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 (VR). This review synthesized evidence on these approaches for training healthcare learners in pediatric endocrine emergency management and identified implications for adaptation and development in Iran.
Materials and Methods: A structured narrative review was conducted using descriptive, analytical, and comparative approaches. Persian- and English-language sources were searched from database inception through February 28, 2026, across international and Iranian databases. Two reviewers independently screened, selected, and reviewed eligible sources; disagreements were resolved by consensus. Data on emergency type, educational modality, learner group, setting, 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-based simulation, interprofessional education, in situ simulation, immersive VR, 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 identified latent safety threats and workflow failures. Evidence for transfer to clinical practice, learning retention, cost-effectiveness, and patient-related outcomes remained limited. Published Iranian evidence on intervention design, implementation, and evaluation was sparse.
Conclusion: Simulation and VR are complementary. Iran should develop phased, locally adapted, Persian-language training for DKA, severe hypoglycemia, and adrenal crisis, incorporating debriefing, interprofessional learning, faculty development, and objective learner and system-level assessment.