Patient Outcomes in Simulation-Based Medical Education: A Systematic Review

Zendejas, Benjamin; Brydges, Ryan; Wang, Amy T.; Cook, David A.

doi:10.1007/s11606-012-2264-5

Cited by 273 publications

(181 citation statements)

References 89 publications

(108 reference statements)

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“…Only a small fraction of studies measured outcomes on real patients, thus limiting our ability to comment on translation of outcomes from the simulated environment to the real clinical environment. 44 Although our meta-analysis of TES with high versus low physical realism revealed favorable effects for high physical realism, we found only 7 studies to include in this analysis. We were unable to draw definitive conclusions related to the optimal…”

Section: Limitations and Strengthsmentioning

confidence: 90%

Technology-Enhanced Simulation and Pediatric Education: A Meta-analysis

et al. 2014

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BACKGROUND AND OBJECTIVE: Pediatrics has embraced technologyenhanced simulation (TES) as an educational modality, but its effectiveness for pediatric education remains unclear. The objective of this study was to describe the characteristics and evaluate the effectiveness of TES for pediatric education.METHODS: This review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards. A systematic search of Medline, Embase, CINAHL, ERIC, Web of Science, Scopus, key journals, and previous review bibliographies through May 2011 and an updated Medline search through October 2013 were conducted. Original research articles in any language evaluating the use of TES for educating health care providers at any stage, where the content solely focuses on patients 18 years or younger, were selected. Reviewers working in duplicate abstracted information on learners, clinical topic, instructional design, study quality, and outcomes. We coded skills (simulated setting) separately for time and nontime measures and similarly classified patient care behaviors and patient effects. RESULTS:We identified 57 studies (3666 learners) using TES to teach pediatrics. Effect sizes (ESs) were pooled by using a random-effects model. Among studies comparing TES with no intervention, pooled ESs were large for outcomes of knowledge, nontime skills (eg, performance in simulated setting), behaviors with patients, and time to task completion (ES = 0.80-1.91). Studies comparing the use of high versus low physical realism simulators showed small to moderate effects favoring high physical realism (ES = 0.31-0.70).CONCLUSIONS: TES for pediatric education is associated with large ESs in comparison with no intervention. Future research should include comparative studies that identify optimal instructional methods and incorporate pediatric-specific issues into educational interventions.

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Section: Limitations and Strengthsmentioning

confidence: 90%

Technology-Enhanced Simulation and Pediatric Education: A Meta-analysis

et al. 2014

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“…3 High-fidelity simulation of clinical scenarios allows repeated practice (RP) within a controlled environment that accommodates educational feedback. 1,2,4 Repetitive practice as provided by simulation has been shown to increase competence in the performance of many clinical procedures, including endoscopy, 5 thoracentesis, 6 advanced cardiac life support, 7 cardiac auscultation, 8 central line placement, 9 lumbar puncture, 10 and neonatal resuscitation skills. 11 Repeated exposure to simulated cases has been shown to improve performance, but repeating case scenarios decreases the learner's overall breadth of exposure.…”

