Journal of Educational Evaluation for Health Professions

Review

The impact of artificial intelligence-driven simulation on the development of non-technical skills in medical education: a systematic review: Sana Loubbairi, Yasmine El Moussaoui, Laila Lahlou, Imad Chakri, Hicham Nassik; J Educ Eval Health Prof. 2025;22:37. Published online November 24, 2025; DOI: https://doi.org/10.3352/jeehp.2025.22.37

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Abstract PDF Supplementary Material: Purpose
Artificial intelligence (AI)-driven simulation is an emerging approach in healthcare education that enhances learning effectiveness. This review examined its impact on the development of non-technical skills among medical learners.
Methods
Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review was conducted using the following databases: Web of Science, ScienceDirect, Scopus, and PubMed. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. The protocol was previously registered in PROSPERO (CRD420251038024).
Results
Of the 1,442 studies identified in the initial search, 20 met the inclusion criteria, involving 2,535 participants. The simulators varied considerably, ranging from platforms built on symbolic AI methods to social robots powered by computational AI. Among the 15 AI-driven simulators, 10 used ChatGPT or its variants as virtual patients. Several studies evaluated multiple non-technical skills simultaneously. Communication and clinical reasoning were the most frequently assessed skills, appearing in 12 and 6 studies, respectively, which generally reported positive outcomes. Improvements were also noted in decision-making, empathy, self-confidence, critical thinking, and problem-solving. In contrast, emotional regulation, assessed in a single study, showed no significant difference. Notably, none of the studies examined reflection, reflective practice, teamwork, or leadership.
Conclusion
AI-driven simulation shows substantial potential for enhancing non-technical skills in medical education, particularly communication and clinical reasoning. However, its effects on several other non-technical skills remain unclear. Given heterogeneity in study designs and outcome measures, these findings should be interpreted cautiously. These considerations highlight the need for further research to support integrating this innovative approach into medical curricula.

Research articles

Mixed reality versus manikins in basic life support simulation-based training for medical students in France: the mixed reality non-inferiority randomized controlled trial: Sofia Barlocco De La Vega, Evelyne Guerif-Dubreucq, Jebrane Bouaoud, Myriam Awad, Léonard Mathon, Agathe Beauvais, Thomas Olivier, Pierre-Clément Thiébaud, Anne-Laure Philippon; J Educ Eval Health Prof. 2025;22:15. Published online May 12, 2025; DOI: https://doi.org/10.3352/jeehp.2025.22.15

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Purpose
To compare the effectiveness of mixed reality with traditional manikin-based simulation in basic life support (BLS) training, testing the hypothesis that mixed reality is non-inferior to manikin-based simulation.
Methods
A non-inferiority randomized controlled trial was conducted. Third-year medical students were randomized into 2 groups. The mixed reality group received 32 minutes of individual training using a virtual reality headset and a torso for chest compressions (CC). The manikin group participated in 2 hours of group training consisting of theoretical and practical sessions using a low-fidelity manikin. The primary outcome was the overall BLS performance score, assessed at 1 month through a standardized BLS scenario using a 10-item assessment scale. The quality of CC, student satisfaction, and confidence levels were secondary outcomes and assessed through superiority analyses.
Results
Data from 155 participants were analyzed, with 84 in the mixed reality group and 71 in the manikin group. The mean overall BLS performance score was 6.4 (mixed reality) vs. 6.5 (manikin), (mean difference, –0.1; 95% confidence interval [CI], –0.45 to +∞). CC depth was greater in the manikin group (50.3 mm vs. 46.6 mm; mean difference, –3.7 mm; 95% CI, –6.5 to –0.9), with 61.2% achieving optimal depth compared to 43.8% in the mixed reality group (mean difference, 17.4%; 95% CI, –29.3 to –5.5). Satisfaction was higher in the mixed reality group (4.9/5 vs. 4.7/5 in the manikin group; difference, 0.2; 95% CI, 0.07 to 0.33), as was confidence in performing BLS (3.9/5 vs. 3.6/5; difference, 0.3; 95% CI, 0.11 to 0.58). No other significant differences were observed for secondary outcomes.
Conclusion
Mixed reality is non-inferior to manikin simulation in terms of overall BLS performance score assessed at 1 month.

