Abstract
The purpose of this article is to describe the process and lessons learned in conducting an international, multisite simulation research study. Key lessons include asking site leaders to complete human subjects training early, applying for a deferral agreement for multiple sites, standardization, seeking consultation, considering differences in simulation centers, and having a back-up plan if committed team members are unable to progress. Although challenging, this process yields many rewards and raises the state of the science to improve pedagogy and student learning outcomes.