Review articleSimulation technology for resuscitation training: A systematic review and meta-analysis☆
Introduction
The infrequency of resuscitation events limits the opportunities for on-the-job training. Such limitations may become more pronounced as duty hours reduce clinical exposures and as training shifts to ambulatory settings.1, 2, 3 Simulation training offers a potential solution that enables deliberate selection and sequencing of cases, practice (and error) without risking patient safety, and accommodation of training schedules. Given these proposed advantages, medical educators have been charged to develop and use simulation training models,4 and medical schools and teaching hospitals have invested heavily in simulation training technologies.5 However, the effectiveness and optimal design of resuscitation training remains unknown.6 A synthesis of available evidence would help educators and policymakers determine the appropriate role of simulation in resuscitation training and optimize instructional design.
Recent reviews have attempted to address this need by synthesizing results of empiric investigations of resuscitation training. However, these reviews had limitations including focus on a single provider type, lack of comprehensive search, or absence of quantitative synthesis.7, 8, 9, 10 A recent review of simulation-based education broadly found large benefits compared with no intervention and modest benefits compared with other instruction, but did not look specifically at resuscitation training.11, 12 We aimed to perform a comprehensive systematic review and meta-analysis focusing on simulation-based resuscitation training to determine effectiveness and best practices for instructional design.
Section snippets
Methods
This review was planned, conducted, and reported in adherence to PRISMA standards of quality for reporting meta-analyses.13 It is a planned sub-analysis of articles identified in general reviews of simulation-based education.11, 12, 14 Our general methods have been described in detail previously;11 we summarize them briefly below.
Trial flow
Our search yielded 10,903 articles. From these we identified 985 comparative studies of simulation-based training, and then 185 studies specific to resuscitation training (see Fig. 1). We identified two articles reporting on the same intervention; we selected the most detailed report for full review and excluded the other. We also excluded two studies without learning outcomes. This left 182 studies enrolling 16,664 participants included for full review, namely 114 comparisons with
Discussion
Meta-analysis of 114 studies indicates that simulation-based resuscitation training is highly effective when compared with no-intervention. Evidence from 21 studies further suggests that simulation-based training may be slightly more effective than non-simulation interventions for process skills, but not for knowledge or procedural speed.
Relatively few studies explored the elements that contribute to effective simulation-based instruction. However, these studies, when clustered by theme,
Funding source
This publication was supported by intramural funds, including an award from the Division of General Internal Medicine, Mayo Clinic.
Conflict of interest statement
No conflict of interest to disclose by any of the authors.
Acknowledgements
The authors acknowledge Stanley J. Hamstra, PhD, Rose Hatala, MD, MSc, Amy Wang MD, and Pat Erwin, MLS, for their efforts in initial study selection and data abstraction.
References (86)
- et al.
Human factors in resuscitation teaching
Resuscitation
(2012) - et al.
Preparing to respond: Joint Trauma Training Center and USAF Nursing Warskills Simulation Laboratory
Crit Care Nurs Clin North Am
(2003) - et al.
From the combat medic to the forward surgical team: the Madigan model for improving trauma readiness of brigade combat teams fighting the Global War on Terror
J Surg Res
(2007) - et al.
Distractions and surgical proficiency: an educational perspective
Am J Surg
(2009) - et al.
Disaster 101: a novel approach to disaster medicine training for health professionals
J Emerg Med
(2010) - et al.
Training physicians for combat casualty care on the modern battlefield
J Surg Educ
(2007) - et al.
Advanced surgical trauma care training with a live porcine model
Injury
(2005) - et al.
Teamwork training improves the clinical care of trauma patients
J Surg Educ
(2010) - et al.
The effect of pre-course e-learning prior to advanced life support training: a randomised controlled trial
Resuscitation
(2010) - et al.
Randomized, controlled trial of video self-instruction versus traditional CPR training
Ann Emerg Med
(1998)
Self-training in the use of automated external defibrillators: the same results for less money
Resuscitation
Effects of monthly practice on nursing students’ CPR psychomotor skill performance
Resuscitation
Basic life support refresher training of nurses: individual training and group training are equally effective
Resuscitation
Comparison of traditional advanced cardiac life support (ACLS) course instruction vs. a scenario-based, performance oriented team instruction (SPOTI) method for Korean paramedic students
J Emerg Med
Improved basic life support performance by ward nurses using the CAREvent® Public Access Resuscitator (PAR) in a simulated setting
Resuscitation
Comparison of two instructional modalities for nursing student CPR skill acquisition
Resuscitation
An evaluation of objective feedback in basic life support (BLS) training
Resuscitation
Voice advisory manikin versus instructor facilitated training in cardiopulmonary resuscitation
Resuscitation
Advanced Cardiac Life Support Courses: live actors do not improve training results compared with conventional manikins
Resuscitation
The effectiveness of a human patient simulator in the ATLS shock skills station
J Surg Res
Comparison of three simulation-based training methods for management of medical emergencies
Resuscitation
Cost: the missing outcome in simulation-based medical education research: a systematic review
Surgery
Translational educational research: a necessity for effective health-care improvement
Chest
Impact of reduction in working hours for doctors in training on postgraduate medical education and patients’ outcomes: systematic review
BMJ
See one, do one, teach one: advanced technology in medical education
Acad Emerg Med
A simulator-based curriculum to promote comparative and reflective analysis in an internal medicine clerkship
Acad Med
(Institute of Medicine). To err is human: building a safer health system
High-fidelity patient simulation: a descriptive white paper report
Nurses’ knowledge and skill retention following cardiopulmonary resuscitation training: a review of the literature
J Adv Nurs
The use of CPR feedback/prompt devices during training and CPR performance: a systematic review
Resuscitation
BEME guide: what is the impact of structured resuscitation training on healthcare practitioners, their clients and the wider service? A BEME systematic review: BEME Guide No. 20
Med Teach
Technology-enhanced simulation for health professions education: a systematic review and meta-analysis
JAMA
Comparative effectiveness of technology-enhanced simulation versus other instructional methods: a systematic review and meta-analysis
Simul Healthc
Preferred reporting items for systematic reviews and meta-analyses: the prisma statement
Ann Intern Med
Randomized controlled trials and meta-analysis in medical education: what role do they play?
Med Teach
Association between funding and quality of published medical education research
JAMA
Internet-based learning in the health professions: a meta-analysis
JAMA
Measuring inconsistency in meta-analyses
BMJ
Statistical power analysis for the behavioral sciences
Impact of a pediatric primary care office-based mock code program on physician and staff confidence to perform life-saving skills
Pediatr Emerg Care
High fidelity medical simulation in the difficult environment of a helicopter: feasibility, self-efficacy and cost
BMC Med Educ
Adding emotional stressors to training in simulated cardiopulmonary arrest enhances participant performance
Med Educ
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2013.04.016