Section: Introductionmentioning

confidence: 99%

Repeated Versus Varied Case Selection in Pediatric Resident Simulation

Tofil¹,

Peterson²,

Wheeler³

et al. 2014

Journal of Graduate Medical Education

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Background Repeated exposure to pediatric emergency scenarios improves technical skills, but it is unclear whether repeated exposure to specific cases affects medical decision making in varied cases. Objective We sought to determine whether repeated exposure to 1 scenario would translate to improved performance and decision making in varied scenarios. Methods Senior pediatrics residents participated in 3 scenarios with scripted debriefing. Residents were randomized to repeated practice (RP) scenarios or mixed (MIX) scenarios. RP residents completed pulseless electrical activity (PEA) with different stems (Case 1, 2, 3). MIX residents completed PEA (Case 1), seizure (Case 2), and ventricular tachycardia (Case 3) scenarios. Four months later, participants returned to complete 3 more cases: PEA (Case 4), seizure (Case 5), and critical coarctation (Case 6). Results Twenty-three residents participated in the study and were randomized to either the RP or the MIX group. The RP group showed statistically significant improvement in time to start chest compressions, whereas the MIX group showed no improvement. Use of a backboard improved significantly in Case 4 for the RP group but not for the MIX group. Similarly, time to check glucose in the seizure scenario was significantly better in the MIX group that had previous exposure to a seizure scenario. No differences in performance were noted between groups in Case 6, which was new to both groups. Conclusions Results of this study indicate that whereas repeated exposure may improve decision-making skills in similar scenarios, it may not translate to improved medical decision making in other scenarios.

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“…A second meta-analysis looked specifically at patient outcomes after simulator training across a heterogeneous group of medical skills. 25 Fifty studies were included and the analysis found improvements in reported patient outcomes when compared to no intervention. The marked improvement in technical and non-technical skills from less than one day of training is encouraging, although the authors do not report which skills drive the significant improvement.…”

Section: Does Simulation Improve Training In Medicine?mentioning

confidence: 99%

Simulator Training in Interventional Cardiology

Joshi¹,

Wragg²

2016

Interventional Cardiology Review

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Simulator training provides the opportunity to acquire and practise technical skills in a safe, controlled and reproducible environment without the risk of harming patients. Although there is no evidence to prove that patient outcomes are worse if trainees undertake interventional procedures, there is an inevitable concern that procedures may not be as safe or successful if undertaken by doctors in training. 1,2 Experiential training in the workplace exposes patients to the theoretical risks of the learning curve of trainees, especially in the radial era. 3 Further, as catheter laboratory (cath lab) scheduling time is precious, having trainees undertaking procedures that inevitably take longer can be difficult to justify when the focus is on lab efficiency. Simulator training has the potential to offer focussed training opportunities that allow both the time and space to develop interventional skills. 4 These skills can then be analysed and critiqued without any risk of patient harm or impact on the cath lab schedule.Enthusiasm for simulation training has increased dramatically over recent years because advances in technology have allowed the delivery of authentic simulated training opportunities.Despite a broad body of evidence supporting the use of simulation in medicine, there are still some concerns when this evidence is extrapolated to less studied specialties. 5 Simulation training enhances learning, especially when used alongside traditional, apprentice models of training, and it is now increasingly recognised in cardiology and interventional training programs. 6,7 In interventional cardiology the evidence and experience of simulation continues to grow, although presently there are no studies that have documented a positive effect on patient outcomes.As mentioned, many healthcare settings have restricted the weekly working hours for doctors in training due to an increasing demand on cath lab schedules. 8,9 Institutions are becoming risk averse and often limit training opportunities through fear that patient outcomes might be lowered when procedures are undertaken by doctors in training. 1These two factors reduce exposure to practical procedures thus weakening the skills and experience of future specialists. Experience is an essential component of becoming an independent operator.Solutions are therefore required to enhance and increase training opportunities and simulation is one of the most useful practical options. Supervised simulated training experiences away from the bedside in a controlled, authentic environment will allow trainees to explore and develop techniques and consolidate their learning without exposing patients to risk, as has been seen in other medical specialties. The Role of Simulation in Other Medical SpecialtiesSimulation is a long established form of medical training. 10 The early cardio-pulmonary resuscitation dolls are a simple but effective way of delivering the core elements of resuscitation training by providing a safe environment to practise and rehearse tasks, algorithms and al...

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Patient Outcomes in Simulation-Based Medical Education: A Systematic Review

Cited by 273 publications

References 89 publications

Technology-Enhanced Simulation and Pediatric Education: A Meta-analysis

Technology-Enhanced Simulation and Pediatric Education: A Meta-analysis

Repeated Versus Varied Case Selection in Pediatric Resident Simulation

Simulator Training in Interventional Cardiology

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