Exploring Contemporary Trends in Simulation Modalities within Emergency Medical Services Education: A Scoping Review

Abstract

Background: With the rapid evolution of simulation modalities, such as the COVID-19 pandemic and various technological advancements, such as computer-based modalities and head-mounted display (HMD)-based technologies, a coatic simulation-based educational environment has been produced, where it has become challenging for Emergency Medical Services (EMS) educational agencies to adapt the proper simulation tool for the best cohort of learners. Consequently, curricular coherence suffers, faculty expertise is diluted, and the calibre of graduates declines, ultimately jeopardizing patient safety and outcomes. Therefore, the demand to map the existing literature on contemporary simulation modalities within the last five years is non-negotiable, ensuring the graduation of high-quality EMS professionals. Methods: Following PRISMA-ScR and JBI guidance, we searched PubMed, Web of Science, and Scopus (January 2020 – June 2025) and supplemented the results with grey literature, hand-searching, and citation chaining. From 979 records, 540 titles/abstracts were screened, 132 full texts were assessed, and 33 studies were included. Descriptive statistics and reflexive thematic analysis (inductive and deductive) were applied to the data on simulation types, barriers, facilitators, and fidelity practices. Results: Most studies originated from the Americas and Europe (36.5 % each); the remainder came from the Eastern Mediterranean, Western Pacific, and Southeast Asia. The methodologies were mainly quantitative (70 %), with mixed methods (21 %) and qualitative designs (9 %). Six modalities dominated: high-fidelity manikins, HMD-based virtual or augmented reality, screen-based simulation, cadaver training, actor-based scenarios, and hybrid design. Barriers and facilitators were clustered into five themes: resource, realism, human, facilitator, and operational or regulatory-related factors. Fidelity reporting was inconsistent; only two studies used an explicit framework, while most misapplied or omitted the concept. Conclusions: EMS practitioners play a pivotal role in life-saving care; therefore, there is no time to lose in preparing competent, knowledgeable, and professional clinicians. Simulation provides a diversified toolbox for cultivating both cognitive and psychomotor skills; however, its educational value depends on aligning each modality and simulation’s appropriate level of fidelity with clearly defined learning outcomes. This review offers a practical decision map that enables stakeholders to understand the benefits and limitations of contemporary simulation options and decide when, how, and for whom each modality should be deployed.