High-fidelity simulation programs in ICU-related ethical non-technical skills training: A narrative review
References
- Moon JY, Kim JO. Ethics in Intensive Care Unit. Tuberculosis and Respiratory Diseases. 2015;78(3):175–179.
- Brasel B, Ballou J. Ethics in Critical Care. Springer International Publishing AG. 2018;601–609.
- Pinar G, Peksoy S. Simulation-Based Learning in Healthcare Ethics Education. Creative Education. 2016;7(1):131–138.
- Meurling L, Hedman L, Sandahl C, Fellander-Tsai L, Wallin CJ. Systematic simulation-based team training in a Swedish intensive care unit: a diverse response among critical care professions. BMJ Qual Saf. 2013;22(6):485–494.
- Tanoubi I, Georgescu M, Robitaille A, Drolet P, Perron R. Using High-Fidelity Simulation to Teach Ethics Related Non-Technical Skills: Description of an Innovative Model. Advances in Medical Education and Practice. 2020;11:247–251.
- N, Lee AJ, Vennero M, Emlet L. Simulation Training in the ICU. CHEST. 2019;156(6):1223–1233.
- Smith A, Lammers S. The Ethics of Simulation. Defining Excellence in Simulation Programs, Wolters Kluwer. 2014;592–596.
- Smith KV, Witt J, Klaassen J, Zimmerman C, Cheng AL. High-fidelity Simulation and legal/ethical concepts: A transformational learning experience. Nursing Ethics. 2012;19(3):390–398.
- Rischbieth A, Benbenishty J. Ethical issues in Critical Care. Clinicalgate. 2015;
https://clinicalgate.com/ethical-issues-in-critical-care/ . - L’Hera E, Geeraerts T, Desclefs JP, Benhamou D, Blanie A, Cerf C, Mossadegh C. Simulation-based teaching in critical care, anaesthesia, and emergency medicine. Anaesth Crit Care Pain Med. 2020;39(2):311–326.
- Preisz A. Fast and slow thinking; and the problem of conflating clinical reasoning and ethical deliberation in acute decision-making. Journal of Paediatrics and Child Health. 2019; 55(6):621–624.
- Rhodes R, Alfandre D. A systematic approach to clinical moral reasoning. Clinical Ethics. 2007;2(2):66–70.
- Harvey DJR, Gardiner D. ‘MORAL balance’ decision-making in critical care. BJA Education. 2019;19(3):68–73.
- Ghoneim N, Dariya V, Guffey D, Minard CG, Fruge E, Harris LL, Arnold J. Teaching NICU Fellows How to Relay Difficult News Using a Simulation-Based Curriculum: Does Comfort Lead to Competence? Teaching and learning in medicine. 2018;31(2):207–221.
- Colman N, Figueroa J, McCracken C, Hebbar KB. Can Simulation-Based Team Training Impact Bedside Teamwork in a Pediatric Intensive Care Unit? J Pediatr Intensive Care. 2019;8(04):195–203.
- Figueroa MI, Sepanski R, Goldberg SP, Shah S. Improving Teamwork, Confidence, and Collaboration Among Members of a Pediatric Cardiovascular Intensive Care Unit Multidisciplinary Team Using Simulation-Based Team Training. Pediatr Cardiol. 2013;34(3):612–619.
- Downar J, Knickle K, Granton JT, Hawryluck L. Using standardized family members to teach communication skills and ethical principles to critical care trainees. Crit Care Med. 2012;40(6):1814–1819.
- Arnold RM, Back AL, Barnato AE, Prendergast TJ, Emlet LL, Karpov I, Nelson JE. The Critical Care Communication project: Improving fellows’ communication skills. Journal of Critical Care. 2015;30(2): 250–254.
- Hope AA, Hsieh SJ, Howes JM, Keene AB, Fausto JA, Pinto PA, Gong MN. Development and Evaluation of a Communication Skills Training Program for Critical Care Fellows. Ann Am Thorac Soc. 2015;12(4):505–508.
- Sung TC, Hsu HC. Improving Critical Care Teamwork: Simulation-Based Interprofessional Training for Enhanced Communication and Safety. Journal of Multidisciplinary Healthcare. 2025;18:355–367.
- Pimenta IDSF, Mata ANDS, Bezerra INM, de Araujo RMP, Santana JLA, Capucho HC, Piuvezam G. Effectiveness of non-technical skills training in intensive care units: a systematic review. BMC Medical Education. 2025;25(1):847.
