Assessing and evaluating computer-based simulation for scrub role training: A systematic review framed by Miller's Pyramid of clinical competence

Background: Computer-based simulation (CBS) is increasingly used to train perioperative staff, yet its effectiveness for scrub role performance remains underexplored. Methods: This systematic review (2019–2024) examined how CBS outcomes for scrub role training are assessed and its effectiveness in developing competence using Miller's Pyramid of Clinical Competence. Results: Nine studies met inclusion criteria. Outcomes were measured using multiple-choice tests, in-game performance metrics, and objective structured clinical examinations. Study quality was moderate. CBS improved knowledge, application, and simulated performance; however, no studies evaluated clinical performance. Conclusion: Methodological variability, limited validity evidence, and a lack of surgical technologists temper confidence and highlight critical gaps research gaps.