Simulation-Based Education for Health Professionals in Rural and Remote Contexts in High-Income Countries: A Scoping Review.

INTRODUCTION: Health professionals in rural and remote settings face distinct challenges including geographical isolation, workforce shortages, limited continuing professional development and reduced exposure to high-acuity, low-occurrence (HALO) clinical scenarios. Simulation-based education (SBE) has been proposed as a strategy to address these challenges; however, its design, implementation and evaluation in rural and remote contexts has not been comprehensively synthesized. OBJECTIVE: To map and characterize existing literature on SBE designed and delivered to rural and remote health professionals in high-income countries. DESIGN: A scoping review was conducted in accordance with JBI guidelines using the participant, concept, context (PCC) framework. Screening and data extraction were conducted using Covidence and results reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). FINDINGS: Thirty-seven articles met the inclusion criteria, predominantly from the United States of America (USA), Australia and Canada. Most used quantitative or mixed methods designs. SBE was characterized across six areas: Simulation activity, modality, facilitators, support structures, research methods and learning objectives. Emergency care training, particularly for the management of deteriorating patients and HALO scenarios, was most prevalent. Modalities included simulated patients, in situ simulation, virtual simulation and procedural simulation. Technology-enabling approaches, including telemedicine and mobile simulation units, were increasingly reported. DISCUSSION: Reporting quality was variable. Most studies focused on learner-level outcomes, with limited evidence on system-level, workforce or patient outcomes. Rural-metropolitan collaboration through telemedicine and virtual facilitation was a recurring theme. CONCLUSION: SBE sustains clinical capability in rural and remote settings, particularly for deteriorating patient management, HALO scenarios and for introducing emerging technologies. Further research on implementation, outcomes and workforce impact is warranted.