A Scoping Review of the Think-aloud Method in Health Professions Education Simulations: Applications, Outcomes, and Best Practices

Interprofessional Education (IPE) improves collaboration, communication, and patient care while reducing errors. Simulation-based IPE bridges classroom-clinical gaps, enhancing role awareness and teamwork. However, research on cognitive processes during IPE simulations is limited. The think-aloud protocol shows promise in medical education for fostering decision-making and problem-solving during interprofessional learning.Goals, objectives, and purpose: This paper reviewed the methodological considerations and outcomes of think-aloud protocols in simulation-based education for health profession students. It explored design and implementation techniques, mapped reported outcomes to Kirkpatrick levels, and provided best practice recommendations to optimize think-aloud protocols for enhancing learning and evaluation in medical education.Methods/Methodology: A comprehensive search across PubMed, EMBASE, CINAHL, and ERIC identified 1,032 articles on "students" and "think-aloud." Two reviewers screened studies using Covidence, applying inclusion criteria (health students, think-aloud in simulations, outcomes described). Data extraction captured study design, protocol details, and outcomes. Discrepancies were resolved through consensus or a third reviewer.Results/Findings: Descriptive and narrative synthesis identified patterns and gaps in think-aloud applications and outcomes, summarized in tables aligned with the Kirkpatrick model. Guided by Arksey and O’Malley’s scoping review framework, the analysis informed conclusions and recommendations to enhance the use of think-aloud protocols in simulation-based education.Conclusions, implications, and/or curiosities: This scoping review identified critical gaps in the reporting of think-aloud protocols, particularly concerning simulation timing, while demonstrating their potential to enhance clinical reasoning, decision-making, and behavioral skills in interprofessional education (IPE) simulations. The outcomes mapped to Kirkpatrick's levels indicate skill improvements and behavioral changes among participants. Despite its promising impact, think-aloud remains underutilized in IPE simulations, which underscores the need for its integration into these learning environments. The review recommends standardizing think-aloud protocols, diversifying simulation scenarios, leveraging technology, and tailoring methods to specific disciplines to enhance the effectiveness of IPE.