Hello and welcome back to the SimKit Podcast. Today, we’re taking a break from specific procedural discussion or case discussion to ask a much bigger question. Does simulation improve patient care? And we’re gonna be looking at a specific article that focused on trauma care, so we can cater that or change that question slightly to, does simulation improve trauma patient care? Now, we’ve all been part of great simulations. We’ve all walked away feeling more prepared, but what does the evidence actually sh- say? Today, we’re gonna be looking at a concise review recently published in the American Journal of Emergency Medicine in January 2026. The paper is titled “A Concise Review Investigating Simulation Modalities’ Effect on Team Efficiency, Provider Well-Being, Education and Clinical Outcomes” by Othman et al. The author searched over 1,000 articles and ultimately included 21 studies looking at simulation’s effect on different categories, including team performance, leadership, education, patient outcomes, provider wellbeing, and cost. So before we dive into the article, whenever I review simulation papers, I ask one question: What outcomes are we actually measuring? Some studies will look at confidence, others will look at knowledge. Some will examine teamwork, patient care, burnout, cost, a variety of different outcome measures. Confidence, of course, it sometimes gets criticized as a, quote-unquote, “soft outcome,” but I personally think that that’s missing the point. Confidence influences behavior. Confident clinicians are more likely to step forward when a rare procedure is needed. They’re less likely to avoid a difficult airway, hesitate during a thoracostomy, or defer a procedure they’ve trained for but have never actually performed. So the goal isn’t confidence for its own sake. The goal is earned confidence, confidence built through deliberate practice, repetition, and realistic simulation. What I like about this review is that it looks beyond this confidence alone. It asks whether simulation changes the way teams function and whether these changes actually impact or affect patient care. So for the paper, the authors start the, in their introduction by noting that literature trends show simulation improving patient outcomes and decreasing complication rates. Now, if you need these articles to justify your sim project development, they’re there in the show notes. They also note that simulation enhances team efficiency, reduces occupational stress and burnout by promoting confidence and preparedness. That is one of the main reasons why I made or started SimKit. It’s with the main goal of improving access to sim and helping providers get more confident in rare procedures. Now, for the paper itself, the author, authors searched five major databases: Cochrane, ProQuest, Google Scholar, interestingly, PubMed, and EMBASE for their articles. Importantly, as I said in the intro, they are focused on trauma simulation for most of their outcomes, really all of them except for cost. They started with nine hundred and ninety-two articles, and after review, found twenty-one high-quality articles to address their questions of simulation’s impact in seven categories: one, collective efficiency; two, leadership behavior; three, comparing the different sim modalities; four, educational tool or the use of sim as an educational tool; five, indirect patient outcomes, and this is a big one; uh, six, well- provider wellbeing; and finally, seven, cost. Let’s look at what they found in each of these categories Collective efficiency. The first thing the authors examined was how simulation affects teams. This was probably the strongest and most consistent finding. Across multiple studies, simulation improved communication, teamwork, and overall team coordination. One study showed that teams recognized and communicated patient desaturations six seconds faster after doing simulation training. Another found improvements in teamwork and task management scores. Interprofessional simulations involving physicians and nurses also improved teamwork skills and knowledge retention. Now, a six-second improvement in recognition of desaturation might not sound dramatic, but during trauma resuscitations or just resuscitations as a whole, every communication delay or team breakdown compounds. That six seconds can lead to increased stress and anxiety in the provider. Their unidirectional or closed-loop communication may default or break down as the desaturation drops further. Then someone doesn’t hear the blood pressure alarm, someone misses the airway challenges, someone forgets TXA, it compounds and compounds. So simulation doesn’t teach the procedures, it’s really teaching the teams how to function together under stress and not let small misses compound, compound, and snowball All right. How about leadership behavior? Leadership was another area in the article that had surprisingly strong evidence. Simulation-trained leaders demonstrated better leadership behaviors during actual trauma resuscitations. Nurses participating in leadership-focused sim also improved crisis resource management, situational awareness, and adherence to their institution’s resuscitation algorithms, which is pretty huge. Now, this does make some intuitive sense. Leadership is difficult to learn from PowerPoint, and on-the-job training is really hard when the trauma bay is packed and the patient is in extremis. Leadership is developed by repeatedly making decisions when people are watching you. Sim is great for this because it’s both kind of high stakes and no stakes. It’s high stakes when we engage in that suspended disre- belief, when we lean into the case scenarios, or sometimes when our boss is watching us or when we’re being scored on a rubric. And it’s no stakes, of course, because there is no patient to underperform on. Simulation gives learners permission to practice leading before they’re forced to lead for real. All right. Number three outcome for the article was comparing simulation modalities, and really the authors had a specific slant here, kind of thinking about AR and VR as the new kids on the block. Now, one question commonly asked by educators is whether these expensive technologies actually add value, and the answer is maybe, unfortunately. Depends on your frequency of use in your institution and its structure. In the actual literature, they found that VR was non-inferior to traditional mannequin simulation. In the scenarios, learners performed similarly, and stress levels were similar across the learners in different groups, mannequin versus VR. And of course, confidence often improved in both. They also looked at AI-based serious game learning, adding an additional different type of sim to the scenarios, and they found that this actually reduced under-triaging by 18% in simulated trauma scenarios for learners. So