Effectiveness of combined virtual and clinical simulation compared with other active teaching strategies on health students' learning: A systematic review protocol

Objective: The objective of this review is to synthesize the available evidence on the effectiveness of combined virtual and clinical simulation compared with other active teaching strategies on health students' learning. Introduction: Current evidence indicates that both virtual simulation and clinical simulation are effective in assisting students to acquire clinical skills. However, there is a knowledge gap regarding the effectiveness of the combined use of both teaching strategies, which could enhance health students' learning. Inclusion criteria: This review will consider experimental, quasi-experimental, and observational studies that address the combined use of virtual simulation with clinical simulation compared with other active teaching strategies in learning, clinical reasoning, clinical decision-making, and/or clinical competencies of health students. Combining different hybrid simulators to form a new one will not be considered for inclusion in the review. Methods: The databases to be searched will include Cochrane Library, MEDLINE (PubMed), CINAHL (EBSCOhost), Scopus, LILACS (VHL), Web of Science Core Collection, Embase, ERIC, and gray literature sources. Two independent reviewers will perform the study selection, critical appraisal, and data extraction using JBI tools. A narrative synthesis will be performed and, if possible, meta-analysis and risk assessment of publication bias. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach will be used to assess the certainty of the findings. Review registration: PROSPERO CRD42023422410.