Patient outcomes in simulation-based medical education: a systematic review

Abstract

Objectives: Evaluating the patient impact of health professions education is a societal priority with many challenges. Researchers would benefit from a summary of topics studied and potential methodological problems. We sought to summarize key information on patient outcomes identified in a comprehensive systematic review of simulation-based instruction.

Data sources: Systematic search of MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, key journals, and bibliographies of previous reviews through May 2011.

Study eligibility: Original research in any language measuring the direct effects on patients of simulation-based instruction for health professionals, in comparison with no intervention or other instruction.

Appraisal and synthesis: Two reviewers independently abstracted information on learners, topics, study quality including unit of analysis, and validity evidence. We pooled outcomes using random effects.

Results: From 10,903 articles screened, we identified 50 studies reporting patient outcomes for at least 3,221 trainees and 16,742 patients. Clinical topics included airway management (14 studies), gastrointestinal endoscopy (12), and central venous catheter insertion (8). There were 31 studies involving postgraduate physicians and seven studies each involving practicing physicians, nurses, and emergency medicine technicians. Fourteen studies (28 %) used an appropriate unit of analysis. Measurement validity was supported in seven studies reporting content evidence, three reporting internal structure, and three reporting relations with other variables. The pooled Hedges' g effect size for 33 comparisons with no intervention was 0.47 (95 % confidence interval [CI], 0.31-0.63); and for nine comparisons with non-simulation instruction, it was 0.36 (95 % CI, -0.06 to 0.78).

Limitations: Focused field in education; high inconsistency (I(2) > 50 % in most analyses).

Conclusions: Simulation-based education was associated with small-moderate patient benefits in comparison with no intervention and non-simulation instruction, although the latter did not reach statistical significance. Unit of analysis errors were common, and validity evidence was infrequently reported.

Figure 1.

Outcomes of simulation-based education in comparison with no intervention. N indicates number contributing outcomes, except where marked as *, which reflects number enrolled/trained. Abbreviations: Discomf. patient discomfort; Complic. complications. Clarification of author/year: Sedlack 2004a, Sedlack 2004b, Barsuk 2009a, Barsuk 2009b, Barsuk 2009c.

Figure 2.

Outcomes of simulation-based education in comparison with non-simulation instruction. N indicates number contributing outcomes. Abbreviations: Comp. comparison intervention (P standardized or real patient; FL face-to-face lecture; C computer assisted instruction); EvalFinal evaluation of final product; Satisf. patient satisfaction; Complic. complications.

Figure 3.

Outcomes of studies comparing two simulation-based educational interventions. N indicates number contributing outcomes.