Table 2.

Feedback from the different simulations.

Study	Type of intervention (Name of software)	Content of educational intervention	Student interaction in the simulation activity with				Time spent in the simulation activity	Description of debriefing and/or facilitation
			No interaction	Peers	The system	A facilitator
RCT
Blaine et al., 2020	Serious game (LabForGames Warning)	In the game, a nurse was expected to identify clinical deterioration in different clinical situations (four different cases available) and warn the medical team appropriately (using EWS and ISBAR). Three consecutive steps were constructed to reproduce complications of increasing severity and introduce early warning signs. Students solved two cases, either in the game (intervention) or in text paper format (control).			X	X	Two hours of lecture prior to the simulation on clinical deterioration, no mention of simulation time	Automatic feedback from the software after the scenario involving main guidelines and key messages, global and detailed scoring according to the grid. Some of the actions in the case got negative, positive or neutral points. Group debriefing by trained instructor based on reaction, analysis and synthesis phases promoted by positive interaction between students and instructor.
Gu et al., 2017	Virtual simulation (vSIM for Nursing)	All the students completed regularly scheduled learning activities together. In the experimental group, the students received access to ten virtual cases for fundamentals of nursing. One week before the regular lecture the students were asked to complete the designated virtual case that corresponded to the lecture. Before the lecture day, the students handed in their feedback screen shots and reported the time spent on completing the virtual case. At the end of the semester, all ten virtual cases had been completed.			X		Average time spent on each virtual patient case was about 29 min	Clear introduction, specific guidance, and personalized feedback were given immediately after the scenario by the platform to facilitate the students' active learning process. Each patient-care decision during the simulation was tracked and measured.
Haerling, 2018	Virtual simulation (vSim)	Both groups prepared for the simulation by completing an independent, computer-based learning module on COPD exacerbation. Then, the control group performed live, facilitated manikin-based simulation in groups, and the intervention group performed virtual simulation independently. The same patient problem (COPD) was used in both simulation methods.			X		30 min	Participants in the control group interacted with the manikin, their facilitator, and peers and then participated in a facilitated debriefing session based on the plus/delta model. Participants in the intervention group interacted independently with the virtual patient and got computer-generated feedback from the software, including opportunities for improvement, a detailed log of actions during the scenario, and a numeric score. Both groups completed a written reflection that also was a part of the debrief process.
LeFlore et al., 2012	Virtual Pediatric Patients (VPP) and Virtual Pediatric Unit (VPU)	The control group received the traditional 3-h lecture by faculty, and the intervention group participated in the virtual patient trainer experience. Students in both groups were assigned textbook readings related to the topic (respiratory diseases). Students in both groups also received a standard medium- and high-fidelity manikin simulation.			X		Maximum 3 h for each student to finish, most finished in less than two hours	Before the virtual simulation, instructions were given by video and on paper, and technology experts were available for computer/software issues. Feedback from the system was given in the form of different coloured smiley faces on the screen: green indicated appropriate performance, yellow indicated caution and reassess actions, red indicated incorrect or delayed actions. If the face turned red, a virtual nurse would appear and coach the student to the next step.
Liaw et al., 2020	CREATIVE	Students simulated in teams, and each team was facilitated by a simulation-trained faculty member. The computer based virtual reality used avatars in a 3D virtual hospital environment. Instructions were given on how to navigate between the tutorial room and the ward setting, how talk among themselves using headsets, and how to perform assessments on the avatar.		X	X	X	3-h team training before the simulation and then 20 min simulation	Each scenario was followed by a debriefing facilitated by a facilitator using a guide focusing on communication skills and lasting for 30 min.
Padihla et al., 2019	Body Interact	Both groups received a 45-min lecture to activate knowledge and develop clinical reasoning skills. The intervention group performed a simulation using a clinical virtual simulator that presents virtual patients backed up by a physiological algorithm that recreates a dynamic health condition that responds to user interventions. The control group used the same case-based learning approach using a low-fidelity simulation and a realistic environment.			X	X	45 min laboratory class	The clinical scenario was initiated by a briefing, then the user could interact with the virtual patient. Immediately after the simulation a differential diagnosis interface was presented. The simulator provided a debriefing tool which included a simulation report, a simulation timeline, and a performance report.