Citations

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Enhancing virtual reality applications for adult basic life support: insights from a comparative analysis
Nino Fijačko, Benjamin S. Abella, Vinay M. Nadkarni, Špela Metličar, Anne-Astrid Agten, Robert Greif
Virtual Reality.2026;[Epub] CrossRef
Enhancing STEM and STEAM Education at the Grade Level Through Mixed Reality Applications: A Meta-analytical Study
Segun Michael Ojetunde, Umesh Ramnarain
Canadian Journal of Science, Mathematics and Technology Education.2026;[Epub] CrossRef
IMPACTOS DO USO DE SIMULAÇÃO IMERSIVA NA CAPACITAÇÃO EM ATENDIMENTO À PARADA CARDIORRESPIRATÓRIA
Iago Brenner Farias Leal, Izabelly Ferreira de Andrade, Yan Carlos de Sousa Diniz, Lara Maria Ferreira Lopes Valéri Pinto, Maria Helena Vieira Pereira Marques, Francisca Evelyn Abreu de Lira, Thaís Helena Gomes de Sousa, Maria Isabelly Araújo Ferreira, A
Revista Multidisciplinar do Nordeste Mineiro.2025; 16(1): 1. CrossRef

Simulation-based teaching versus traditional small group teaching for first-year medical students among high and low scorers in respiratory physiology, India: a randomized controlled trial: Nalini Yelahanka Channegowda, Dinker Ramanand Pai, Shivasakthy Manivasakan; J Educ Eval Health Prof. 2025;22:8. Published online February 21, 2025; DOI: https://doi.org/10.3352/jeehp.2025.22.8

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Abstract PDF Supplementary Material

Purpose
Although it is widely utilized in clinical subjects for skill training, using simulation-based education (SBE) for teaching basic science concepts to phase I medical students or pre-clinical students is limited. Simulation-based education/teaching is preferred in cardiovascular and respiratory physiology when compared to other systems because it is easy to recreate both the normal physiological component and alterations in the simulated environment, thus a promoting deep understanding of the core concepts.
Methods
A block randomized study was conducted among 107 phase 1 (first-year) medical undergraduate students at a Deemed to be University in India. Group A received SBE and Group B traditional small group teaching. The effectiveness of the teaching intervention was assessed using pre- and post-tests. Student feedback was obtained through a self administered structured questionnaire via an anonymous online survey and by in-depth interview.
Results
The intervention group showed a statistically significant improvement in post-test scores compared to the control group. A sub-analysis revealed that high scorers performed better than low scorers in both groups, but the knowledge gain among low scorers was more significant in the intervention group.
Conclusion
This teaching strategy offers a valuable supplement to traditional methods, fostering a deeper comprehension of clinical concepts from the outset of medical training.

Citations

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Use of simulation in physiology teaching: a focus on medical education
Levi Davis, Madeline Rapp, Zachary Rundell, Layla Al-Nakkash
Current Opinion in Physiology.2026; 47: 100920. CrossRef
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Case Study

Feasibility of utilizing functional near-infrared spectroscopy to measure the cognitive load of paramedicine students undertaking high-acuity clinical simulations in Australia: a case study: Jason Betson, Erich Christian Fein, David Long, Peter Horrocks; J Educ Eval Health Prof. 2024;21:38. Published online December 10, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.38

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Abstract PDF Supplementary Material

Purpose
Paramedicine education often uses high-fidelity simulations that mimic real-life emergencies. These experiences can trigger stress responses characterized by physiological changes, including alterations in cerebral blood flow and oxygenation. Functional near-infrared spectroscopy (fNIRS) is emerging as a promising tool for assessing cognitive stress in educational settings.
Methods
Eight final-year undergraduate paramedicine students completed 2 high-acuity scenarios 7 days apart. Real-time continuous recording of cerebral blood flow and oxygenation levels in the prefrontal cortex was undertaken via fNIRS as a means of assessing neural activity during stressful scenarios.
Results
fNIRS accurately determined periods of increased cerebral oxygenation when participants were undertaking highly technical skills or making significant clinical decisions.
Conclusion
fNIRS holds potential for objectively measuring the cognitive load in undergraduate paramedicine students. By providing real-time insights into neurophysiological responses, fNIRS may enhance training outcomes in paramedicine programs and improve student well-being (Australian New Zealand Clinical Trials Registry: ACTRN12623001214628).

