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The purpose of this systematic review was to explore the benefits and challenges in the implementation of simulation-based education (SBE) in the classroom and clinical settings in sub-Saharan Africa. The objectives of this systematic review were to identify the benefits of utilising SBE in the classroom and clinical practice in sub-Saharan Africa and to assess the challenges in the implementation of SBE in the classroom and clinical practice in sub-Saharan Africa.

Five databases were searched for existing English literature (Medline, CINAHL and Science Direct), including grey literature on the subject. Out of 26 eligible studies conducted in sub-Saharan Africa between 2014 and 2021, six studies that used mixed-methods design were included. Hawker et al.’s framework was used to assess the quality of the studies. Quantitative data were presented using descriptive and inferential statistics in the form of means and standard deviations while qualitative data were analysed and presented thematically.

Quantitative findings showed that participants rated SBE highly in terms of teaching (93.2%), learning (91.4%) and skill acquisition (88.6%). SBE improved the clinical skill competency from 30% at baseline to 75% at the end. On the other hand, qualitative findings yielded themes namely: improved confidence and competence; knowledge acquisition and critical thinking; motivation and supervision; independent, self-paced learning; simulation equipment and work schedules; and planning and delivery of simulation activity. Pedagogical skills, competence and confidence are some of the elements that determine the feasibility of implementing SBE in the classroom and clinical settings.

SBE could help to bridge the gap between theory and practice and improve the quality of care provided by nurses. Simulation-based training is effective in improving the clinical skills of midwives and increasing their confidence in providing care. However, SBE trainees require motivation and close supervision in classroom settings if simulation is to be successfully implemented in sub-Saharan Africa. Furthermore, careful planning of scenarios, students briefing and reading of content prior to implementation facilitate effective simulation.

While there may be a lack of literature on the use of SBE for training nurses and midwives in the developing world, there is growing evidence that it can be an effective way to improve clinical skills and quality of care. However, there are also significant challenges to implementing simulation-based training in resource-limited settings, and more research is needed to understand how best to address these challenges. This study fills this gap in the literature.

The purpose of this study was to explore the clinical readiness of simulation-based education (SBE) in preparing nursing and midwifery students for clinical practice in sub-Saharan Africa. This study has synthesised the findings from existing research studies and provides an overview of the current state of SBE in nursing and midwifery programs in the region.

A qualitative meta-synthesis of previous studies was conducted using the following steps: developing a review question, developing and a search strategy, extracting and meta-synthesis of the themes from the literature and meta-synthesis of themes. Five databases were searched for from existing English literature (PubMed, Cumulative Index for Nursing and Allied Health Professional Literature [CINAHL], PsycINFO, EMBASE and ScienceDirect Medline, CINAHL and Science Direct), including grey literature on the subject. Eight qualitative studies conducted in sub-Saharan Africa between 2014 and 2022 were included. Hawker et al.'s framework was used to assess quality.

The following themes emerged from the literature. Theme 1: Improved skills and competencies through realism and repetition. Theme 2: Improved skills and competencies through realism and repetition. Theme 3: Improved learning through debriefing and reflection. Theme 4: Constraints of simulation as a pedagogical teaching strategy.

The qualitative meta-synthesis intended to cover articles from 2012 to 2022. Between 2012 and 2013, the authors could not identify purely qualitative studies from sub-Saharan Africa. The studies identified were either mixed methods or purely quantitative. This constitutes a study limitation.

Findings emphasise educator training in SBE. Comprehensive multidisciplinary training, complemented by expertise and planned debriefing sessions, serves as a catalyst for fostering reflective learning. Well-equipped simulation infrastructure is essential in preparing students for their professional competencies for optimal patient outcomes. Additional research is imperative to improve the implementation of SBE in sub-Saharan Africa.

The originality and value of SBE in nursing and midwifery programs in sub-Saharan Africa lie in its contextual relevance, adaptation to resource constraints, innovative teaching methodologies, provision of a safe learning environment, promotion of interprofessional collaboration and potential for research and evidence generation. These factors contribute to advancing nursing and midwifery education and improving healthcare outcomes in the region. This study fills this gap in the literature.