Table 7 Summary of study results as reported by included reviews. Linked to RQ5.

 Reduced procedure/performance time

20

[29, 35, 36, 39, 41, 47, 60, 66, 75, 76, 84, 92, 96, 99, 100, 102, 103, 107, 108, 110]

 Reduced procedure/performance time: mixed results

6

[32, 42, 44, 69, 101, 104]

 Increased procedure/examination score

10

[35, 37, 39, 42, 60, 84, 85, 92, 110, 117]

 Increased procedure/examination score: mixed results

5

[32, 44, 46, 47, 69]

 Increased performance

12

[46, 47, 64, 76, 89, 98, 100, 101, 105, 107, 108, 111]

 Increased performance: mixed results

3

[59, 102, 104]

 Reduced error rates during procedures

11

[35, 46, 63, 73, 96, 99, 101, 103, 104, 115, 117]

 Reduced complication rates

8

[39,40,41, 66, 98, 100, 107, 109]

 Reduced complication rates: mixed results

1

[69]

 Significant correlation between performance in simulation and mean OSACSS scores

2

[40, 63]

SKILLS AND KNOWLEDGE ACQUISITION

 Skill acquisition demonstrated

11

[11, 30, 41, 45, 47, 58, 94, 99, 109, 112, 113]

 Skill acquisition: mixed results

6

[3, 35, 55, 64, 75, 104]

 Knowledge acquisition demonstrated

10

[3, 11, 45, 58, 60, 72, 75, 86, 94, 113]

 Knowledge acquisition: mixed results

5

[47, 55, 64, 73, 116]

 Improved spatial understanding and visualisation

6

[43, 44, 60, 86, 104, 115]

 Less guidance needed after simulation

2

[47, 98]

 Increased empathy

1

[49]

DIFFERENT LEVELS OF VALIDITY

 Face validity demonstrated

3

[43, 71, 111]

 Content validity demonstrated

1

[71]

 Construct validity demonstrated

14

[29, 36, 37, 42, 43, 47, 63, 71, 77, 97, 99, 102, 111, 112]

 Concurrent validity demonstrated

1

[36]

 Transfer validity demonstrated

11

[11, 35, 37, 41, 46, 64, 66, 96, 97, 99, 105]

 Transfer validity: mixed results

2

[30, 70]

 Evidence of complete validation is poor

1

[68]

SATISFACTION, MOTIVATION, ATTITUDE, CONFIDENCE, SELF-EFFICACY

 Satisfaction / Motivation / Attitude demonstrated

13

[11, 35, 45, 49, 50, 61, 72, 73, 85, 86, 89, 115, 117]

 Satisfaction / Motivation /Attitude: mixed results

4

[3, 55, 64, 75]

 Level of confidence improved / Reduced anxiety or stress

2

[115, 117]

 Level of confidence improved / Reduced anxiety or stress: mixed results

4

[3, 55, 64, 75]

 Increased self-efficacy

2

[64, 107]

LEARNING CURVES

 Higher improvement among novices than experts

4

[35, 37, 63, 77]

 Longer learning curve in comparison to other learning methods

2

[50, 64]

 Long-term retention demonstrated

2

[42, 86]

 Long-term retention: mixed results

2

[44, 64]

PATIENT OUTCOMES

 Improved patient care quality / outcomes

6

[45, 66, 73, 84, 94, 98]

COST-EFFECTIVENESS

 Cost-effectiveness demonstrated

2

[3, 46]

 Cost-effectiveness: lack of evidence

1

[30]