Abstract: Objective To systematically synthesize existing literature, identify the core competency ele- ments essential for instructors to effectively deliver pediatric simulation-based teaching, and provide evidence- based references for faculty development and evaluation. Methods A systematic review was conducted by searching PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Data Knowledge Service Platform from database inception to January 31, 2026. Two researchers independently performed literature screening and data extraction according to predefined inclusion and exclusion criteria. Methodological quality was assessed using the mixed methods appraisal tool (MMAT). Thematic synthesis was employed to code, summarize, and integrate the included literature. Results A total of 14 studies published between 2019 and 2026 were included, comprising 7 from China, 3 from the United States, and 1 each from Turkey, Japan, India, and Canada. In terms of study design, there were 3 randomized controlled trials, 4 qua-si-experimental studies, 1 qualitative study, 2 cross-sectional surveys, 3 non-randomized controlled trials, and 1 mixed-methods study. Five studies received an MMAT score of 100%, while 9 scored 80%, indicating an overall moderate-to-high methodological quality. A total of 87 initial codes were extracted, which were compared and consolidated into 25 subclusters and 8 descriptive themes, ultimately abstracted into 4 analytical themes (i. e., four core competency domains): curriculum design and development; instructional facilitation and feedback; technical proficiency and scenario management; and assessment, reflection, and continuous professional development. Conclusions The four-core-competency framework identified in this study encompasses the complete teaching chain from pre-session preparation and in-session implementation to post-session evaluation and improvement, and may serve as a reference for the selection, training, assessment, and career development of pediatric simulation educators.