Different theoretical frameworks offer specific, but separate, understandings of the same phenomenon. With the increasing use of simulation for training and assessment in medical education, it is vital to consider how different frameworks grant various insights into the pedagogical value of simulation. In this article, the author evaluated three exemplar theoretical frameworks, cultural-historical activity theory, cognitive load theory, and grounded theory, considering their ontological and epistemological stances, their limitations, and their application to simulation training. The greater understanding offered by this article will inform research design and interpretation of results, enabling a more theoretically poised construction of pedagogical techniques.