Virtual clinical simulation as a pedagogical strategy in healthcare learning: Evidence and gap map

To map and characterize, systematically, the volume, scope and distribution of systematic review evidence on virtual clinical simulation in healthcare education, describing the educational outcomes assessed, the contexts and modalities where virtual simulations have been implemented and the main evidence gaps identified.

Virtual clinical simulations are increasingly used to support healthcare education and training. However, existing evidence on their effectiveness remains fragmented, with variations in methodological quality and scope.

Evidence and Gap Map (EGM) following Campbell Collaboration Guidance.

A systematic search was conducted across nine databases and two gray literature sources. Eligible studies included systematic reviews examining healthcare professionals or students using virtual simulations. Data were extracted using the PICOS framework and reviewed independently by two researchers. Methodological quality was assessed using AMSTAR-2 and confidence in findings was appraised using CERQual.

A total of 118 reviews met inclusion criteria: 91 systematic, 25 scoping and 2 umbrella reviews. Most were published within the past four years and originated from high-income countries. We identified seven categories across the results: (1) Learning and Knowledge Acquisition; (2) User Perception; (3) Development of Technical Skills; (4) Simulation Performance; (5) Development of Practical Skills; (6) Transfer to Real Clinical Practice; and (7) Program Effectiveness. More than half of the systematic reviews were rated as low or critically low quality, with only 10 % achieving high methodological rigour.

Virtual clinical simulations demonstrate potential to enhance learning outcomes in healthcare education. However, evidence is limited by uneven methodological quality, concentration in high-income settings and a lack of research on emerging technologies and long-term educational impacts. Future high-quality, comparative studies are needed to strengthen the evidence base.