Virtual simulation combined with standardized patients in nursing education: A scoping review of current practice, educational outcomes and research gaps.

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.