Exploring accessible, inclusive and sustainable simulation-based education in remote and rural communities: a realist review

Access to and inclusion in simulation-based education (SBE) for remote and rural (RR) healthcare practitioners, irrespective of geographic setting, professional background and workplace context, is challenging. This challenge is compounded because simulation in healthcare education is acknowledged as a complex intervention, and healthcare systems are in and of themselves complex. A realist review of published and grey literature was conducted, seeking to identify programme theories and to explore what works, how and why, in respect of mobile and distance SBE for healthcare practitioners in RR and harder-to-reach communities. There is limited rigorous research in this field. Mobile and distance simulation programmes exist in physical, digital and hybrid forms. This makes simulation more accessible and inclusive for RR healthcare professionals in respect of facilitating simulation. It allows for clinical and simulation centres of expertise to collaborate with harder-to-reach communities enabling the contextualizing of learning with, from and about the needs of a target population. However, the challenges of implementing and sustaining mobile and distance simulation interventions are underexplored. Mobile and distance programmes of SBE are introduced into and are subject to dynamic and heterogeneous social contexts. The intended outcomes of such programmes are dependent on building relationships, trust and networks between geographically distanced communities of practice. These social connections are the key mechanisms which support accessibility, inclusivity and sustainability. Further explorations of mobile and distance simulation innovations are critical to building capacity, sustainable solutions and enhancing future use.