International Journal of Healthcare Simulation

Background and aim:

The effectiveness of simulation-based education (SBE) in improving healthcare education among practising healthcare professionals (HCPs) is well recognized [1–3]. However, there is limited research available that explores the facilitators and barriers to the use of these activities amongst this population. The aim of this study was to determine those barriers and facilitators that exist to the use of healthcare simulation amongst practising HCPs through the systematic review of existing qualitative literature.

Methods:

Searches were performed using Medline and CINAHL from February to May 2022 with an updated search performed in June 2022. Reference list searches of included studies were also conducted. English-language, peer-reviewed studies that used qualitative methodology to examine barriers and/or facilitators to the use of SBE activities amongst HCPs practising in a hospital setting were included. Data were extracted and a quality appraisal tool was applied by the primary author, with 30% of included studies independently extracted and appraised by a second author to examine the agreement. Barriers and facilitators were coded inductively using thematic analysis.

Results:

Thirteen studies were included out of a total of 2109 screened. Four main themes related to facilitators and barriers were identified: (1) management and leadership; (2) resources; (3) perceived impact and (4) learning experience (see Table 1-A18). Amongst studies, positive learning experience was a commonly identified facilitator (n = 10), while leadership and management were a frequently cited barrier (n = 13).

Table 1-A18:

Thematic analysis of facilitators and barriers to the use and uptake of SBE activities

Themes	Facilitator codes	No. of studies, empirical sources	Barrier codes	No. of studies, empirical sources
(1) Management and leadership	-Responsive/ supportive leadership -Effective scheduling -Dealing appropriately with difficult environment -Visibility of managerial personnel -Simulation as mandatory assessment and training tool -Collaboration with other centres -Common vision -Good communication	N = 7 (64.6%)	-Lack of responsive leadership -Lack of time/poor scheduling -Staff shortages -Perceptions of hierarchy -Lack of interprofessional involvement -Poor work culture -Competing vision -Poor communication	N = 13 (100%)
(2) Resources	-High standard equipment -Engaging scenarios -Familiarity with equipment/environment -Appropriate personnel -Adequate preparation -Advanced technology -High degree of realism	N = 8 (72.7%)	-Poor realism -Financial restraints -Lack of equipment/facilities -Limited technology -Lack of best practice standards -Lack of appropriate personnel (e.g., trainers, SP, limited learners) -Unfamiliar equipment or facilities	N = 10 (76.9%)
(3) Perceived impact	-Perceived quality and safety benefits -Improved culture -Multidisciplinary collaboration -Core job responsibility/role accountability -Valued experience -Improved teaching skills and techniques -Demonstrable cost-benefit	N = 7 (64.6%)	-Participant stress/anxiety/discomfort -Interprofessional conflict - Ineffective use of effort or time -Benefits of simulation unclear	N = 6 (46.2%)
(4) Learning experience	-Consistency in delivery -Material aligned to staff interest/needs -Trainer expertise -High-impact learning -Safe and positive environment -Individualized feedback	N = 10 (90.9%)	-Inconsistency in programme delivery -Trainers seen as outsiders -Limited engagement -Curriculum not adapted to needs -Purpose not clear	N = 7 (53.8%)

Conclusion:

This study identified common barriers and facilitators to the use of SBE activities. By anticipating and addressing these adequately, the use and uptake of SBE activities amongst practising HCPs can be further enhanced.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.