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.

Simulation is an educational approach that promotes the mastery of technical skills while advancing the development of non-technical competencies, both of which are widely acknowledged as essential in clinical practice. This review aimed to synthesize findings on the impact of simulation in enhancing critical thinking and reflection among nursing and medical students. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a systematic review was conducted by searching the following databases: PubMed, Science Direct, and Scopus. The quality of the included studies was assessed using Joanna Briggs Institute critical appraisal tools. The protocol was previously registered in the PROSPERO registry (CRD42022371971). From 1,323 studies identified in primary research, 16 were included in this review, involving a total of 1,283 students. Of the 16 studies, seven investigated the impact of simulation on critical thinking and reported a positive effect compared to traditional teaching methods. For student reflection, only one study addressed this theme and reported a positive effect on nursing students. This review demonstrated that simulation has a positive impact on critical thinking; however, its impact on reflection remains inconclusive. Further research is essential to explore its effects across diverse populations, including those in developing countries, to maximize its educational potential in health professions education.

Background: This study evaluated the impact of high-fidelity simulation versus simulation with standardized patients on the development of reflective practice among medical students. Methods: A randomized controlled trial design with both pre- and post-simulation assessments was adopted. Thirty-two final-year medical students were randomly assigned to two groups (Group 1: high-fidelity simulation (n = 16); Group 2: simulation with standardized patients (n = 16)). Each group participated in six sessions over the course of two months, including six identical scenarios for both groups. The Groningen Reflection Ability Scale (GRAS) was used to assess the participants’ reflection skills before and after the simulation. Data were analyzed using descriptive statistics, paired t-tests for within-group changes, and independent t-tests for between-group comparisons. Results: Reflection scores improved significantly from pre- to post-simulation across the combined sample (p < 0.05). Within-group analyses demonstrated statistically significant improvements in self-reflection (31.3 ± 7.11 vs. 36.8 ± 5.34; p < 0.001), empathic reflection (19.1 ± 4.68 vs. 20.6 ± 4.51; p = 0.020), and reflective communication (23.1 ± 5.11 vs. 25.5 ± 4.35; p < 0.001). Additionally, between-group comparison revealed that the high-fidelity simulation group attained a significantly higher total reflection ability score compared with the standardized patient group (91.8 ± 7.70 vs. 74.0 ± 11.55; p <0.001). Conclusions: Simulation practice, whether high-fidelity or with standardized patients, helps to improve students’ reflection. However, high-fidelity simulation was proven to be more effective than simulation with standardized patients. This study reinforces the use of simulation as a tool for developing reflective practice skills in medical training.

Purpose: This review examined the impact of learner role—active participant versus observer—on learning outcomes in healthcare simulation-based education using Kirkpatrick’s evaluation model.Methods: Five databases—PubMed, Scopus, Web of Science, ScienceDirect, and EBSCOhost—were searched for studies published from January 2018 to November 2024. Eligibility criteria, defined using the PICOS framework, targeted studies comparing learning outcomes between active participant and observer roles among health professions students and practitioners. Methodological quality was appraised using the Medical Education Research Study Quality Instrument, and findings were synthesized narratively. This review was registered in PROSPERO under registration number CRD42024611988.Results: Of 648 records, 15 studies involving 1,799 participants met the inclusion criteria; role allocation was specifically reported for 644 active participants and 709 observers. Most studies were conducted in high-income countries (13/15) and nursing programs (11/15). At Kirkpatrick Level 1, most studies reported no statistically significant between-role differences, although an active participant advantage emerged for emotional arousal. At Level 2, knowledge, skills, and most attitudinal outcomes did not differ significantly between roles; active participant advantages were observed for technical skills at delayed follow-up, affective competencies in palliative care, and perceived learning transfer. No study assessed Levels 3 or 4.Conclusion: Most studies found no significant differences between observer and active participant roles at Kirkpatrick Levels 1 and 2. Generalizability across all health professions and settings is limited. Pedagogically appropriate use of the observer role supports learning outcomes and may expand access to simulation-based education.