Introduction Deficiencies in non-technical skills—including communication and leadership—are well-established causes of clinical errors in healthcare. Healthcare students and professionals increasingly use high-fidelity and virtual reality (VR) simulation to replicate clinical practice, through immersive and realistic scenarios in a risk-free teaching setting. However, there is no up-to-date, high-quality synthesis of the effects of high-fidelity and VR simulation on non-technical skills for healthcare students and professionals. A systematic review and meta-analysis of this literature is required to enhance the current knowledge. Methods This protocol has been reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement. We will include randomised trials and other controlled studies that report differences in non-technical skills between high-fidelity and VR simulation. We will search MEDLINE, Scopus, EMBASE, ERIC and CINAHL, from database inception. We will also search reference lists and contact experts to identify additional studies. Two independent reviewers will screen titles and abstracts, review full texts, and extract data. Discrepancies will be resolved through discussion, with a third reviewer if necessary. For randomised trials, we will use the Cochrane Risk-of-Bias 2.0 (RoB2) tool to evaluate the risk of bias in the included studies. For non-randomised studies, we will use the Risk Of Bias In Non-randomized Studies (ROBINS-1) assessment tool. If appropriate, meta-analysis will be performed. We will analyse continuous outcomes using weighted mean differences (with 95% CIs) or standardised mean differences (with 95% CIs) if different measurement scales are used. We will use subgroup and sensitivity analyses to explore heterogeneity. The overall certainty of evidence will be assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) tool. Ethics and dissemination Ethical approval is not applicable for this study because no primary data have been collected. This review will be disseminated through peer-reviewed publication and presented at conferences to inform ongoing educational practises. PROSPERO registration number CRD420251136479.
Hunt et al. (2026) studied this question.