Scoping Review Maps Simulation-Based Team Training in Surgery

A new scoping review published in Advances in Simulation provides a comprehensive map of how simulation-enhanced interprofessional education is currently practiced and researched within surgical contexts. The study, led by Sean Stevens and colleagues, analyzed 81 articles to characterize the diversity of training scenarios, the professions involved, and the methodological approaches used to evaluate these educational interventions. By synthesizing this emerging body of literature, the researchers aimed to identify gaps in practice and research that could inform future developments in surgical education and patient safety.

The review focused specifically on simulation-based education that combines interprofessional learning, a method where two or more health professions learn with, from, and about one another to improve collaborative care. In surgery, this approach is particularly relevant because serious adverse outcomes are often linked to failures in communication and teamwork rather than technical error alone. The authors sought to understand how this educational model is implemented in a field characterized by high complexity, significant patient risk, and traditional hierarchical structures that may resist collaborative training paradigms.

Methodologically, the researchers followed the Arksey and O’Malley framework for scoping reviews and adhered to the PRISMA-ScR checklist for reporting. They searched five electronic databases, including Medline, EMBASE, Web of Science, PsycINFO, and ERIC, for records published after January 1, 2000. The search strategy targeted studies involving surgeons, surgical trainees, or medical students learning surgical topics within hospital settings, such as operating theatres, emergency departments, or surgical wards. This rigorous approach ensured that the included studies were conceptually coherent and directly relevant to the intersection of simulation and interprofessional surgical care.

The analysis revealed a rich variety of simulation scenarios, with the majority involving doctors and nurses. Specifically, 86.1% of the scenarios included nurses, and just over half involved a combination of doctors, nurses, and other healthcare workers. These ‘other workers’ encompassed a wide range of professions, including physiotherapists, pharmacists, paramedics, and theatre technicians. General surgery was the most commonly represented specialty, accounting for nearly two-thirds of the studies, followed by cardiothoracic and pediatric surgery. The settings for these simulations were predominantly the operating theatre and the emergency department, reflecting the high-stakes environments where interprofessional teamwork is most critical.

In terms of simulation modalities, manikins were the most frequently used tool, appearing in 75% of the scenarios. However, the review highlighted a trend toward multimodal simulations, with nearly 28% of scenarios using multiple modalities simultaneously. These additional tools included simulated participants, cadavers, task trainers, computers, and laparoscopic simulators. The use of multiple modalities allows for a more realistic and comprehensive training experience, enabling participants to practice a broader range of skills, from technical procedures to complex communication tasks such as breaking bad news to family members.

One of the key findings of the review was the limited depth of evaluation in the existing literature. Almost half of the studies that reported on evaluation outcomes were limited to assessing participants’ views of their learning experience and satisfaction with the program, known as Level 1 in the Modified Kirkpatrick Model. Fewer studies examined higher-level outcomes, such as changes in workplace behavior or benefits to patients. This focus on short-term, learner-level outcomes suggests that the field has yet to fully demonstrate the long-term impact of simulation-enhanced interprofessional education on clinical practice and patient safety.

The review also identified significant barriers to the implementation of these programs. The most frequently cited barrier was the lack of protected training time within regular working hours, a challenge exacerbated by the high demand for surgical services and the pressure to maintain theatre productivity. Funding was another major issue, with many programs terminating once initial research grants ended. Cultural factors, including traditional hierarchies and skepticism toward interprofessional education, also posed challenges. The authors noted that overcoming these barriers would require both structural changes, such as policy and funding support, and cultural shifts in leadership and team identity.

Despite these challenges, the review found several facilitators that supported the successful implementation of simulation-enhanced interprofessional education. Skilled faculty with experience in simulation-based education were identified as crucial for designing and delivering effective programs. Institutional support was also vital, providing the necessary resources, access to clinical spaces, and organizational backing. Furthermore, scenarios that were perceived as relevant to all participating groups tended to have higher acceptability and learner buy-in. The presence of robust evidence of benefit and endorsement by national or international bodies were also seen as important factors in sustaining these educational initiatives.

The authors highlighted a notable gap in the application of educational theory and theoretical frameworks in the reviewed studies. The vast majority of articles did not mention a recognized theoretical framework, and only a small fraction explicitly used theory to anchor their research design and analysis. This lack of theoretical grounding makes it difficult to determine which constructs are being targeted and how change is expected to occur. The review suggests that future research should incorporate educational theories to guide both the design and evaluation of simulation programs, thereby enhancing the rigor and generalizability of the findings.

While the review found that most interventional studies reported positive effects from simulation-enhanced interprofessional education, such as improved knowledge, skills, and communication behaviors, the authors cautioned that these results may be influenced by publication bias. They also noted some less intuitive findings, such as reduced confidence in leading trauma resuscitations after training, which they suggested might represent a productive recalibration of learners’ self-assessment rather than an educational failure. Additionally, the review found that observers of simulation scenarios could also benefit from the experience, aligning with social learning theory and suggesting that programs should explicitly design for observer engagement.

The study concluded that simulation-enhanced interprofessional education in surgery is a rapidly expanding field with a rich diversity of scenarios and learner mixes. However, it is limited by inconsistent reporting, weak theoretical alignment, and a focus on short-term outcomes. The authors recommended that future practice and research prioritize more rigorous reporting, theory-driven design, and higher-level evaluation to demonstrate organizational and patient benefits. They also identified under-represented settings, such as intensive care units and surgical wards, and disciplines, such as radiology, as areas for future development.

This scoping review offers a valuable snapshot of the current state of simulation-enhanced interprofessional education in surgery, highlighting both the progress made and the challenges that remain. As the field continues to evolve, addressing the identified gaps in multidisciplinary decision-making and under-represented settings will be crucial for maximizing the potential of this educational approach. By fostering a more collaborative and evidence-based culture in surgical training, healthcare systems can work toward improving patient safety and quality of care.

Subject of Research: Simulation-enhanced interprofessional education in surgery – a scoping review

Article Title: Simulation-enhanced interprofessional education in surgery – a scoping review

Article References: Stevens, S., Morice, O., Colville, D., Muralidharan, V., Paige, J., & Nestel, D. (2026). Simulation-enhanced interprofessional education in surgery – a scoping review. Advances in Simulation, 11(1), Article 76. https://doi.org/10.1186/s41077-026-00453-8

Image Credits: AI Generated

DOI: 10.1186/s41077-026-00453-8

Keywords: Simulation-enhanced, interprofessional, education, surgery, scoping, review, scientific research