Verkuyl et al., 2018	Virtual Gaming Simulation (VGS)	After a virtual gaming simulation, students were divided into three groups to test different debriefing methods; 1) In-person debrief (facilitated in-person debrief during scheduled class, 2) Self-debrief (provided debrief questions via LMS and wrote down their reflections without facilitator), or 3) Synchronous debrief (using Zoom to simultaneously communicate with each other and the facilitator.			X	X	30–60 min to play	Feedback from the system informed students of their decisions at each decision point. Debriefing in groups (max 10 students) after the simulation – within 72 h. Faculty were experts in debriefing and had completed debriefing workshop prior to the student debrief. All the debriefers followed the same script and questions.
Mixed methods
Choi et al., 2020	ComEd	The program consisted of a brief patient medical history video, an interactive clinical performance with virtual patients, and a debriefing session. The control group watched an educational video on the same topic as the virtual patient cases (mental health issues and communication skills).			X		Varied between students, approximately 40–50 min	The intervention included a debriefing session with model videos demonstrating therapeutic communication skills, student review of their own clinical performance, and tailored feedback on each performance. There is no mention of debriefing for the control group.
Donovan et al., 2018	vSim for Nursing (Laerdal)	A computer-based simulation program providing medical-surgical simulation scenarios that creates an active learner-centric environment was introduced to the students prior to their first simulated lab experience. Ten cases were available. Students began the first simulation two weeks after the orientation, and eight weeks elapsed between the first and the last simulation.			X		15–30 min per scenario	Debriefing with a faculty member occurred immediately after the lab simulation experience and included a discussion of student reactions and content learned during the simulation.
Flo et al., 2021	BodyInteract™	Students interacted with the virtual patient through dialogues (by choosing among specific questions), by monitoring different physiological parameters, by performing a physical examination and by initiating nursing interventions. The students were divided in groups. Three students in each group were appointed by the faculty to actively take part in the simulation. Students did not know beforehand who would be chosen to ensure that all students who participated were prepared. The rest of the students observed the simulation and could contribute with questions or input through a chat function.		X	X	X	90 min	Each patient case started with a short briefing and ended with a debriefing session. Immediately after the simulation a differential diagnosis interface was presented. The simulator provided a debriefing tool which included a simulation report, a simulation timeline, and a performance report. The report gave the students feedback on their level of knowledge and the competencies they had achieved. In the debriefing, the students reflected upon their assessments and actions coached by the facilitator who also encouraged them to consider other possible actions that could have benefited the situation. Two experienced faculty members participated: one navigating the software and the dialogue with the students, the other helping stimulate the discussions.
Foronda et al., 2016	V-CAEST	Students could perform a variety of interventions, such as assessing mental status, taking a pulse, and auscultating breath sounds. Once a triage determination was made, students would attempt to select the appropriate colour on the triage tag. Multiple participants could participate at the same time and communicate with each other, providing opportunities for collaborative problem solving, peer feedback and constructive discussions.		X	X		1 h and 15 min	15 min pre-simulation orientation by a facilitator. If a student selected the wrong colour, the program would not allow them to progress. A 15 min debriefing session occurred to elicit students' reflections about the virtual simulation experience. The facilitator typed field notes during the debriefing sessions to capture the students' comments.
Lee et al., 2021	Computer simulation-based, interactive, communication education (ComEd)	The ComEd program consists of a patient medical history video, an interactive clinical performance with two virtual patients (a depressed and a psychotic patient), and a debriefing session. The user first watches the patient's medical history video and starts interacting with a virtual patient in various clinical situations. During the interaction, the user chooses a response they believe is appropriate for the situation among multiple-choice questions and records it with their voice or provides an appropriate response to the open-ended questions.			X	X	40–50 min	The debriefing session provides tailored feedback based on the answers given by the program user. During debriefing, the user watches model videos demonstrating therapeutic communication skills and reviews their virtual clinical performance. The program proceeds if the user chooses an appropriate response using therapeutic communication skills (a total of 13 nurse–patient interactions for each scenario). The program is terminated if the user chooses an inappropriate response using non-therapeutic communication skills.
