Aug 2026· Nurse Education Today· Vol 167, pp.
107332
· 0 citations· 51 references
Medicine
TL;DR
There remains a significant gap in the literature supporting the use and application of VR, specifically for training NTS, and it is evident that there is a need to explore whether this simulation modality has great potential for NTS education delivery.
Abstract
Background
Medical errors are a global concern and can compromise patient safety, with up to 80% of these errors directly linked to non-technical skills (NTS) failures. Traditional simulation using mannikins is resource-intensive, and virtual reality simulation (VR) has the potential to offer comparable outcomes with enhanced consistency and lowered resource requirements, but the effectiveness of VR to teach and enhance NTS has been underexplored.
Aim
This scoping review explores the existing literature on VR simulation as a method for teaching NTS in nursing to evaluate whether VR simulation yields positive learning outcomes, particularly in comparison to traditional training methods such as mannikin-based simulation.
Method
The Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) guidelines were utilised. Included studies were written in English and published between 2005 and 2025, leveraging either mixed methods, qualitative or quantitative studies and retrieved from EMBASE, CINAHL, PUBMED, and MEDLINE OVID. The search terms, including nurs*, virtual reality and non-technical skills, were developed using the PCC mnemonic: Population, Concept and Context.
Results
A total of 2787 articles were originally identified. The final selection of 11 articles met the inclusion criteria. The main NTS element measured was communication. No articles explored all elements of NTS, and limited studies measured confidence in performing NTS. Only two articles compared the acquisition of NTS learning within traditional simulation and VR, with neither affirming a preferred training modality.
Conclusion
From the 11 studies reviewed regarding simulation practice as a method for teaching NTS in nursing, there is a large focus on communication related outcomes. However, there remains a significant gap in the literature supporting the use and application of VR, specifically for training NTS. Whilst it is clear, further research is needed to determine the efficacy of VR in relation to NTS performance and related confidence, it is evident that there is a need to explore whether this simulation modality has great potential for NTS education delivery. What is known is VR is cost-effective, accessible and has good usability.
AIM
To examine the current evidence regarding the combined use of virtual simulation and standardized patients in nursing education and to identify implementation patterns, educational outcomes and research gaps.
BACKGROUND
Virtual simulation and standardized patients are widely used in simulation-based nursing education, yet each approach has limitations when used alone. Their combined use may integrate the advantages of repeatable digital practice and authentic interpersonal interaction.
DESIGN
Scoping review.
METHODS
The review followed the Arksey and O'Malley framework and Joanna Briggs Institute guidance. PubMed, Web of Science, Embase, CINAHL, the Cochrane Library, CNKI, Wanfang and CBM were searched from inception to 6 May 2026. Two reviewers independently screened studies and charted data. Findings were synthesised descriptively.
RESULTS
Eight studies published between 2017 and 2025 were included. The studies focused mainly on paediatric nursing, health assessment, end-of-life communication, basic nursing skills and telehealth. Three integration patterns were identified: virtual pre-training followed by standardized-patient scenarios; high-fidelity or electronic simulation combined with standardized patients and immersive virtual reality followed by face-to-face standardized-patient simulation. At the study level, positive changes were reported for knowledge and/or skills in several studies, although the magnitude and statistical significance varied by study design and outcome measure. For example, Yang et al. (2025) reported improvements in selected learning outcomes, whereas the between-group difference in theory scores was not statistically significant. These findings should therefore be interpreted in relation to the methodological heterogeneity of the included studies.
CONCLUSIONS
Combining virtual simulation with standardized patients shows promise for strengthening clinical competence in nursing education. Future research should prioritise standardised intervention frameworks, core outcome sets, multicentre trials, longitudinal follow-up and economic evaluation.
TEL methods appear to improve student learning and provide safe environments for practice, and future research should examine the long-term impact of TEL on learning outcomes, its cost-effectiveness, and its implementation in resource-constrained settings.
Maha Besbes, Anaam Soloh, Mohammed Mustafa et al.· BMC Medical Education· 0 citations
A scoping review was conducted to characterise how Sim-IPE in surgery is practised and researched and described a rich variety of Sim-IPE scenarios, including multiple professions, disciplines, training levels, simulation modalities and settings, facilitating training in a broad range of skills reflective of the complexity of modern surgical care.
Sean Stevens, O. Morice, Deborah Colville et al.· Advances in Simulation· 0 citations
OBJECTIVE
Simulation has become a mainstay in surgical education as it is proven to improve trainees' surgical skills. Virtual reality is a relatively new technology that allows for high-fidelity surgical simulation for many surgical procedures across many specialties. However, there is currently a lack of evidence regarding the effectiveness and value of virtual reality simulation across all surgical specialties. Therefore, we performed a systematic review on the impact of virtual reality surgical simulation on the acquisition of surgical skills.
