Simulation gives students opportunities to practise professional work without the risks, unpredictability or access limitations of real practice.
A simulation might involve:
What makes these activities simulation is not the technology. It is that students are asked to respond to a representation of professional practice.
This distinction matters. Watching someone demonstrate a procedure or reading a clinical case may help students learn, but simulation requires the learner to do some of the cognitive, interpersonal or physical work of practice themselves.
For example, instead of telling students how to manage a deteriorating patient, challenging classroom interaction or difficult consultation, give them an opportunity to notice what is occurring, decide how to respond, act on that decision and experience the consequences of their choices.
Simulation has a large positive effect on the development of complex professional skills ➕➕➕➕➕ [1–4]. Benefits have been demonstrated across higher education, including nursing and pre-service teacher education, and are particularly evident for skills such as professional performance, problem-solving, diagnostic reasoning and technical performance.
The amount and type of support students need appears to depend on their experience. Less experienced learners may benefit from greater guidance, prompts and examples, while more experienced learners can increasingly manage the task and reflect on their own performance [1].
More realism is not automatically better. Higher-fidelity simulation can improve skill performance and clinical competence ➕➕➕➕➕, but does not reliably improve knowledge, confidence or satisfaction [6]. The best simulation is therefore the one that reproduces the important demands of the capability being taught. For example, human simulated patients may be particularly useful when communication and interpersonal responsiveness are central to the task [5].
This summary is informed primarily by four meta-analyses and one umbrella review, with additional reviews used to examine specific simulation-design features [1–7].
The broadest meta-analysis included 145 studies of simulation-based learning across higher education [1]. The effect remained large in the subgroup of undergraduate and graduate students, but heterogeneity was very high. We rate this review as high quality ➕➕➕➕.
An umbrella review of undergraduate nursing included six systematic reviews representing 133 primary studies [2]. It found substantial benefits for knowledge and professional performance, although heterogeneity remained high ➕➕➕. Evidence from pre-service teacher education also showed positive effects, supporting some generalisation beyond healthcare [4].
Other reviews examining standardised patients and simulation fidelity are less robust, but provide useful information about implementation [5,6]. In particular, higher fidelity appears beneficial for some performance outcomes but is not consistently superior for knowledge, confidence or satisfaction.
Overall, the evidence strongly supports simulation as a professional-learning strategy, but there is less certainty about which particular simulation design is best.