Liaw et al., 2014	e-RAPIDS	A virtual patient simulator with demonstration of ABCDE and SBAR. The learner enters the virtual ward, receives a handover report, and meets the virtual patient. The learner could choose to participate in any scenarios, receive handover and manage patient clinical deterioration. 5 scenarios with acute medical conditions			X		2 h	Immediate feedback, including information and physiological changes, was programmed into the system to respond to the student's actions. The feedback was given by a virtual nurse verbally and through a text display and a debriefing screen when completed. Feedback was provided by the software in the form of 1) 5 debriefing questions, 2) an evaluation tool and 3) a performance score.
Liaw et al., 2019	3D-VE	The software program supports multi-user real-time interactions in a virtual hospital environment, including an intensive care unit, a general acute ward, and a community care ward. Tutorial and family conference rooms were built within each of these areas. The scenario focus was an elderly man who was admitted for right knee replacement. The intervention was implemented over three days among six healthcare teams in a computer lab and the students were supported by two facilitators and standardized patients. The student also received asynchronous online video describing the use of communication tools and team care models.		X	X	X	Not specified	The participants were able to communicate with each other with headsets, only one speaker at time by activating the speaker button. The facilitator could move freely inside the hospital and teleport from one place to another. The facilitator could also interject or pause any ongoing conversation and adjust the physiological parameters and responses of the virtual patient. After an interprofessional round in the patient room the students returned to the tutorial room for a debriefing session. After a break the students received an online video instruction on the discharge team before they went again into the patient room to deal with discharge and caregiving issues.
Redmond et al., 2020	Virtual Patient	The simulated patient was played by an actor and the students watched a video of that person. Guided by a linear pathway design, students acquired data sequentially to parallel real clinical experiences. Students were presented with some clinical information and could choose from a designated list of options.			X		Not described	Feedback on correct, partially correct and incorrect actions was provided by the system. The feedback was continuous and immediate. At some points, students were asked to reflect on their assessment, to propose hypotheses and to provide summary statements or rationales for their own clinical decisions.
Rim & Shin, 2021	Multi-User Virtual Environment (MUVE) including Second-Life and Unity 3D	The MUVEs comprised five scenarios. Virtual spaces included pediatric outpatient department, pediatric ward, and neonatal intensive care unit settings. The learner was able to communicate with characters such as doctors, patients, caregivers, and laboratory staff appearing in the scenario. For each scenario, learners had two chances in practice mode and one in test mode. The simulation training was divided into groups of six to eight students each. The students attended five sessions each for two weeks.		X	X	X	2.5 h per scenario	Colleagues and professors left feedback on the learner's nursing activities based on a clinical judgment rubric while the learner was participating in the simulation in test mode. The program operation consisted of pre-exploration, pre-briefing, simulation running, debriefing using self-reflection with peer feedback, and group reflection. Debriefing took place on a virtual conference system as well as offline including reflective debriefing and guided structured reflections both individually and in groups.
Tjoflåt et al., 2018	vSim for Nursing (Laerdal)	A web-based simulation platform linked to the curriculum to simulate clinical scenarios, including fully integrated learning resources. The students worked in pairs to allow for discussion.		X (Worked in pairs)		X	2 h session	A faculty member and a clinical tutor guided the students. The students received real-time feedback on what they did.
Verkuyl et al., 2019	Virtual Gaming Simulation (VGS)	The game was constructed using video clips of standardized patients acting their assigned role in typical clinical situations. Students collected data, made intervention decisions and received immediate feedback. Three debriefing methods were tested: 1) Self-debrief, 2) Self-debrief followed by small group debrief sitting in a circle, and 3) Self-debrief followed by large group debrief in a traditional classroom.		X	X	X	1 h	Students received formative and summative feedback in a summary report on the consequences of their decisions. Faculty leading the debriefing were experts in debriefing. All the debriefers followed the same script and questions.