Citations

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Effect of repeating simulated high-stress scenario assessments on paramedicine student performance and psychophysiological response
Jason Betson, Erich C. Fein, David Long, Peter Horrocks
Interactive Learning Environments.2025; : 1. CrossRef
Relationships between cognitive appraisals of threat and challenge, psychophysiological responses, and clinical performance during high-stress simulated osces
Jason Betson, Erich C. Fein, David Long, Peter Horrocks
BMC Medical Education.2025;[Epub] CrossRef

Research articles

The effect of simulation-based training on problem-solving skills, critical thinking skills, and self-efficacy among nursing students in Vietnam: a before-and-after study: Tran Thi Hoang Oanh, Luu Thi Thuy, Ngo Thi Thu Huyen; J Educ Eval Health Prof. 2024;21:24. Published online September 23, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.24

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Abstract PDF Supplementary Material

Purpose
This study investigated the effect of simulation-based training on nursing students’ problem-solving skills, critical thinking skills, and self-efficacy.
Methods
A single-group pretest and posttest study was conducted among 173 second-year nursing students at a public university in Vietnam from May 2021 to July 2022. Each student participated in the adult nursing preclinical practice course, which utilized a moderate-fidelity simulation teaching approach. Instruments including the Personal Problem-Solving Inventory Scale, Critical Thinking Skills Questionnaire, and General Self-Efficacy Questionnaire were employed to measure participants’ problem-solving skills, critical thinking skills, and self-efficacy. Data were analyzed using descriptive statistics and the paired-sample t-test with the significance level set at P<0.05.
Results
The mean score of the Personal Problem-Solving Inventory posttest (127.24±12.11) was lower than the pretest score (131.42±16.95), suggesting an improvement in the problem-solving skills of the participants (t172=2.55, P=0.011). There was no statistically significant difference in critical thinking skills between the pretest and posttest (P=0.854). Self-efficacy among nursing students showed a substantial increase from the pretest (27.91±5.26) to the posttest (28.71±3.81), with t172=-2.26 and P=0.025.
Conclusion
The results suggest that simulation-based training can improve problem-solving skills and increase self-efficacy among nursing students. Therefore, the integration of simulation-based training in nursing education is recommended.

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Paola Del Sette, Gabriella Biffa, Annamaria Bagnasco, Gianluca Catania, Milko Zanini, Francesca Riccardi
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Mario Roberto Sate, María Eugenia Gonzalez, Carmen Graciela Mezacapo, Pablo Andrés Salgado, Gloria Ester Rodríguez
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Medical students’ self-assessed efficacy and satisfaction with training on endotracheal intubation and central venous catheterization with smart glasses in Taiwan: a non-equivalent control-group pre- and post-test study: Yu-Fan Lin, Chien-Ying Wang, Yen-Hsun Huang, Sheng-Min Lin, Ying-Ying Yang; J Educ Eval Health Prof. 2022;19:25. Published online September 2, 2022; DOI: https://doi.org/10.3352/jeehp.2022.19.25

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Abstract PDF Supplementary Material

Purpose
Endotracheal intubation and central venous catheterization are essential procedures in clinical practice. Simulation-based technology such as smart glasses has been used to facilitate medical students’ training on these procedures. We investigated medical students’ self-assessed efficacy and satisfaction regarding the practice and training of these procedures with smart glasses in Taiwan.
Methods
This observational study enrolled 145 medical students in the 5th and 6th years participating in clerkships at Taipei Veterans General Hospital between October 2020 and December 2021. Students were divided into the smart glasses or the control group and received training at a workshop. The primary outcomes included students’ pre- and post-intervention scores for self-assessed efficacy and satisfaction with the training tool, instructor’s teaching, and the workshop.
Results
The pre-intervention scores for self-assessed efficacy of 5th- and 6th-year medical students in endotracheal intubation and central venous catheterization procedures showed no significant difference. The post-intervention score of self-assessed efficacy in the smart glasses group was better than that of the control group. Moreover, 6th-year medical students in the smart glasses group showed higher satisfaction with the training tool, instructor’s teaching, and workshop than those in the control group.
Conclusion
Smart glasses served as a suitable simulation tool for endotracheal intubation and central venous catheterization procedures training in medical students. Medical students practicing with smart glasses showed improved self-assessed efficacy and higher satisfaction with training, especially for procedural steps in a space-limited field. Simulation training on procedural skills with smart glasses in 5th-year medical students may be adjusted to improve their satisfaction.

