A Scoping Review of Pakistani Healthcare Simulation: Insights for Lower-Middle-Income Countries.

Healthcare simulation has gained global recognition in health professions education, yet its adoption in Pakistan, a lower-middle-income country (LMIC), remains limited. This scoping review aimed to explore how simulation is integrated into healthcare education in Pakistan, highlighting challenges and opportunities to inform similar LMICs. Pakistan serves as a critical case study for LMICs due to its unique challenges, including uneven access to simulation technologies and limited faculty training, which are shared by many similar resource-constrained settings. Using the Arksey and O'Malley framework, a systematic review of 693 publications identified 145 studies that met inclusion criteria. The findings revealed diverse simulation modalities primarily focused on skills training and clinical decision-making. Notable innovations included low-cost simulation solutions, effectively addressing resource constraints. However, significant gaps emerged, including an urban-centric focus with limited rural representation, insufficient evaluation of long-term impacts, and the absence of standardized terminology and training protocols. These challenges hinder broader integration and equitable access to simulation-based learning. Addressing these gaps through strategic collaborations, capacity-building initiatives, and innovative, cost-effective solutions, such as low-cost simulators crafted from readily available materials, could enhance simulation adoption in Pakistan and similar LMICs. This review highlights the importance of adopting evidence-based practices, increasing funding, and conducting comprehensive research on simulation's long-term impact to ensure effective implementation and improved healthcare education and outcomes globally.