Should we add smells in simulation training? A systematic review of smells in healthcare-related simulation training

Olfactory stimuli are rarely used in healthcare-related simulation training. Their addition may improve simulator validity, biographical memory formation and coping mechanisms for exposure to strong malodours. Some military simulators already employ smells in simulation training, and the technology and principles may be used to cross over into medical simulation training. We set out to determine if there is evidence to suggest that smell should be routinely incorporated into medical simulation training. We carried out a systematic review of the literature relating to use of olfactory stimuli in medical simulation training, and identified 5 relevant papers. 3 were experimental studies and 2 were observational studies. The results of the experimental studies were mixed, though there were some indications that the use of a clinically relevant smell instead of a congruent background smell may be more effective. We discuss the benefits of the inclusion of smell in simulation training and identify that there are currently few high-quality studies addressing the use of smell in medical simulation training.