Citations

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A narrative review of advancing medical education through technology: the role of smart glasses in situated learning
Bahareh Ghavami Hosein Pour, Zahra Karimian, Nazanin Hatami Niya
BMC Medical Education.2025;[Epub] CrossRef
Improvement of the Endotracheal Intubation Skill of Nurse Anesthesia Students Using Visual Self-evaluation in Iran: A Randomized Controlled Study
Mahdieh Parhizkar, Ali Khalafi, Masoumeh Albooghobeish, Nooshin Sarvi-Sarmeydani
Shiraz E-Medical Journal.2024;[Epub] CrossRef
The use of smart glasses in nursing education: A scoping review
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Simulation-based training using a novel Surabaya hysterectomy mannequin following video demonstration to improve abdominal hysterectomy skills of obstetrics and gynecology residents during the COVID-19 pandemic in Indonesia: a pre- and post-intervention study: Dara Dasawulansari Syamsuri, Brahmana Askandar Tjokroprawiro, Eighty Mardiyan Kurniawati, Budi Utomo, Djoko Kuswanto; J Educ Eval Health Prof. 2022;19:11. Published online May 17, 2022; DOI: https://doi.org/10.3352/jeehp.2022.19.11

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Abstract PDF Supplementary Material

Purpose
During the coronavirus disease 2019 (COVID-19) pandemic, the number of abdominal hysterectomy procedures decreased in Indonesia. The existing commercial abdominal hysterectomy simulation model is expensive and difficult to reuse. This study compared residents’ abdominal hysterectomy skills after simulation-based training using the Surabaya hysterectomy mannequin following a video demonstration.
Methods
We randomized 3rd- and 4th-year obstetrics and gynecology residents to a video-based group (group 1), a simulation-based group (group 2), and a combination group (group 3). Abdominal hysterectomy skills were compared between before and after the educational intervention. The pre- and post-tests were scored by blinded experts using the validated Objective Structured Assessment of Technical Skills (OSATS) and Global Rating Scale (GRS).
Results
A total of 33 residents were included in the pre- and post-tests. The OSATS and GRS mean differences after the intervention were higher in group 3 than in groups 1 and 2 (OSATS: 4.64 [95% CI, 2.90–6.37] vs. 2.55 [95% CI, 2.19–2.90] vs. 3.82 [95% CI, 2.41–5.22], P=0.047; GRS: 10.00 [95% CI, 7.01–12.99] vs. 5.18 [95% CI, 3.99–6.38] vs. 7.18 [95% CI, 6.11–8.26], P=0.006). The 3rd-year residents in group 3 had greater mean differences in OSATS and GRS scores than the 4th-year residents (OSATS: 5.67 [95% CI, 2.88–8.46]; GRS: 12.83 [95% CI, 8.61–17.05] vs. OSATS: 3.40 [95% CI, 0.83–5.97]; GRS: 5.67 [95% CI, 2.80–8.54]).
Conclusion
Simulation-based training using the Surabaya hysterectomy mannequin following video demonstration can be a bridge to learning about abdominal hysterectomy for residents who had less surgical experience during the COVID-19 pandemic.

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Improving the quality of care and patient safety in oncology, the contribution of simulation-based training: A scoping review
Nadia Al Wachami, Mohamed Chahboune, Ibtissam Youlyouz-marfak, Mohamed Reda Mesradi, Hajar Lemriss, Abderraouf Hilali
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Comparison of the use of manikins and simulated patients in a multidisciplinary in situ medical simulation program for healthcare professionals in the United Kingdom: Marrit Meerdink, Joshua Khan; J Educ Eval Health Prof. 2021;18:8. Published online April 20, 2021; DOI: https://doi.org/10.3352/jeehp.2021.18.8

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Abstract PDF Supplementary Material

