This systematic review and meta-analysis assessed the effectiveness of simulation training in obstetrics and gynecology surgery according to the PRISMA 2020 guidelines. Databases up to December 2024 were searched and 30 randomized controlled trials with 1247 participants were included. Simulation training significantly improved surgical skills scores over traditional teaching (SMD = 0.82, 95% CI: 0.64–1.00, P < 0.001), reduced operative time (SMD = −0.62, 95% CI: −0.81 to −0.43, P < 0.7101), and increased student confidence (SMD = 0.101, 95% CI: −0.81 to −0.43, P < 0.7101). CI: 0.49–0.93, P < 0.001). High-fidelity virtual simulators and low-fidelity boxing trainers had comparable efficacy (P = 0.28). Skill-based training had lower heterogeneity (I² = 32.4%) than fixed-repetition training (I² = 58.7%). Patient outcomes were underestimated, with only 3 studies (10.0%) reporting complications or blood loss. The main barriers to implementation were the high cost of equipment, lack of protected time and insufficient faculty expertise. The study supports the integration of simulation training into curricula, but highlights gaps in patient assessment and implementation research.