Non-randomized
Atthill et al., 2021	Virtual simulation game (VSG)	Students were randomized to either an asynchronous or face-to-face debriefing strategy. Students in the face-to-face debriefing strategy completed pre-simulation activities before attending the in-person class, where they first engaged in debriefing about the virtual simulation games (VSG) before beginning the live simulation. Participants in the asynchronous debriefing strategy completed the pre-simulation activities including the VSG and a self-reflection within 12 h, followed by an asynchronous debrief which occurred 48 h after the VSG but before the in-person class.			X		Not specified	The debriefing guidelines were structured according to the INACSL 3D model of debriefing. The asynchronous debrief was accessed by students through their learning management software and required students to respond to a series of group discussion posts related to the VSG. The nursing faculty was responsible for posting the initial discussion questions and responding to students' posts during the asynchronous debrief.
Bogossian et al., 2015	FIRST2ACT™	Final year nursing students could complete the FIRST2ACT program at their own pace and convenience. The program consisted of three stages: pre–e-simulation, the e-simulation intervention and post e-simulation (all electronically). In the pre–e-simulation the students could access a power point presentation on managing a deteriorating patient. The e-simulation consisted of three scenarios, each commenced with a video handover. In the virtual patient room, participants were able to click selected actions and respond to cues in the environment. They could call for assistance from other team members.			X		Varied from 27 min to 1604 min to complete 3 scenarios	On completion of each scenario, the participants were awarded a numeric score for performance and provided with general formative feedback incorporating patient diagnosis and best practice management. When finished with the e-simulation component, the participants received a generic debriefing of the experience and were provided with links to resources for further self-directed learning.
Campell et al., 2021	The Virtual Dementia Tour (VDT)	Students from different courses were placed into teams of four during the sessions. The VDT® experience began with a 15-min team pre-briefing session where the students were orientated to the space and equipment, the simulation objectives were reviewed, and an environment of trust and respect was established. Then each student participated individually for approximately 10 min. During the experience, each student was provided with equipment that altered their vision, hearing and touch. Prior to entering the patient room, students were given five tasks to try to complete during their 10 min in the simulated environment.		X	X		45 min	Trained facilitators guided participants and one facilitator participated as an observer, recording participants' actions and behaviours. While the students were in the patient room, a faculty facilitator was in the corner of the room observing students for any notable behaviours. Immediately after all four students finished, a 30-min team debriefing session facilitated by faculty using the Plus/Delta debriefing technique was held. The Plus/Delta strategy is a straightforward method for debriefing that facilitates discussion focused on describing the successful actions and results (plus) and the areas needing improvement (delta) during the VDT experience.
Dubovi, 2018	SimNurse	A computer-based simulation platform integrating a variety of educational e-learning tools designed to provide multiple clinical online experiences (case study scenarios with virtual patients, games, virtual mentoring, self-assessment tools, 3D visualization, interactive videos, digital-dynamic tools, and biochemical models for discovery learning. Simple-2-complex or productive failure approaches were tested.	Not stated	Not stated	Not stated	Not stated	Not stated	The two approaches tested provided different feedback. Due to the complexity of clinical problems in the productive failure approach, support such as reflection prompts, question prompts, content support, and opportunity for knowledge assembling was provided.
Hanson et al., 2020	3D CAVE2	An immersive learning experience with an artefact that visualizes the effect of the autonomic nervous system on heart rate. There were two different visualization modes: CAVE2 facility or mobile handheld device with stereoscopic lenses attached to it.	X				Not specified	Not specified.
