Journal of Surgical Simulation 2022; 9: 19 - 30

Published: 28 March 2022


Review article

Multi-disciplinary team-based simulation training in acute care settings: a systematic review of the impact on team performance

Christopher Agbo, Seilo Koshoedo, Sivakumar Sridharan, Ken Spearpoint, Shivani Sharma and Kunle Ashaye
Corresponding author: Christopher Agbo, School of Life & Medical Science, University of Hertfordshire, Hatfield AL10 9EU, UK. Email:


Background: Teamwork plays an essential role in providing quality health care and ensuring good outcomes and safe practices in any health care system. This has been demonstrated in several studies in emergency care where resuscitation teams perform at a high level to achieve desired outcomes in life-threatening situations. Simulation has been identified as an effective way of improving team performance skills, especially in acute care settings where team dynamics change rapidly and require good collaboration. In addition to clinical competence, the members of the team need to be conversant with non-technical skills such as team leadership and communication.

Methods: The MEDLINE, EMBASE and Cochrane Library databases were searched for original articles from the last 20 years investigating team performance in multi-disciplinary team-based simulation training in acute care settings. The research questions were developed using the participants, intervention, comparisons, outcome (PICO) framework. The review was designed and reported in accordance with PRISMA guidelines. The articles were then assessed by independent reviewers using the Critical Appraisal Skills Program (CASP) to standardize the assessment process.

Results: Of the 1260 articles identified, 12 primary research articles representing a variety of team-based simulation training in various acute care settings were included. The studies were published between 2002 and 2020 and included 679 participants > 18 years of age. All articles were original research papers with a combination of pre-/post-test, observational, randomized, and prospective designs; 11 were single-site studies and one was a multi-site study. Six studies used a pre-/post-test interventional method, four used a post-interventional method and one was an observational study. One study used a prospective blinded controlled observational method. Most of the articles reviewed did not provide high-level evidence and the control aspect of PICO was not applied because the review focused mainly on the intervention and outcome with no comparator. This study shows that 72.2% of the reviewed articles demonstrated a positive impact of team-based simulation training on team performance.

Discussion: This review has demonstrated some evidence that team-based simulation training used in various emergency and acute care clinical settings does improve team performance. However, how that translates to improvement in patient safety and clinical outcomes was not fully addressed by most of the articles reviewed and other previous studies. Simulation enhances team training; the evidence to support multi-disciplinary team training is positive although limited and will require further research to fully develop and validate simulation-based team training programmes.


simulation; medical education; team-based training; multi-disciplinary training; acute care; team performance