- Orford NR, Milnes S, Simpson N, Elderkin T, Bone A, Corke C. Effect of communication skills training on outcomes in critically ill patients with life-limiting illness referred for intensive care management: a before-and-after study. BMJ Supportive & Palliative Care. 2017;9(1):e21–e21.
- Garbee DD, Paige JT, Bonanno LS, Rusnak VV, Barrier KM, Kozmenko LS, Nelson TK. Effectiveness of teamwork and communication education using an interprofessional high-fidelity human patient simulation critical care code. Journal of Nursing Education and Practice. 2013;3(3):1.
- Gillis AE, Morris MC, Ridgway PF. Communication skills assessment in the final postgraduate years to established practice: a systematic review. Postgrad Med J. 2015;91(1071):13–21.
- Turkelson C, Aebersold M. Improving Nursing Communication Skills in an Intensive Care Unit Using Simulation and Nursing Crew Resource Management Strategies. J Nurs Care Qual. 2017;32(4):331–339.
- Krimshtein NS, Luhrs CA, Puntillo KA, Cortez TB, Livote EE, Penrod JD, Nelson JE. Training Nurses for Interdisciplinary Communication with Families in the Intensive Care Unit: An Intervention. Journal of Palliative Medicine. 2011;14(12):1325–1332.
- Niglio de Figueired M, Krippeit L. ComOn-Coaching: The effect of a varied number of coaching sessions on transfer into clinical practice following communication skills training in oncology: Results of a randomized controlled trial. PLoS ONE. 2018;13:1–20.
- Coggins A, Desai M, Nguyen K, Moore N. Early acquisition of non-technical skills using a blended approach to simulation-based medical education. Advances in Simulation. 2017;2(1):12.
- La Cerra C, Dante A, Caponnetto V, Franconi I, Gaxhja E, Petrucci C, Lancia L. Effects of high-fidelity simulation based on life-threatening clinical condition scenarios on learning outcomes of undergraduate and postgraduate nursing students: a systematic review and meta-analysis. BMJ Open. 2019;9(2):1–11.
- Scheunemann LP, Khalil R, Rajagopal PS, Arnold RM. Development and Pilot Testing of a Simulation to Study How Physicians Facilitate Surrogate Decision-Making Based on Critically Ill Patients’ Values and Preferences. J Pain Symptom Manage. 2018;57(2):216–223.
- Cummings CL. Teaching and assessing ethics in the newborn ICU. Semin Perinatol. 2016;40(4):261–269.
- Lewis G, McCullough M, Maxwell AP, Gormley GJ. Ethical reasoning through simulation: a phenomenological analysis of student experience. Advances in Simulation. 2016;1(1):1–10.
- Couto TB, Farhat SC, Geis GL, Olsen O, Schvartsman C. High-fidelity simulation versus case-based discussion for teaching medical students in Brazil about pediatric emergencies. Clinics. 2015;70(6):393–399.
- Mutter MK, Martindale JR, Shah N, Gusic ME, Wolf SJ. Case-Based Teaching: Does the Addition of High-Fidelity Simulation Make a Difference in Medical Students’ Clinical Reasoning Skills? Medical Science Educator. 2020;30(1):307–313.
- Sedgwick M, Yanicki S, Harder N, Scott D. A scoping review of the integration of ethics education in undergraduate nursing high-fidelity human simulation-based learning. Journal of Clinical Nursing. 2020;30(5-6):605–614.
- Souza AD, Vaswani V. Diversity in approach to teaching and assessing ethics education for medical undergraduates: A scoping review. Ann Med Surg. 2020;56:178–185.
- Lippert A, Dieckmann P. Ethics in Simulation for Intensive Care. ICU Management. 2013;12(4):39–41.
- Elshama SS. How to apply Simulation-Based Learning in Medical Education? Ibroamerican Journal Of Medicine. 2020;2(2):79–86.
- Mills S, Bryden DC. A practical approach to teaching medical ethics. Journal of medical ethics. 2010;36(1):50–4.
- Honkavuo L. Ethics simulation in nursing education: Nursing students’ experiences. Nurs Ethics. 2021;28(7-8):1269–1281.
- Goethals S, Gastmans C, Casterle BD. Nurses’ ethical reasoning and behaviour: A literature review. International Journal of Nursing Studies. 2010;47(5):635–650.
- Buxton M, Phillippi JC. Simulation: A New Approach to Teaching Ethics. Journal of Midwifery & Women’s Health. 2014; 00.
- Harwayne-Gidansky I, Zurca A, Maa T, Bhalala US, Malaiyandi D, Nawathe P, Emlet LL. Defining Priority Areas for Critical Care Simulation: A Modified Delphi Consensus Project. Cureus. 2021;13(6).
