Clinical reasoning is universally recognised as an essential competency for physicians and a central focus of undergraduate medical education. Traditionally, clinical reasoning development has relied heavily on experience in clinical settings; however, reliance on placement-based learning carries practical and pedagogical limitations. In response, medical educators have increasingly introduced simulation-based methods, including the use of standardised patient (SP) simulations, to recreate clinical encounters in a controlled learning environment.
Despite wider adoption of SP methods, the specific contribution of SP teaching to the development of medical students’ clinical reasoning competence remains unclear. Studies vary in design, outcomes measured, and context, making it difficult to draw firm conclusions from individual reports. To address this gap, the authors present a systematic review protocol designed to identify, appraise, and synthesise evidence on the impact of SP teaching on clinical reasoning among medical students.
This systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidance for transparent reporting. The planned literature search will be comprehensive and will include five major electronic databases: PubMed, Embase, Web of Science, Education Research Complete, and the Cochrane Library. The search strategy aims to capture studies that evaluate SP teaching interventions with outcomes related to clinical reasoning competence in medical students.
The review will use a two-stage screening process. An initial screening of titles and abstracts will be conducted to efficiently identify potentially relevant studies. Articles deemed potentially eligible will proceed to full-text assessment to determine final inclusion according to predefined criteria.
To reduce selection bias and improve reliability, two reviewers will independently perform study selection. Discrepancies between reviewers will be resolved according to the review team’s predefined procedures (details of which are not reported in this protocol abstract). The use of dual independent review is intended to strengthen study identification and inclusion decisions.
Data extraction will be conducted using a standardised form to ensure consistent capture of study characteristics, intervention details, and outcomes. The protocol specifies a primary outcome of clinical reasoning competence. Secondary outcomes to be extracted and synthesised include communication skills and student satisfaction. The protocol does not provide the specific measurement instruments or operational definitions used across included studies; such detail will depend on what the primary studies report.
Two reviewers will independently extract data to minimise extraction errors and reviewer bias. The standardised form will guide the collection of relevant variables necessary for risk of bias assessment and potential quantitative synthesis.
The methodological quality and risk of bias of included studies will be assessed using the Cochrane Risk of Bias tool 2. Two reviewers will independently evaluate each study to identify potential sources of bias that could affect outcomes. The protocol indicates that this assessment will inform interpretation of study findings and decisions about the appropriateness of quantitative synthesis.
Depending on the number, quality, and homogeneity of eligible studies identified by the search, the review will proceed with a meta-analysis where feasible. If included studies are sufficiently similar in population, intervention, comparator, and outcomes, pooled estimates may be calculated.
If heterogeneity or insufficient quantitative data precludes meta-analysis, the authors will present a narrative synthesis of the evidence. The narrative approach will summarise study designs, interventions, outcomes, and risk of bias assessments to characterise the body of evidence on SP teaching and clinical reasoning in medical students.
As a systematic review protocol that synthesises published studies, this work does not involve human subjects and does not require primary ethical approval. The authors plan to disseminate the review findings through publication as a manuscript submitted to a peer-reviewed journal.
The protocol reports a PROSPERO registration number (PROSPERO CRD420251163882), indicating the review has been registered. No additional details about planned timelines or specific reporting outcomes are provided in the source abstract.