Education Research: Simulation-Based Interventions in Acute Stroke Care From Symptom Onset to Acute Treatment: A Scoping Review.

Abstract

Background and objectives: Simulation-based interventions serve several purposes in acute stroke care. The diversity of reported objectives, techniques, and outcomes makes it difficult to assess effectiveness and derive guideline recommendations. This scoping review aims to map existing research to identify knowledge gaps and suggest future directions.

Methods: This review was conducted in accordance with the Joanna Briggs Institute guidelines for scoping reviews. Empirical research on simulation training targeting health care professionals in acute stroke care from symptom onset to acute treatment was included. We searched MEDLINE, Embase, Education Resources Information Center, ClinicalTrials.gov, and International Clinical Trials Registry Platform. Two independent blinded reviewers performed selection and data extraction using Rayyan.ai, with additional verification by Consensus AI. We performed descriptive analyses and visualized key characteristics.

Results: Fifty-nine studies (95% published between 2015 and 2025) were included. Objectives were categorized as system improvement (31%), educational (31%), technical skills (20%), research (14%), and diagnostic (5%), each with a range of reported techniques (role-playing, task trainer, 3D printing, and virtual reality). There is a paucity of data on the application of simulation for competency assessment, continuing education, specific scenarios such as intracerebral hemorrhage, its application in the prehospital setting, and remote delivery. Several studies lacked reporting of patient-related outcomes (52% of 48 eligible). Most reported outcomes were short-term effects of a single simulation session (85%), limiting the assessment of long-term impact. Inadequate study design and reporting, combined with insufficient details on simulation conduct, particularly debriefing, psychological safety, and resource utilization, limit the inferences that can be drawn from the included studies.

Discussion: We reported a diverse range of objectives, techniques, and outcomes of simulation-based interventions in acute stroke care. There is limited evidence on the translation of simulation training effects to clinical practice and their long-term sustainability. Further research should strengthen the link between simulation interventions, their conduct, patient-related outcomes, and sustainability. In addition, exploring underused applications may help broaden the role of simulation in acute stroke care. The scientific assessment of simulation intervention effectiveness requires standardized reporting, long-term outcome measurement, and study designs that allow for causal inference.