Purpose
Simulation training is increasingly popular in healthcare education, and often relies on specially designed manikins. However, it is also possible to work with actors, or simulated patients (SPs), which may provide a greater sense of realism. This study aimed to compare these 2 approaches, to ascertain which makes healthcare professionals feel most comfortable, which leads to the greatest improvement in confidence, and which is most beneficial to learning.
Methods
This study was embedded in a pre-existing multidisciplinary in situ simulation program. A multidisciplinary group of learners from a range of backgrounds—including nurses, doctors, and other allied health professionals—were asked to complete a questionnaire about their learning preferences. We collected 204 responses from 40 simulation sessions over 4 months, from September to December 2019. Of these 204 responses, 123 described using an SP and 81 described using a manikin.
Results
We found that 58% of respondents believed they would feel more comfortable working with an actor, while 17% would feel more comfortable using a manikin. Learners who used both modalities reported a significant increase in confidence (P<0.0001 for both). Participants felt that both modalities were beneficial to learning, but SPs provided significantly more benefits to learning than manikins (P<0.0001). The most common reason favoring SP-based simulation was the greater realism.
Conclusion
In scenarios that could reasonably be provided using either modality, we suggest that educators should give greater consideration to using SP-based simulation.

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Brief report

Impact of multi-professional simulation-based training on perceptions of safety and preparedness among health workers caring for coronavirus disease 2019 patients in Pakistan: Jamal Azfar Khan, Muhammad Rizwan Bashir Kiani; J Educ Eval Health Prof. 2020;17:19. Published online June 29, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.19

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Abstract PDF Supplementary Material

This study aimed to evaluate perceptions of safety and preparedness among health workers caring for coronavirus disease 2019 (COVID-19) patients before and after a multi-professional simulation-based course in Pakistan. Health workers’ perceptions of preparedness, safety, and their willingness to care for COVID-19 patients were measured before and after they attended a simulation-based training course to prepare them to care for COVID-19 patients at Combined Military Hospital Landi Kotal Cantt, from March 1 to April 30, 2020. The participants’ perceived level of safety and preparedness to care for COVID-19 patients before the simulation-based course was low, but increased after completing it (P<0.05). They felt confident and were significantly more willing to care for patients with COVID-19 or other infections requiring strict isolation. Simulation-based training is an effective tool to improve perceptions of risk and readiness to deal with COVID-19 among medical and non-medical health workers in Pakistan.

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Research Article

Randomized study of effectiveness of computerized ultrasound simulators for an introductory course for residents in Brazil: Jack Philip Silva, Trevor Plescia, Nathan Molina, Ana Claudia de Oliveira Tonelli, Mark Langdorf, John Christian Fox; J Educ Eval Health Prof. 2016;13:16. Published online April 4, 2016; DOI: https://doi.org/10.3352/jeehp.2016.13.16

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Abstract PDF

Purpose
This study aimed to assess the impact of ultrasound simulation (SonoSim) on educational outcomes of an introductory point-of-care ultrasound course compared to hands-on training with live models alone. Methods: Fifty-three internal medicine residents without ultrasound experience were randomly assigned to control or experimental groups. They participated in an introductory point-of-care ultrasound course covering eight topics in eight sessions from June 23, 2014 until July 18, 2014. Both participated in lecture and hands-on training, but experimental group received an hour of computerized simulator training instead of a second hour of hands-on training. We assessed clinical knowledge and image acquisition with written multiple-choice and practical exams, respectively. Of the 53 enrolled, 40 participants (75.5%) completed the course and all testing. Results: For the 30-item written exam, mean score of the experimental group was 23.1±3.4 (n=21) vs. 21.8±4.8 (n=19), (P>0 .05). For the practical exam, mean score for both groups was 8.7 out of 16 (P>0 .05). Conclusion: The substitution of eight hours of ultrasound simulation training for live model scanning in a 24 hour training course did not enhance performance on written and image acquisition tests in an introductory ultrasound course for residents. This result suggests that ultrasound simulation technology used as a substitute for live model training on an hour-for-hour basis, did not improve learning outcomes. Further investigation into simulation as a total replacement for live model training will provide a clearer picture of the efficacy of ultrasound simulators in medical education.

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