Cultural Simulations, Authenticity, Focus, and Outcomes: A Systematic Review of the Healthcare Literature

Background: Simulation-based cultural competence training is core pedagogy in nursing education. With reference to the Healthcare Simulation Standards of Best Practice^TM, we sought toidentify strategies used to support culturally authentic experiences and the focus, theoretical framings, and outcomes of cultural simulations. Methods: We searched 11 electronic databases and included empirical papers from any healthcare discipline reporting any type of simulation-based training and outcome measures of cultural competence. Results: We identified thirty papers and some evidence to support the efficacy of cultural simulations. However, we identified a low level of quality, inconsistent consideration of relevant standards, limited evidence of meaningful co-construction, some potentially negative cultural representations and a primary focus on cultural knowledge and skill. Conclusion: More robust designs that extend beyond a competency paradigm to examine the relative benefits of different simulation modalities and their impact on actual patient care are required. We recommend that researchers examine their own cultural lens, take cognizance of threats posed by oversimplifying the cultural experience, engage in inclusive partnerships and explicitly consider simulation best practice and reporting standards.