Heinrich et al., 2012	MicroSIMR	MicroSIM provided complex patient cases and was integrated into the class content on two different days, one week apart. The software could be used on an individual basis or in a group activity in the classroom environment. The scenarios begun in the emergency department and all nursing interventions were recorded in the medical record and could be viewed at all times. The simulation was projected onto a large screen at the front of the class. At the end of the simulation the students were asked to transfer the patient either to a critical care setting, a medical unit or home.		X	X	X instructor led activity	Not specified	The student group needed to agree on the appropriate nursing care and the faculty acted as a resource as needed. On completion of the patient scenario, the debriefing process started. An overall score was reported, and then a detailed step-by-step analysis of the students' performance was provided. The care provided was compared with accepted standards. Correct interventions were listed, and incorrect interventions were also identified (with rationale). Students' response system was used during each simulation to validate participation under the virtual patient scenario.
Kang et al., 2020	vSim for Nursing™	Students took part in virtual simulation scenarios in groups. The instructor explained the scenario (15 min) and then conducted a pre-simulation quiz in groups (30 min). The instructor immediately showed students the answers to facilitate their learning. Students entered the simulation room with the instructor. After the simulation, the students were informed of the percentage of nursing interventions performed with detailed information and could go back to the simulation room to finish incomplete interventions. The instructor provided 10 post-simulation quizzes.		X (collaborating in groups)	X	X	30 min	Students self-studied for the post-simulation quiz and instructors reviewed the quiz results. The instructors debriefed the simulation with a class of 14 to 21 students who experienced the same scenario. Debriefing was based on the “debriefing overview” provided by the program. Debriefing questions like “On what care practices do you think did well in this scenario?” were the starting point for students to discuss their ideas freely, and after sufficient student discussion, the instructor summarized students' ideas.
Liu, 2021	vSim for Nursing Mental Health	The students were required to complete one virtual simulation scenario every week on five specific mental disorders as individual homework before receiving theoretical education on each disorder. Before launching the actual simulation, students were assigned to complete the suggested readings concerning the scenario and take a pre-simulation quiz to assess their knowledge.	X				Each simulation timed out in 30 min	Students received real-time feedback on their performance, and post-quiz remediation links were provided for immediate access to remediation resources. The students could repeat the simulation multiple times to reach a satisfactory score required by the course (80% on each case). No debriefing sessions were held by faculty.
O'Flaherty & Costabile, 2020	Desktop simulation about the hemolytic disease of the newborn (HDN)	All students attended an online course covering key topics related to hemolytic disease of the newborn (HDN). Students then watched and participated in an interactive simulation and then answered several questions built into the simulation on the covered content. Students received instant feedback on their answers. Students who did not achieve a passing grade were given a second opportunity to watch the simulation and resubmit their answers.			X	X	Not specified. Students were allocated two weeks to complete the three phases	At the end of the simulation, as part of a post simulation debriefing, students tested their understanding of HDN by answering 12 MCQs with immediate feedback provided for any incorrect choices. An informal, virtual debriefing at the end of the simulation which included several guided reflection questions where students were invited to describe their simulation experience, comment on how the simulation could be improved, and leave comments on anything else they would like to discuss.
Roh & Kim, 2014	MicroSim In-Hospital Self-Directed Learning System	All students performed a manikin-based simulation. The intervention group also completed a computer-based simulation as self-directed resuscitation training before a simulation testing session.			X		Not specified	A detailed evaluation log of students' performance was provided by the MicroSim program, pointing out participants' “correct” and “incorrect” actions. There was no debrief after the virtual simulation, but one was held after the manikin-based simulation.
Sapiano et al., 2018	FIRST2ACTweb	The students participated in three scenarios involving deteriorating patients within a four-week period using their own computers. The simulation started with a brief virtual handover by faculty, and then the patient (an actor) explained how he was feeling (prerecorded video clips). The student clicked buttons on the screen to indicate the most appropriate actions.			X		Max 8 min to complete each scenario	Computer-generated performance feedback was provided at the end of each scenario. A weighted score was applied for correctness of each action chosen. A score out of a possible total of 30 points for each scenario was provided to each student together with written feedback. A score under 10 was classified as poor, scores above 20 constituted a distinction and scores in between were considered good.
