Advancing Continuous KRT Education: Simulation and Technology-Enhanced Learning in Contemporary Practice

Continuous renal replacement therapy (CRRT) is a technically complex, high-risk ICU therapy in which preventable interruptions, alarm-related downtime, and circuit failure remain common and strongly influenced by clinician-dependent troubleshooting. High workforce turnover and variable local mentorship further limit consistent skills acquisition, while institutional heterogeneity in practice persists across settings. Despite these realities, structured CRRT training and validated competency assessment frameworks remain inconsistently implemented, creating a critical gap between clinical demands and current educational infrastructure. Simulation-based education offers a uniquely suitable strategy to address these gaps by enabling safe, reproducible deliberate practice of rare-but-critical events, structured development of higher-order decision-making, and multidisciplinary rehearsal of time-sensitive troubleshooting. This narrative review synthesizes current evidence on simulation-based CRRT training, spanning traditional low- and high-fidelity in-person approaches as well as technology-enhanced virtual modalities such as screen-based platforms, virtual/augmented reality environments, and embedded learning analytics. We highlight how these approaches can improve accessibility and scalability by delivering standardized, repeatable practice of high-risk workflows (e.g., circuit setup, alarm management, escalation decision-making) across institutions with variable equipment, faculty expertise, and local CRRT volume. We also review emerging artificial intelligence-enabled approaches, including adaptive simulation engines and large language model-driven virtual patients, that may enable dynamic scenario progression, performance-targeted feedback, and more cognitively realistic longitudinal patient trajectories. Finally, we propose practical principles for integrating simulation modalities in a layered framework aligned with competency domains and cognitive demands, while emphasizing how digital innovation could augment hands-on practice, bedside supervision, and expert mentorship to improve CRRT competency, standardization, equity, and safety worldwide.