DESIGN
The review was performed across MEDLINE, Embase, and Web of Science from date inception until April 28, 2025. Articles were included if they explore virtual reality simulation for surgical skills in medical students, surgical residents/interns/fellows, or surgical staff. Outcomes of interest were performance, time, errors, and confidence.
RESULTS AND CONCLUSIONS
The review yielded a total of 22,198 studies, of which 7282 were duplicates. After abstract and full text review, 235 studies were included in the systematic review. The studies came from over 30 countries, and about half studies were randomized controlled trials (51.49%). Residents were the most studied population, and most of the studies were either in general or orthopedic surgery. Most studies reported improvements in performance (75.8%), time (69.9%), errors (66.2%), and confidence (76.2%). Over 60% of studies demonstrated consistent efficacy for all but one outcome subcategory. Ultimately, this review demonstrates that virtual reality surgical simulation has clear benefits for surgical trainee skills.
M. Gold, Élissa S. Colucci, Boaz Laor et al.· Journal of Surgical Educatio...· 0 citations
Virtual simulation has become an increasingly used pedagogical approach in nursing education, particularly since the COVID-19 pandemic. Despite rapid uptake across diverse modalities, a comprehensive map of the evidence covering the post-pandemic surge is lacking. This scoping review systematically maps evidence on virtual simulation in nursing education, identifying technology types, educational applications, research designs, outcome measures, and knowledge gaps to inform future practice and research. A scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology and reported using the PRISMA-ScR checklist; the protocol was retrospectively registered on the Open Science Framework. PubMed, CINAHL (via EBSCOhost), Web of Science Core Collection, and Scopus were searched on 15 January 2026 for English-language peer-reviewed primary research published between January 2019 and December 2025. Two reviewers independently screened records and extracted data, with a third reviewer adjudicating disagreements. Findings were synthesised using descriptive statistics and descriptive categorisation of the extracted data. Of 5,990 records retrieved, 198 studies were included. Publications rose sharply, increasing from two studies in 2019 to 82 in 2025, with almost two-thirds appearing in 2024–2025 (64.6%). Studies originated predominantly from South Korea (21.2%), the USA (18.7%), and China, Taiwan (11.1%). Interactive immersive virtual reality and 360-degree/180-degree video virtual reality together accounted for 63.1% of studies, followed by screen-based virtual simulation (23.7%); augmented reality accounted for a smaller share (4.0%). Quasi-experimental designs (27.8%) and randomised controlled trials (22.7%) predominated. Self-confidence/self-efficacy (44.4%), knowledge acquisition (42.4%) and satisfaction (39.4%) were the most frequently measured outcomes. Favourable findings were commonly reported for these outcomes among the included studies; however, this review did not chart the direction or magnitude of effects, and no methodological quality appraisal was undertaken. Virtual simulation has been implemented across a broad range of nursing education contexts, and the mapped studies predominantly reported positive learning outcomes; however, limited longitudinal follow-up, geographic concentration in East Asia, small samples, and inconsistent outcome measures constrain the evidence base and warrant standardised, multi-site research. Not applicable.
Han Dong, Chen Zhou, Li-Chun Xing et al.· BMC Nursing· 0 citations
Modern surgical training is challenged by reduced operative exposure and increasing requirements for demonstrable technical competence. Virtual Reality (VR) simulation offers an immersive, scalable, and reproducible platform with the potential to modernise laparoscopic training. Understanding VR’s true impact is essential to guide curriculum development and future investment in surgical education. This review evaluates the effectiveness of VR-based training compared with conventional methods in improving laparoscopic technical performance, efficiency, and error reduction in general surgery.
A systematic search of PubMed, Embase, and the Cochrane Library (01/01/2010–present) identified studies involving medical students and surgical trainees performing VR-based laparoscopic training in general surgery. Comparators included curricula and box trainers. Outcomes included OSATS, GOALS, GEARS, task completion time, errors, and precision. Screening followed PRISMA. Risk of bias was assessed using RoB-2, and certainty of evidence was guided by GRADE. The protocol is undergoing PROSPERO registration (ID: 1166264).
Thirty-seven studies demonstrated consistent benefits for VR. Task completion time improved by 10–40%, error rates were reduced by up to 50%, and OSATS/GOALS/GEARS scores showed moderate-to-large gains. Studies reported skill retention for up to 16 weeks. Adjuncts including 3D vision, telestration, robotic guidance, hybrid feedback, and self-debriefing further enhanced efficiency, accuracy, non-technical skills, and learner confidence. Satisfaction with VR was high.
VR-based training accelerates laparoscopic skill acquisition, enhances safety, and improves trainee readiness. These findings support scalable integration of VR within general surgical training pathways to standardise early competence, modernise technical training, and strengthen preparedness for contemporary practice.
E. Alford, Sophie Hong, Gareth Chionh et al.· British Journal of Surgery· 0 citations
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