Tschannen et al., 2012	Second Life	The students participated in three virtual simulation sessions in Second Life. The students got handouts explaining the basic skills needed to use the software. The focus of the simulations for this study included: (1) communication/ conflict management, (2) priority setting, and (3) problem solving related to a patient safety issue. Between 12 and 15 students participated in each group in the simulation. Students had the opportunity to practice for 5 min before the scenario started.		X	X	X	The total time was 35 min (15–20 min for simulation and 15 min for debriefing)	The students who were active met the facilitator in the virtual conference room and were pre-briefed there. A debriefing was led by a faculty member at the simulation center. All the students participated in the debriefing session, which included a discussion of the scenario (e.g. ‘What went well?’) and ways to improve performance in the future (e.g. ‘How might you have done this differently?’).
Weston & Zauche, 2021	i-Human	i-Human is a virtual simulation platform with interactive medical patient encounters. Each case includes an animated avatar in which students take patient history, perform physical assessment, identify health problems, and prioritize interventions. The weekly virtual simulation included a 90-min pre-brief.			X	x	4 h per case (total 35 h over 5 weeks including pre- and debrief)	i-Human tracked each decision that students made and provided them with immediate feedback about their decision making. Performance reports were available to faculty for use in debrief. After each session, students met online with their clinical faculty for a one-hour debrief. Debrief guidelines were followed using the recommended best practice standards from INACSL
Qualitative methods
Buijs-Spanjers et al., 2020	The Delirium Experience	The Delirium Experience is a serious game that makes use of video simulation. The game represents four working days of a healthcare professional. The game includes the narratives of an older patient undergoing hip surgery and a healthcare professional who must provide care to this patient. After surgery, the patient experiences delirious episodes, showing the mixed subtype of delirium. The episodes differ in severity depending on the care provided. All the player's actions will change the narrative.			X		20 min to complete the game once	After each play day of the game, players receive tailored feedback on how their care can be improved. In addition, players receive feedback through the patient's responses to their actions and the impact of their actions on the delirium symptoms. At the end of the game, final written feedback on all chosen care options is provided within the game.
Johannesson et al., 2013	UrecathVision	A portable virtual reality task trainer with haptic properties for providing training in urethral catheterization. The first module explained procedures using multimedia techniques. When students inserted the catheter, they could follow their performance on the computer screen and anatomical features were seen as anatomic cross-section features. Resistance could be felt.		X	X	After the simulation in the debriefing session (SRC method)	Sessions of 15–20 min	The simulation was videotaped, and stimulated recall was used following interviews. Students worked in pairs and the assisting student was a discussion partner.
Johnsen et al., 2021	Hands-on simulation with simulated patients and a serious video-based game	Over the course of two days, 26 nursing students were exposed to five different patient scenarios (Day 1: three hands-on scenarios, Day 2: two computer-based serious game (SG) scenarios). The scenarios concerned a COPD patient with a noninfectious deterioration and another with an infectious deterioration. Actors were provided with scripts but were encouraged to act as themselves. Quiz-based questions and tasks were presented during each scenario (interactive design).			X	X	60–120 min	All simulation sessions involved participant briefing, simulation, and a final debriefing. The facilitating teacher was available the entire time the SG was being played. Students received feedback on incorrect and correct answers, including a demonstration by the RN of the proper care. Plenary debriefing was held with all students in an auditorium to facilitate group discussion of answers to the quiz-based tasks.
Koivisto et al., 2017	CareMe	The 3D simulation game with modular, customizable, graphically pleasing and platform independent intervention included two gaming sessions: both a single player and multiplayer patient scenario.		X In the multiplayer scenarios	X	X	10–20 min to solve the cases	The debriefing focused on the learning aspect of the game in general without a specific focus on any learning outcomes.
