Health professions education faces a critical challenge: providing practical, hands-on experience in a safe environment.1 Simulation-based training offers a solution by bridging these gaps. However, the substantial costs of the necessary equipment and software present considerable obstacles for many institutions.2 These financial burdens undermine the quality of education and exacerbate inequalities, particularly impacting programs that are resource-constrained.3 Therefore, there is a need to develop a more accessible and equitable approach to simulation-based training.

Among a range of potential solutions, low-cost simulation is a feasible alternative. This method employs cost-effective materials to construct realistic training scenarios.4 Although previous studies confirm its effectiveness, research has focused on specific areas like urology, otorhinolaryngology, and general surgery.5,6 This narrow focus limits our comprehensive understanding of the field. Therefore, a more profound and extensive knowledge of low-cost simulations is essential to inform and guide future research initiatives.

To meet the identified need, we conducted a bibliometric analysis to map the research field of low-cost simulation (Concept) in health professions education (Context). This analysis documents and assesses foundational work, setting the stage for future studies and practical implementation. Moreover, the findings hold the potential to influence policy decisions and reduce disparities in health professions' education quality.

A bibliometric study, a methodology that uses quantitative methods on bibliographic data,7 was conducted to analyze the research field of low-cost simulation in health professions education publications indexed in Scopus between 2003 and 2022. To enhance the replicability of our study, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 reporting guidelines,8 as done in previous bibliometric analyses in health professions education.9,10

On October 11, 2023, a search was conducted in the Scopus Database using a strategy designed and reviewed collaboratively by two authors. The strategy was as follows: (TITLE-ABS-KEY(Low-fidelity) OR TITLE-ABS-KEY(low-cost) OR TITLE-ABS-KEY(homemade) OR TITLE-ABS-KEY(budget)) AND (INDEXTERMS(«Simulation Training») OR TITLE-ABS-KEY(Simulation)).

The screening of titles and abstracts was performed in duplicate. Publications were included if they fulfilled the following criteria: (1) discussed the development, validation, or implementation of low-cost simulation and (2) were in English.

Then, for each study included, the following data points were extracted: (1) study aim, (2) study design, (3) comparison with a standard commercial model (if applicable) or indication of no model used for comparison, (4) medical specialty employing the low-cost simulation model (e.g., surgery, anesthesiology, emergency medicine) with the specific task, and (5) reported cost of the low-cost simulation model.

Fig. 1 shows the overall growth of publication. The growth of studies published in low-cost simulation from 2005 (n=1) to 2022 (n=19). Scientific production did not experience significant growth before 2015. The year with the highest production was 2020, with even more publications in Scopus Quartile1 journals.

Fig. 1.

Overall growth and per quartile of low-cost simulation studies published in the Scopus database from 2003 to 2022.

Note: The first publication was in 2005.

(0.21MB).

Of the 105 studies included, 68.57% (n=72) were observational, 22.86% (n=24) were experimental, and 8.57% (n=9) were review articles as shown in Table 2. Of these, 96 articles had a comparison, with 94 (97.92%) not using a model and 2 (2.08%) comparing against the standard model. General surgery (27.08%) was the most predominant specialty where low-cost simulation was researched, followed by obstetrics and gynecology (14.58%), ear-nose and throat (12.5%), cardiovascular surgery (9.37%), and gastroenterology (6.25%). Less than half of the studies (45.84%) reported the cost of the models.

In Table 1, Simulation in Healthcare performed the best in terms of indicators, with 45 CT and 4 NP and a CiteScore 2022 of 3.4 (Q2). The International Journal of Gynecology and Obstetrics had the highest CiteScore 2022, ranking 5.7 in Q1. The five most productive authors' research fields were general surgery and obstetrics. Furthermore, when applying Lotka's law, 514 (94%) authors had only one publication in low-cost simulation. Additionally, 31 authors (5.7%) had 2 publications. However, only 2 authors (0.3%) had 3 publications. Moreover, all most impactful publication were in the surgical fields (see Table 3).

According to Fig. 2A, the United States (US) has the highest scientific production and is the center of collaboration networks in the field. The largest production in the field is in North America (US, Mexico, and Canada), with 40 studies. Fig. 2B shows a relationship between Ghanaian, Indian, and US production regarding collaboration networks.

Fig. 2.

Countries' production and collaboration networks in the research field of low-cost simulation in health professions education from 2003 to 2022 in the Scopus database.

(0.12MB).

We employ a keyword co-occurrence analysis (3A) and co-citation analysis (3B) to delve into the conceptual and intellectual structure. Fig. 3A identified 4 clusters: learning curve (yellow), surgical model development (red), simulation in surgery (blue), and simulation in obstetrics (green). In Fig. 3B, the co-citation analysis shows 4 clusters focused on developing the surgical model in the green, yellow, and blue clusters and the transferability of these models in the curriculum as shown in the red cluster. Therefore, this suggests that the field of low-cost simulation in health professions education is dominated by surgical simulation training.

Fig. 3.

Conceptual (3A) and intellectual structure (3B) in the research field of low-cost simulation in health professions education from 2003 to 2022 in the Scopus database.

(0.33MB).

This work received no funding.