Technology-enhanced simulation associated with large effects in health professions education

Cook D. JAMA. 2011;306:978-988.

Issue: October 2011

Technology-enhanced simulation training in health professions education is consistently associated with large effects for outcomes of knowledge, skills, and behaviors and moderate effects for patient-related outcomes, according to a study.

Using Medline, Embase, Cinahl, PsycInfo, Eric, Web of Science, and Scopus databases, researchers searched terms, topics and learners to find original research that evaluated simulation compared with no intervention for training practicing and student physicians, nurses, dentists and other health care professionals. Outcomes of learning, behaviors or effects on patients were measured to present an overview of technology-enhanced simulation vs. no intervention. Single-group pretest-posttest, two-group nonrandomized, and randomized studies, parallel-group and crossover designs, and studies of “adjuvant” instruction in which simulation was added to other instruction common to all learners were included, according to the researchers.

Overall, 609 studies that enrolled 35,226 trainees were analyzed. Researchers found that when they compared technology-enhanced simulations vs. no intervention, there were only rare exceptions associated with better learning outcomes. According to the study, pooled effect sizes for technology-enhanced simulations vs. no intervention were 1.20 (95% CI, 1.04-1.35) for knowledge outcomes (n=118 studies), 1.14 (95% CI, 1.03-1.25) for time skills (n=210), 1.09 (95% CI, 1.03-1.16) for process skills (n=426), 1.18 (95% CI, .98-1.37) for product skills (n=54), 0.79 (95% CI, 0.47-1.10) for time behaviors (n=20), 0.81 (95% CI, 0.66-0.96) for other behaviors (n=50), and 0.50 (95% CI, 0.34-0.66) for direct effects on patients (n=32). Inconsistencies were high among all results.

Disclosure: Dr. Cook reports no relevant financial disclosures.

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