OBJECTIVE: To propose a simulation-based learning curriculum for trainees to comprehend and apply qualitative methodology. DESIGN: After learning theoretical principles of qualitative methodology through assigned readings and meetings with an expert, a surgical simulation fellow practiced applying grounded theory principles to evaluate a piloted simulation curriculum teaching surgery residents de-escalation communication skills. The simulation consisted of a "just-in-time" de-escalation training, 2 simulated patient (SP) encounters, and 2 learner debrief sessions. All components were video recorded, then transcribed. The first authors performed first and second level coding yielding thematic data. SETTING: Single academic institution PARTICIPANTS: One surgical simulation fellow. RESULTS: About 3 themes emerged describing key aspects of the pilot simulation. The first, Escalation Spirals and SP case portrayal, consisted of the SP assuming the role of an agitated patient, as trained, with escalating and de-escalating emotions based on learner interactions. The second theme, Safety Codes, identified critical safety issues in the simulation. Lastly, Rule Confusion included the learner not understanding simulation logistics. These themes informed the team of what to keep and change for the next simulation pilot of the de-escalation curriculum. CONCLUSIONS: Teaching qualitative methods in a practice-based learning format is feasible and has simultaneous potential to improve educational content and safety simulation-based curricula.