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Simulation-based learning offers a wide range of opportunities to practice complex skills in higher education. This meta-analysis includes 143 empirical studies and investigates the effectiveness of different instructional support measures on fostering different knowledge and skill outcomes. Instructional support enhances learning of knowledge and skills beyond the effect of simulation based learning only if properly designed. Combining knowledge convey with scaffolding is effective for most types of knowledge and skills, but providing feedback is essential for fostering diagnostic skills and technical performance. We conclude that (1) instructional support enhances effects of simulations (2) different types of knowledge and skills benefit from different combinations of instructional support.