Healthcare providers are often trained and evaluated in an encounter of a single patient. Healthcare education does not adequately instruct or assess trainees in the management of increasing cognitive complexity and system influences of real-life clinical environments during multi-patient care. It is imperative that we begin to understand the best methodologies to improve knowledge, skills, teamwork, and communication during the care of multiple patients. The purpose of this chapter is to provide a practical guide for simulation educators and researchers who wish to design simulation resources to improve individual, team, or system skills during clinical surges.