Background: Pediatric endocrine emergencies require rapid, guideline-based management, complication monitoring, and effective teamwork. Limited exposure to high-risk clinical cases and patient-safety concerns highlight the value of clinical simulation and virtual reality. This review synthesized evidence on these approaches for training in pediatric endocrine emergency management and identified implications for their adaptation and development in Iran.

Methods: A structured narrative review was conducted using descriptive, analytical, and comparative approaches. Persian and English sources were searched from database inception to March 31, 2026, across international and Iranian databases. Two reviewers independently screened, selected, and reviewed relevant sources, with disagreements resolved by consensus. Data on emergency type, educational modalities, learner groups, settings, instructional design, debriefing, outcomes, and implementation factors were extracted and narratively synthesized using Kirkpatrick’s framework.

Results: Evidence primarily addressed pediatric diabetic ketoacidosis (DKA); studies of adrenal crisis, severe hypoglycemia, congenital adrenal hyperplasia-related hyperkalemia, thyroid storm, and hyperosmolar hyperglycemic state were limited. Principal modalities included high-fidelity manikin simulation, interprofessional education, in situ simulation, immersive virtual reality, and screen-based virtual patients. These approaches generally improved knowledge, problem-solving, confidence, simulated performance, and team coordination. Multifaceted interventions combining simulation, structured feedback, and guideline-based checklists improved adherence to DKA-management processes in some studies. In situ simulation also identified latent safety threats and workflow failures. Evidence for clinical transfer, learning retention, cost-effectiveness, and patient-centered outcomes remained limited. Published Iranian evidence on the design, implementation, and evaluation of these interventions was sparse.

Conclusion: Simulation and virtual reality are complementary approaches. Iran should develop phased, Persian, locally adapted, guideline-based training packages for diabetic ketoacidosis, severe hypoglycemia, and adrenal crisis, including structured debriefing, interprofessional training, faculty development, and objective assessment.