Simulation-based learning (SBL) is often used in healthcare education. Professional development has been identified as crucial to the success of SBL. Effective, high-quality SBL requires facilitators who are multiskilled and have a range of SBL-related knowledge, skills and attitudes, which require time and practice to acquire. However, investment in facilitators' competence is often limited, particularly at smaller institutions without an associated simulation centre. The purpose of this study is to describe how a smaller university college with limited resources and limited facilitation experience has initiated continuing professional development and how this continuing professional development has contributed to maintaining and developing SBL facilitators' competence. Participatory action research has been used to improve the practice of SBL facilitators at a university college in Norway. The evaluations and reflections of 10 facilitators engaged in professional development and 44 national simulation conference participants have been analysed by way of Vaismoradi's qualitative content analysis. A culture of participation and engagement and a clear professional development structure are both of crucial importance in the implementation and maintenance of continuing professional development in SBL. When these are present, not only does facilitation become more transparent, but facilitators become more aware of their own strengths and weaknesses, manage to address these and perceive an improvement in their confidence and competence. Facilitators at smaller institutions without an associated simulation centre can improve their competence and confidence in SBL beyond the initial course, despite the absence of experienced mentors. The results indicate the importance of engaging in ongoing training and self-reflection based on peer feedback, the facilitators' own experience and up-to-date literature. Implementing and maintaining professional development at smaller institutions requires a clear structure, clear expectations and a culture of participation and development.

Background/Objectives: Anxiety and depression are common among individuals with coronary heart disease (CHD) and pose significant barriers to lifestyle modifications. Evidence on sex-related differences in anxiety and depression following cardiac rehabilitation (CR) remains inconclusive. This study aims to assesses the prevalence and changes in anxiety and depression symptoms during CR and explores potential sex differences. Methods: A quasi-experimental one-group pretest–post-test design was employed, measuring self-reported anxiety and depression symptoms utilizing the Hospital Anxiety and Depression Scale (HADS). Results: HADS was reported by 175 patients, 122 men and 53 women, at CR admission and discharge between 1 January 2022 and 30 April 2024. The prevalence of anxiety symptoms (HADS-anxiety score ≥ 8) significantly decreased from 28.2% at admission to 16.9% at discharge, while depression prevalence dropped (HADS-depression score ≥ 8) from 16.3% to 6.2%. Statistically significant sex differences were observed in depression prevalence at discharge, with women exhibiting lower symptom prevalence. Both sexes experienced significant HADS-anxiety and HADS-depression score reductions (p < 0.001) in both the overall sample and the sub-analysis of patients presenting with symptoms at admission. Women initially presented higher HADS-anxiety scores and significantly greater HADS-anxiety score reductions (p = 0.014) than men. No significant sex differences were observed in the reduction in HADS-depression scores. Conclusions: The prevalence of anxiety and depression symptoms significantly decreased among both sexes compared to admission, with women experiencing greater symptom reduction at discharge than men. Further research is needed to determine specific CR components contributing to these improvements.