology: simulation cannot be substituted for clinical experience, and cases counted toward the core curriculum must be completed during live surgical procedures.

Pharmacy technician, dental hygiene and laboratory science

The 2026 ASHP and ACPE pharmacy technician standard requires at least 400 hours across three modalities, with 50 hours of hands-on simulation and 120 hours of experiential training. Simulation here is a required stage that prepares students for externship, not a credit against it.

The CODA dental hygiene standards define laboratory or preclinical instruction as supervised experience using study models, manikins or other simulation methods, and clinical education as the patient care experiences required for competence. The text reviewed does not credit simulation as clinical education. NAACLS requires clinical or applied learning with an assigned preceptor, and the text reviewed says nothing about simulation. Silence is not permission, so a program should ask before relying on simulation for clinical credit.

How to use this when evaluating a virtual lab

• Identify the accreditor and the exact standard version in force, including any edition effective next year.
• Decide whether the use is rehearsal, assessment or substitution, since standards treat them differently.
• Where substitution is allowed, record the cap, conversion rate, debriefing requirement and instructor ratio.
• Ask the accreditor and any state or provincial regulator in writing, because regulators can be stricter.

ngnsimulation offers unscripted AI patient encounters inside an EHR-style chart, including spoken OSCE practice, adaptive study and quizzing with a placement check, and faculty-facing competency analytics, running alongside an existing LMS. Whether simulated hours may be credited is a decision for each program and its accreditor. For nursing rules, see does simulation count toward clinical hours, and for requirements by role, see the free licensure map at the licensure map.