More is Not Better: A Scoping Review of Simulation in Transition to Residency Programs

Transition to residency (TTR) programs are increasingly prevalent, particularly due to perceptions that new interns are unprepared for residency. Non-clinical attributes (NCAs) are frequently cited as areas of weakness of interns. TTR programs frequently use simulation to promote clinical skills but place limited emphasis on NCAs. This scoping review addressed: 1) How is simulation being used in TTR programs? and 2) Which key NCAs are addressed by the simulation activities in these programs? Studies were included if they involved United States-based TTR courses for graduating medical students that utilized simulation. Two authors independently screened all abstracts and full text articles and identified NCAs elicited in each study. Database search identified 578 articles. 63 full texts were reviewed for eligibility with 38 included in final analysis. Simulation activities were categorized as mock paging (37%, 14/38), case-based scenarios (74%, 28/38), and/or procedural skills (39%, 15/38). Simulation tools were also categorized with the most common being standardized patients (26/38, 64.8%). The most elicited NCAs were communication skills, critical thinking, and teamwork. Utilizing more simulation activity categories (3.2 vs 3.6 vs 3.6, p=0.8) or simulation tools (3.2 vs 3.5 vs 3.5, p =0.8) did not increase the mean number of NCAs elicited. Simulation is used broadly in TTR but only captures few of the NCAs required for a successful transition. This review found that incorporating more simulation does not translate to more NCAs elicited, illustrating the importance of developing more targeted simulation activities to promote NCAs effectively in future programs.