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Previous research on Simulator Based Education (SBE), has indicated lack of theory guided research. We apply a sociocultural lens on tool-mediation, which widens our understanding of how humans learn, develop and transform their local environment through tool-mediated activities (Vygotsky 1986). The data consist of 48 hours of video recorded interactions of nursing students (N=40) and their instructors (N=10), in three advanced simulator suits. By analyzing expansive and restrictive use of digital and hands-on artifacts and tools our study provides new research knowledge on the meaning of material artifacts in social interactions in the context of medical education/training. Our work informs the future educational design of simulation exercises, for the advancement of students’ 21st century skills and continuous learning opportunities.