Liaw et al., 2021	Three-dimensional virtual world (3DVW)	Using the Unity 5 games engine, a virtual hospital environment, avatar roles and head-up displays for different healthcare professions, facilitators and simulated patients were developed in the 3DVW to support multi-user real-time interaction. The initiation of the simulation involved gathering each interprofessional team in a virtual tutorial room to introduce the team members and receive a briefing from the facilitator on the learning objectives and activities. Students were then provided with an electronic health record of an 80-year-old patient who was admitted for a right knee replacement. The team then navigated to the ward setting to participate in two scenarios and an interprofessional family conference with the patient and his daughter.		X	X	X	120 min	Each team was supported by a simulated patient who was trained to act as the role of the patient's avatar. Each scenario ended with a debriefing session for the team to reflect on their experiences.
Peddle et al., 2019	VSPR (virtual simulated patient recourse) E-learning modules and branching narrative VP	Students engaged in the simulation as themselves. The narrative VP used a “choose your own adventure game” approach with short video vignettes depicting a patient's story over time. The simulation progressed when students selected from two choices appearing on the screen following the video vignette. A decision tree using a branching algorithm determined the next video in the simulation sequence. Seven VP scenarios are available in the VSPR.		X	X		Not specified	Consequences of decisions resulted in positive or negative feedback on the patient's outcome, providing intrinsic feedback to students on their actions. Learning was supported through small group activities, by group discussions at the end of each vignette and by a concluding facilitator-guided debriefing.
Saunder & Berridge, 2015	Shareville	Students started a three-hour classroom session with a group discussion of their personal and professional experience of people with learning disability. Students were encouraged to share positive and negative experiences and to explore their own values and attitudes. They were then fully briefed on how to use Shareville. They worked at their own pace, experiencing the simulated reality scenarios and collating information and reflections in an electronic workbook. Group size varied from 13 to 23 students.		X	X	X	Approx. 60 min	To optimize participation, students used Shareville in classroom sessions facilitated by teaching staff, blending both independent and group work. Each session was led by faculty – one with expertise in learning disability and the other with expertise in adult, child, or mental health nursing, as appropriate. Students discussed their experience in small groups and identified key considerations that they would need to incorporate into practice to enhance the quality of care delivered to people with learning disabilities.
Shorey et al., 2020	Virtual Counseling Application using Artificial Intelligence (VCAAI)	The VCAAI is visualized as a three-dimensional (3D) avatar. Ninety-three undergraduate nursing students received communication training using Virtual Patient (VP) simulations before their clinical postings for each semester (two semesters per year) in educational years two and three. The VP trainings took place once per semester at a computer lab in the university, where different case scenarios were presented each time.			X		Not specified	No debriefing was described.
Singleton et al., 2021	Virtual reality (VR) diabetes simulation	Students played a nurse avatar who stayed within the private room. A virtual handover gave the nursing student knowledge about the patient's condition, current medication, and observations and provided extensive details relating to the patient's history and condition. The student had to make a safe clinical decision about how to react and communicate with the patient. Students were presented with clinical decisions in multiple-choice questions via pop-up text boxes.			X		60 min	If the student made unsafe decisions, instant feedback was given via text boxes asking them to reconsider quickly because the patient was deteriorating. The patient was programmed to look unwell if the student did not correct the patient's blood glucose quickly. No debrief was described. Each clinical decision was followed up with instant feedback so that the student could learn and improve. The student could complete the simulation multiple times. The lecturer was sent data analytics about each student's performance.
Verkuyl et al., 2020	Virtual Gaming Simulation (VGS)	The game is a branching scenario where the user has options (i.e., clinical decision-making based on the simulation) and can control the pace of play. Students assumed the role of the nurse during the simulation and were required to choose appropriate questions, respond to specific assessments and provide health teaching to the client. Three debriefing methods were tested, 1) self-debrief, 2) self-debrief followed by small group debrief (max 12 students), and 3) self-debrief followed by a large group debrief (max 30 students).		Interaction in the debriefing phase	X		Max 60 min	Feedback on the user's decisions was provided throughout the experience along with a final score and an autogenerated summary report of each decision they made in relation to the correct response. The self-debrief was finished within one hour of completing the simulation and then submitted. The group debriefing occurred within one to two weeks from completing the simulation. All the facilitators had completed comprehensive simulation courses and two hours of training. They used the same facilitation guide.