Technology‐enhanced Simulation in Emergency Medicine: A Systematic Review and Meta‐Analysis

Abstract

Objectives: Technology-enhanced simulation is used frequently in emergency medicine (EM) training programs. Evidence for its effectiveness, however, remains unclear. The objective of this study was to evaluate the effectiveness of technology-enhanced simulation for training in EM and identify instructional design features associated with improved outcomes by conducting a systematic review. Methods:The authors systematically searched MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, Scopus, key journals, and previous review bibliographies through May 2011. Original research articles in any language were selected if they compared simulation to no intervention or another educational activity for the purposes of training EM health professionals (including student and practicing physicians, midlevel providers, nurses, and prehospital providers). Reviewers evaluated study quality and abstracted information on learners, instructional design (curricular integration, feedback, repetitive practice, mastery learning), and outcomes.Results: From a collection of 10,903 articles, 85 eligible studies enrolling 6,099 EM learners were identified. Of these, 56 studies compared simulation to no intervention, 12 compared simulation with another form of instruction, and 19 compared two forms of simulation. Effect sizes were pooled using a random-effects model. Heterogeneity among these studies was large (I 2 ! 50%). Among studies comparing simulation to no intervention, pooled effect sizes were large (range = 1.13 to 1.48) for knowledge, time, and skills and small to moderate for behaviors with patients (0.62) and patient effects (0.43; all p < 0.02 except patient effects p = 0.12). Among comparisons between simulation and other forms of instruction, the pooled effect sizes were small ( 0.33) for knowledge, time, and process skills (all p > 0.1). Qualitative comparisons of different simulation curricula are limited, although feedback, mastery learning, and higher fidelity were associated with improved learning outcomes.Conclusions: Technology-enhanced simulation for EM learners is associated with moderate or large favorable effects in comparison with no intervention and generally small and nonsignificant benefits in comparison with other instruction. Future research should investigate the features that lead to effective simulation-based instructional design.ACADEMIC EMERGENCY MEDICINE 2013; 20:117-127 © 2013 T echnology-enhanced simulation has emerged as a cornerstone of many emergency medicine (EM) training programs. 1-3 Simulation allows complex tasks to be deconstructed into more manageable learning objectives and fosters repeated practice on specific tasks that occur infrequently or expose patients to risk when performed by novice learners. 4 Computer-based virtual reality simulators, robotic and static mannequins, artificial models, live animals, inert animal products, and human cadavers have all been employed as educational tools for these purposes.1 At the 2008 Academic Emergency Medicine (AEM) consensus conference entitled...

Technology-Enhanced Simulation and Pediatric Education: A Meta-analysis

“…3,15,18,45,46 Previous reviews using the MERSQI have reported average scores ranging from 9.6 to 12.3, compared with a mean MERSQI score of 11.8 in our study. 3,15,17,18,45,46 Our finding that high physical realism simulators are weakly associated with improved outcomes when compared with low physical realism simulators differs from the results of other systematic reviews, suggesting that degree of realism has a negligible impact on learning outcomes. [47][48][49][50] These results suggest that the relationship between realism and learning is complex and nonlinear.…”

“…Although several narrative reviews have described the use of simulation in pediatrics, [10][11][12][13][14] these reviews had limitations, including a lack of a systematic search for articles, an analysis of the quality of existing research, or a quantitative synthesis of outcomes. Furthermore, we cannot assume that the results from systematic reviews of TES in other fields 3,15 can be extrapolated to the pediatric population. Pediatric patients vary from adults in size, physiology, and diseases treated; and the pediatric work environment and demographic characteristics of pediatric health care providers often differ from those of adult medicine.…”

Determining content for a simulation-based curriculum in pediatric emergency medicine: results from a national Delphi process

“…10 It is now widely used for teaching clinical expertise in domains that are infrequently encountered in the clinical setting [11][12][13] and has proven to be effective in promoting the acquisition of the knowledge, skills, and attitudes necessary to perform effectively as an emergency physician. [13][14][15][16][17][18][19][20][21][22][23][24][25][26] SBE affords residents the opportunity to apply and improve their individual and team crisis resource management (CRM) skills, 27 as well as practice recognition and medical management of rare events. 28 The opportunity to practice in a safe learning environment with dedicated time for debriefing allows the development of competence that is not easily achieved in the clinical environment.…”

Integrating Google Glass into simulation-based training: experiences and future directions

“…The practitioners and students are asked to work through the scenario in the same manner they would approach a similar case presenting in their department or office. In most simulation-based training exercises, both summative and formative feedback is provided to the participants based on information from educators actively observing and taking notes from the case, from direct observation of the critical actions of the case, from analysis of the end-point of the case, assessment of whether or not the team or individuals reached the end-point in the appropriate manner, and through observation of intent [4][5][6] .…”