notice, though, that the authors aren’t saying VR replaces or should replace mannequins. They’re saying that it performs similarly while offering some advantages in scalability and accessibility. The authors note a much larger upfront cost with AR and VR, which da- gradually decreases with the use. I personally have pretty strong opinions on high versus low fidelity sim in AR and VR, but for objectivity, I’ll keep it simple. I think we’ve talked in SimKit many times about anything being better than nothing. Working with a low-fidelity simulator that’s easy to use and super accessible is better than not doing any sim at all, and probably better than that very expensive Laerdal trainer that gets taken out once a year, once every three years. AR and VR, I think of similarly. It’s gonna have a high upfront cost, but if you’re using it regularly and the barriers for use aren’t really there, then it might have at some advantages in decreasing per-use cost All right, so how about outcome number four? Simulation itself as an educational tool. This section won’t surprise anyone who’s taught procedures before. They found in the kind of compilation of the articles that simulation improved diagnostic accuracy, task completion, success rates for procedures, provider performance, and learner confidence. One randomized trial found that simulation-trained learners completed post-testing in roughly half the time and achieved 100% success rate compared to a 64% in controls. Now, not every intervention showed superiority. For relatively simple techni- technical tasks like tourniquet application, hybrid sim wasn’t better than mannequin training. That’s actually kind of reassuring. We don’t need high-tech solutions for every educational problem. It’s really sometimes we note that repetition matters more than that fidelity, which we talked a little bit about before or above. All right, number five is indirect patient outcomes. For me, this is the most interesting section of the paper because simulation research rarely has enough power to demonstrate reductions in mortality or improved patient outcomes. Instead, the researchers measure outcomes that kinda matter clinically, surrogates, if you will. Following trauma training, the trauma teams they found in these articles, they completed secondary surveys faster, they prepared patients for CT more quickly, they therefore got the CT started sooner, they reduced overall trauma resuscitation time, which is huge, and completed more of the critical casts- tasks when looking at a rubric. And these are in real patients. These are not necessarily simulation metrics. They’re downstream effects seen in the clinical practice. This is about as good as we’re gonna get for patient mortality outcomes, again, because of power for sim, uh, articles or literature generally being underpowered to look at mortality benefits Now, again, none of these prove that simulation saved lives, but they are the exactly the kinds of process improvements that we spend enormous amounts of effort trying to achieve in our trauma systems and our resuscitation systems as a whole. So it appears that simulation is capable of moving these needles, which is really important and a useful take-home for those trying to justify their simulation training in their institution. How about number six, provider wellbeing? This section was definitely smaller, but pretty fascinating. They found that simulation reduces perceived stress. I think we kinda know that. From that, we noted that actual burnout scores improved. Professional accomplishments for the providers interestingly increased. Providers reported greater confidence performing neurologic assessments, doing rescue airways, arterial lines, tourniquets, and hemorrhage control. That’s pretty important stuff because emergency medicine is stressful. Anything that helps clinicians feel more prepared for the rare high-acuity events may improve not only performance, but the longevity of the professional performing the task. Again, we’re talking about earned confidence, preparedness. That’s what simulation does best All right, number seven, cost. Finally, money. Let’s talk a little money. So they found that VR requires a much larger upfront investment. The totals are shocking and in the show notes. But over time, they found that the math kinda changes. One analysis found that recurring mannequin-based simulation costs about $300 per participant, while VR fell to about $150 per participant after scaling across multiple repeated trainings. Another study found that VR was roughly 40% less expensive overall. Now, that doesn’t mean that every hospital should replace its simulation center tomorrow and invest in VR. But if you’re training hundreds of learners year after year, the econ- economics of this, uh, increasingly come, becomes compelling for AR, VR, or some augmented version of traditional mannequin use. All right, what are the limitations of this article? The review that we see here is encouraging, but of course, it’s not perfect. Most included studies were pretty small. The simulation methods varied tremendously, of course, and the outcome measures weren’t standardized. Many studies measured short, short-term improvements and not that long-term retention. And while indirect patient outcomes improved, direct patient outcomes remain very difficult to study in these sim-based type of articles. These are limitations of simulation research really as a whole, and not just for this paper So what’s my take on this article? This paper doesn’t tell us that one simulator is magical or that we should switch to AR or VR. It actually tells us, I think, something much more useful. Simulation consistently improves the things that matter before a rare critical event occurs. It makes teams communicate better, leaders lead better, providers feel more prepared, and patient care becomes more efficient. That is perhaps mo- the most important thing. Simulation creates earned confidence, the confidence that comes from having physically worked through difficult scenarios enough times that when the real patient arrives, your brain says, “I’ve been here before.” Whether that’s a high-fidelity mannequin, in a virtual reality, or on a task trainer matters less than one thing. Did you deliberately practice? Because repetition, not realism, is ultimately what changes performance. So I hope this literature review is helpful for you. I love getting into this type of material. It’s sometimes more important to have this for justification of the processes we’re doing in our hospital to bring our group, our team, or ourselves up to speed, ready, and smooth so that we’re ready to take care of the next critical patient. Take a look at the show notes for all our references. Again, please feel free to use them to justify your group’s or team’s investment in some simulation and happy practicing.