Low versus high level of physical resemblance in simulation for the acquisition of basic surgical skill: a meta-analysis

Abstract

Background: Many studies explored the use of simulation in basic surgical education, with a variety of devices, contexts and outcomes, with sometimes contradictory results.

Objectives: The objectives of this meta-analysis were to focus the effect that the level of physical resemblance in a simulation has on the development of basic surgical skill in undergraduate medical students and to provide a foundation for the design and implementation of a simulation, with respect to its effectiveness and alignment with the learning outcomes.

Study selection: We searched PubMed and Scopus database for comparative randomised studies between simulations with a different level of resemblance. The result was synthesised as the standardised mean difference, under a random effect model.

Findings: We selected 12 out of 2091 retrieved studies, reporting on 373 undergraduate students (mean of subjects 15.54±6.89). The outcomes were the performance of simple skills and the time to complete a task. Two studies reported a scoring system; seven studies reported time for a task; and three studies reported both. The total number of measures included in the meta-analysis was 456 for score and 504 for time. The pooled effect size did not show any significant advantage in a simulation of a high level of physical resemblance over a lower level, both for the scoring system (-0.19, 95% CI -0.44 to 0.06) and for time (-0.14, 95% CI -0.54 to 0.27).

Conclusion: Simulations with a low level of physical resemblance showed the same effect as the simulation using a higher level of resemblance on the development of basic surgical skills in undergraduate students.

Keywords: medical education research; simulation; surgery general; surgical education; undergraduate education.

Figure 1

Flowchart of the search of articles.

Figure 2

Forest plot of the comparison between simulations with a high versus low level of physical resemblance for the outcome score. The pooled effect size is represented by the black diamond. CI, confidence interval; IV, interval variable.

Figure 3

Forest plot of the comparison between simulations with a high versus low level of physical resemblance for the outcome time. The pooled effect size is represented by the black diamond.