Beyond the Checklist: How Different Prebriefing Tools Influence Simulation Outcomes—A Systematic Review and Meta-Analysis

<title>Abstract</title> <p> <bold>Background/Objectives:</bold> While prebriefing is essential for simulation-based education (SBE), the differential impacts of varying tool innovation levels remain unclear. This systematic review and meta-analysis aimed to evaluate how innovative prebriefing strategies, classified by the Substitution, Augmentation, Modification, and Redefinition (SAMR) framework, affect simulation performance, psychological safety, and simulation experience. <bold>Methods:</bold> Following PRISMA guidelines (PROSPERO: not registered), four databases (ScienceDirect, Embase, Medline, Web of Science) were searched from inception to August 6, 2025. We included randomized controlled trials (RCTs) and quasi-experimental studies comparing structured prebriefing to standard or no prebriefing in healthcare SBE. Risk of bias was assessed using Cochrane RoB 2 and ROBINS-I tools. Random-effects models were used to calculate pooled standardized mean differences (SMDs) and 95% confidence intervals (CIs). Subgroup analyses stratified interventions by tool used in prebriefing. <bold>Results:</bold> Fifteen studies (6 RCTs, 9 quasi-experimental) were included. All quasi-experimental studies exhibited moderate risk of bias. Overall, innovative prebriefing significantly improved simulation performance (SMD = 1.04, 95% CI [0.73, 1.36], $I^2$ = 71.6%). For psychological safety, the overall effect (SMD = 0.84, 95% CI [0.27, 1.42]) was substantially attenuated to non-significance following trim-and-fill adjustment for detected publication bias (adjusted SMD = 0.47, 95% CI [-0.49, 1.43]). Simulation experience showed no significant overall improvement (SMD = 0.22, $p$ = 0.32). Subgroup analyses revealed that Group 2 interventions (Augmentation: structured worksheets combined with facilitated interaction) demonstrated the most consistent effects and lowest heterogeneity across domains (e.g., performance $I^2$ = 58.2%). Conversely, Group 3 interventions (Modification: advanced digital tools like VR/AI) produced the highest performance estimates (SMD = 1.25) but generated extreme heterogeneity ($I^2$ = 88.0%) and failed to significantly improve psychological safety (SMD = 0.51, 95% CI [-3.53, 4.55]). <bold>Conclusion:</bold> The application of different prebriefing tool types is significantly associated with varying SBE outcomes. Higher technological novelty does not uniformly yield superior results and may introduce extraneous cognitive demands that hinder psychological safety. Moderate-innovation approaches incorporating facilitated interactive elements represent the most reliable, evidence-supported strategy for prebriefing design. </p>