- Gopaldas JA, Narayanaswamy N, Chandregowda NP. Communication Skill Training Levels among Critical Care Doctors in India. Indian Journal of Critical Care Medicine. 2023;27(8):567.
- Chiu M, Tarshis J, Antoniou A, Bosma TL, Burjorjee JE, Cowie N, Tremblay MH. Simulation-based assessment of anesthesiology residents’ competence: development and implementation of the Canadian National Anesthesiology Simulation Curriculum (CanNASC). Can J Anesth/J Can Anesth. 2016;63(12):1357–1363.
- Fawzi MM. Medical ethics educational improvement, is it needed or not?! Survey for the assessment of the needed form, methods, and topics of medical ethics teaching course amongst the final year medical students, Faculty of Medicine, Ain Shams University (ASU), Ca. Journal of Forensic and Legal Medicine. 2011;18(5):204–207.
- Vanlaere L, Timmermann M, Stevens M, Gastmans C. An explorative study of experiences of healthcare providers posing as simulated care receivers in a ‘care-ethical’ lab. Nursing Ethics. 2012;19(1): 68–79.
- Ziv A, Wolpe PR, Small SD, Glick S. Simulation-Based Medical Education: An Ethical Imperative. Academic Medicine. 2003;1(4):252–256.
- Gautier WC, Abaye M, Dev S, Seaman JB, Butler RA, Norman MK, White DB. Developing and User Testing a Scalable Web- and Videoconference-based Training Platform to Improve Clinicians’ Serious Illness Communication Skills. Am J Crit Care. 2022;31(3):189–201.
- Picozzi M, Gasparetto A. Clinical ethics consultation in the intensive care unit. Minerva anestesiologica. 2020;86(6): 670–677.
- Vergano M, Naretto G, Elia F, Gandolfo E, Calliera CN, Gristina GR. ELS (Ethical Life Support): a new teaching tool for medical ethics. Crit Care. 2019;23(1):204.
- Wolbrink TA, Burns JP. Teaching trainees to perform procedures on critically ill children: ethical concerns and emerging solutions. AMA Journal of Ethics. 2012;14(10): 771–777.
- Vergano M, Magavern E, Zamperetti N. Clinical ethics: what the anesthesiologist and the intensivist need to know. Minerva Anestesiol. 2018;84(4):515–22.
- Ilgen JS, Ma IW, Hatala R, Cook DA. A systematic review of validity evidence for checklists versus global rating scales in simulation-based assessment. Medical education. 2015;49(2):161–173.
- Y, Zhang Y, Zhang L, Bai H, Wang G, Guo L. The impact of SimMan on resident training in emergency skills. Medicine. 2019;98(2:e13930.
- R, Gautier W, Abaye M, Dev SP, Butler RA, Norman MK, White DB. Developing and User-Testing a Web-and Videoconference-Based Training Platform to Improve Clinicians’ Serious Illness Communication Skills. American Thoracic Society. 2021;TP12:A1538–A1538.
- Meurling L, Hedman L, Sandahl C, Felländer-Tsai L, Wallin CJ. Systematic simulation-based team training in a Swedish intensive care unit: a diverse response among critical care professions. BMJ quality & safety. 2013;22(6):485–494.
- Vangone I, Caruso R, Magon A, Giamblanco C, Conte G, Baroni I, Arrigoni C. High-Fidelity simulation and its impact on non-technical skills development among healthcare professionals: a systematic review and meta-analysis. ACTA BIOMEDICA. 2024;95(2):1–17.
- Gawronski O, Thekkan KR, Genna C, Egman S, Sansone V, Erba I, Chiusolo F. Instruments to evaluate non-technical skills during high fidelity simulation: A systematic review. Frontiers in Medicine. 2022;9:986296.
- Reader T, Flin R, Lauche K, Cuthbertson BH. Non-technical skills in the intensive care unit. BJA: British Journal of Anaesthesia. 2006;96(5):551–559.
- Metaxa VA, Ostermann M. Ethical considerations in research involving ICU patients who lack capacity: navigating the updated Helsinki Declaration. Intensive Care Med. 2025;51:146–149.
Language: English
Page range: 150 - 157
Submitted on: Oct 4, 2025
Accepted on: Jan 26, 2026
Published on: Apr 30, 2026
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Related subjects:
© 2026 Alexandra-Maria Boldis, Cristina Petrisor, Darius Turcas, George-Calin Dindelegan, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.