More is not better: A scoping review of simulation in transition to residency programs

Transition to residency programs frequently use simulation to promote clinical skills but place limited emphasis on non-clinical skills. We conducted a scoping review to determine how simulation is being used in transition to residency programs and the key non-clinical skills addressed by simulation activities and tools in these programs.

We searched PubMed, Scopus, and Embase to identify articles addressing transition to residency, simulation, and non-clinical skills/attributes. Two authors independently screened all abstracts and full-text articles and identified non-clinical attributes elicited in each study. Using descriptive statistics, we characterized the simulation activities and tools and the number and type of non-clinical attributes captured in the programs. Using analysis of variance, we compared the number of non-clinical attributes elicited based on the number of simulation activities used and compared the number of non-clinical attributes elicited based on the number of simulation tools used.

We identified 38 articles that met the study criteria. We characterized simulation activities as mock paging (37%), case-based scenarios (74%), and/or procedural skills training (39%). We found that the most common simulation tools were standardized patients (64.8%), and the most elicited non-clinical attributes were communication skills, critical thinking, and teamwork. Using more simulation activity categories or simulation tools did not increase the number of non-clinical skills elicited.

Simulation is used broadly in transition to residency programs but provides training in a few of the non-clinical skills required for a successful transition. Incorporating more simulation activities or tools does not increase the number of non-clinical attributes elicited, illustrating the importance of developing more targeted simulation activities to promote non-clinical skills more effectively.