High-Fidelity Simulators in Undergraduate Medical Education: A Systematic Review.

High-fidelity simulators (HFS) have become integral to undergraduate medical education (UME), offering realistic clinical training and skill development opportunities. Despite their growing use, the comparative effectiveness of HFS versus low-fidelity simulators (LFS) and traditional teaching methods remains unclear. This review evaluates the impact of HFS in UME, focusing on skill acquisition, knowledge retention, student confidence, and cost-effectiveness. A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PUBMED, Ovid, and LibSearch for studies from 2000 to 2025 comparing HFS with LFS or traditional teaching methods in UME. Forty-four studies met the inclusion criteria and were critically appraised. HFS significantly improved procedural skills, particularly in high-stakes scenarios such as emergency medicine. They also enhanced student confidence in complex clinical situations. However, evidence on the impact of HFS on knowledge retention was mixed, and LFS were found to offer similar outcomes for basic skills training at a lower cost. HFS play a valuable role in UME, especially for complex skills, but a tiered approach utilizing LFS for basic training may offer cost-effective alternatives. Future research should evaluate the long-term effects of HFS on clinical practice.