Abstract

This systematic review synthesizes evidence from 300 studies to establish best practices for integrating simulations into curricula, thereby optimizing educational outcomes. Findings reveal that pedagogical alignment—structured debriefing, scaffolded complexity, and fidelity matching learning objectives—is paramount. Effective integration requires evidence-based frameworks (e.g., spiral curricula, mastery learning), with faculty development as the strongest predictor of success. Simulations significantly enhance skill acquisition, retention, and transfer when strategically embedded. However, gaps persist in equity, cultural adaptation, and longitudinal validation. Practical recommendations include scalable models (e.g., shared resources, low-fidelity equivalency) and allocating faculty workload. Policy implications emphasize the importance of accreditation standards and the responsible use of AI. Future research should focus on accessibility, cultural sensitivity, and AI-augmented debriefing.