Building interoperability early: international faculty perspectives on multinational military medical education in undergraduate training

Introduction: As military operations increasingly rely on coalition partnerships, interoperability has become a core competency for medical readiness. Traditionally emphasised in postgraduate or deployment settings, earlier integration of interoperability-focused training in undergraduate medical education (UME) may better prepare physicians for coalition environments. Simulation-based education (SBE) offers an effective platform for developing shared understanding, communication, and trust within multinational teams, with multinational faculty informing best practices in programme design and implementation. Methods: We conducted a qualitative phenomenological study exploring faculty perspectives on multinational SBE during a large-scale, high-fidelity military training exercise. Faculty from multiple North Atlantic Treaty Organization partner nations participated in semistructured interviews and focus groups conducted during or shortly after the exercise. Transcripts were analysed using inductive thematic analysis to identify patterns related to learning outcomes, interoperability and coalition readiness. Results: Four themes emerged: enhanced cultural competence, development of a common operating picture, increased interoperability and a positive outlook on international collaboration. Multinational SBE promoted shared professional identity, reduced cultural and communication barriers and supported development of non-technical skills, including communication, situational awareness and decision-making under pressure. Interoperability was described as extending beyond equipment compatibility to include procedural alignment, shared cognition and mutual trust. International faculty were essential for modelling best practices, identifying operational frictions and supporting curricular transfer across institutions. Conclusions: Multinational SBE is a key enabler of military medical training, fostering competencies required for effective coalition performance. Early integration of interoperability-focused training in UME, supported by international faculty engagement, may strengthen readiness, reduce operational friction and enhance global health security.