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Both the ethics of simulation and how it may be used to explore, train and assess ethical issues in a clinical context have received growing interest in recent years. As ethical considerations permeate almost every element of simulation and clinical practice, the emerging literature in this field remains relatively fragmented, lacking a common vocabulary or standardised practice and methodology. Given this, the primary aim of this paper was to systematically map the literature related to ethics in healthcare simulation, guided by the research question of ‘how is ethics in healthcare simulation recorded in current literature?’. Our secondary aim was to explore the feasibility of conducting a systematic mapping review. One hundred and four papers were included and analysed. Results suggest that this is relatively small, but rapidly growing field. Most research was carried out in the US and with variety of research methods employed. Research involving samples of nurses relied more heavily on qualitative methods and students in their samples than that of medical doctors or other professions. Keyword co-occurrence suggested that studies utilised simulation overwhelmingly in an educational context.

Background \ud There is a growing interest in ethics in simulation. The Ethical issues that are largely considered in simulation range from the vulnerability of standardised patients1 to debating the use of death in simulation2. This Systematic mapping review set out to systematically map the literature relating to ethics in healthcare simulation.\ud Methods\ud A search was carried out on Scopus, Medline, CINAHL and Psychinfo. The search terms were broad and reflected key concepts related to our research question. Bibliometric data was captured and papers were further coded. \ud Results\ud In total, 104 papers were included for review, 25% focused on the ethics of simulation, 73% focused on simulation as a means to explore/assess or train ethical issues related to healthcare. One paper focused on both issues. Just over half of the papers (n = 56; 54%) were coded as being empirical research. Of those, the majority focused on simulation as a means to explore/assess or train ethical issues (n = 49; 87.5%) as opposed to the ethics of simulation (n = 7; 12.5%).\ud The majority of outputs came from the US. Studies were mainly conducted by nurse and medical doctors, with very few from other allied health professionals and limited co-authorship. Nurses relied more heavily on qualitative methods and students in their samples than that of medical doctors or other professions. \ud Conclusions\ud This study identified that ethics in healthcare simulation is a small but rapidly growing field. However, there is little in the way of collaboration and multi-interdisciplinary approaches. The use of simulation for training of ethical dilemmas is greater than the ethics of simulation itself, however, this may be due to terminology used within healthcare simulation. \ud \ud Recommendations\ud \ud This study has identified that there is further need to explore and develop our understanding of the role of ethics in healthcare simulation itself, looking at higher quality collaborative approaches across disciplines to further the field.