Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Dec 5:26:e56195.
doi: 10.2196/56195.

Effectiveness of Virtual Simulations Versus Mannequins and Real Persons in Medical and Nursing Education: Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials

Nan Jiang #  1 , Yuelun Zhang #  2 , Siyu Liang  3 , Xiaohong Lyu  4 , Shi Chen  3 , Xiaoming Huang  5 , Hui Pan  3
Affiliations
Meta-Analysis

Effectiveness of Virtual Simulations Versus Mannequins and Real Persons in Medical and Nursing Education: Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials

Nan Jiang et al. J Med Internet Res. .

Abstract

Background: Virtual simulation (VS) is a developing education approach with the recreation of reality using digital technology. The teaching effectiveness of VSs compared to mannequins and real persons (RPs) has never been investigated in medical and nursing education.

Objective: This study aims to compare VSs and mannequins or RPs in improving the following clinical competencies: knowledge, procedural skills, clinical reasoning, and communication skills.

Methods: Following Cochrane methodology, a meta-analysis was conducted on the effectiveness of VSs in pre- and postregistration medical or nursing participants. The Cochrane Library, PubMed, Embase, and Educational Resource Information Centre databases were searched to identify English-written randomized controlled trials up to August 2024. Two authors independently selected studies, extracted data, and assessed the risk of bias. All pooled estimates were based on random-effects models and assessed by trial sequential analyses. Leave-one-out, subgroup, and univariate meta-regression analyses were performed to explore sources of heterogeneity.

Results: A total of 27 studies with 1480 participants were included. Overall, there were no significant differences between VSs and mannequins or RPs in improving knowledge (standard mean difference [SMD]=0.08; 95% CI -0.30 to 0.47; I2=67%; P=.002), procedural skills (SMD=-0.12; 95% CI -0.47 to 0.23; I2=75%; P<.001), clinical reasoning (SMD=0.29; 95% CI -0.26 to 0.85; I2=88%; P<.001), and communication skills (SMD=-0.02; 95% CI: -0.62 to 0.58; I2=86%; P<.001). Trial sequential analysis for clinical reasoning indicated an insufficient sample size for a definitive judgment. For procedural skills, subgroup analyses showed that VSs were less effective among nursing participants (SMD=-0.55; 95% CI -1.07 to -0.03; I2=69%; P=.04). Univariate meta-regression detected a positive effect of publication year (β=.09; P=.02) on communication skill scores.

Conclusions: Given favorable cost-utility plus high flexibility regarding time and space, VSs are viable alternatives to traditional face-to-face learning modalities. The comparative effectiveness of VSs deserves to be followed up with the emergence of new technology. In addition, further investigation of VSs with different design features will provide novel insights to drive education reform.

Trial registration: PROSPERO CRD42023466622; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=466622.

Keywords: artificial intelligence; clinical virtual simulation; medical education; meta-analysis; nursing education; virtual patient; virtual reality.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) flow diagram.
Figure 2
Figure 2
Risk of bias summary [16,18,30-54]. +: low risk of bias; –: high risk of bias; ?: unclear risk of bias.
Figure 3
Figure 3
Forest plot of virtual simulations versus mannequins or real persons for knowledge [32,35,37,41,44-46,50].
Figure 4
Figure 4
Forest plot of virtual simulations versus mannequins or real persons for procedural skills [16,18,32-34,36,37,42,49,51].
Figure 5
Figure 5
Forest plot of virtual simulations versus mannequins or real persons for clinical reasoning [38,40,43,45,47,48,50,52,53].
Figure 6
Figure 6
Forest plot of virtual simulations versus mannequins or real persons for communication skills [30,31,39,52,54].
See this image and copyright information in PMC

References

    1. Khan K, Pattison T, Sherwood M. Simulation in medical education. Med Teach. 2011;33(1):1–3. doi: 10.3109/0142159X.2010.519412. - DOI - PubMed
    1. Herrera-Aliaga E, Estrada LD. Trends and innovations of simulation for twenty first century medical education. Front Public Health. 2022;10:619769. doi: 10.3389/fpubh.2022.619769. https://europepmc.org/abstract/MED/35309206 - DOI - PMC - PubMed
    1. Ziv A, Wolpe PR, Small SD, Glick S. Simulation-based medical education: an ethical imperative. Acad Med. 2003;78(8):783–788. doi: 10.1097/00001888-200308000-00006. - DOI - PubMed
    1. McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med. 2011;86(6):706–711. doi: 10.1097/ACM.0b013e318217e119. https://europepmc.org/abstract/MED/21512370 - DOI - PMC - PubMed
    1. Shin S, Park JH, Kim JH. Effectiveness of patient simulation in nursing education: meta-analysis. Nurse Educ Today. 2015;35(1):176–182. doi: 10.1016/j.nedt.2014.09.009.S0260-6917(14)00307-4 - DOI - PubMed

Publication types

MeSH terms

LinkOut - more resources