Gippsland Medical School, Monash University, Northways Road, Victoria 3842, Australia.
Simul Healthc. 2011 Aug;6 Suppl:S10-3. doi: 10.1097/SIH.0b013e318227ce96.
Simulation is increasingly used to support learning of procedural skills. Our panel was tasked with summarizing the "best evidence." We addressed the following question: To what extent does simulation support learning and teaching in procedural skills?
We conducted a literature search from 2000 to 2010 using Medline, CINAHL, ERIC, and PSYCHINFO databases. Inclusion criteria were established and then data extracted from abstracts according to several categories. Although secondary sources of literature were sourced from key informants and participants at the "Research Consensus Summit: State of the Science," they were not included in the data extraction process but were used to inform discussion.
Eighty-one of 1,575 abstracts met inclusion criteria. The uses of simulation for learning and teaching procedural skills were diverse. The most commonly reported simulator type was manikins (n = 17), followed by simulated patients (n = 14), anatomic simulators (eg, part-task) (n = 12), and others. For research design, most abstracts (n = 52) were at Level IV of the National Health and Medical Research Council classification (ie, case series, posttest, or pretest/posttest, with no control group, narrative reviews, and editorials). The most frequent Best Evidence Medical Education ranking was for conclusions probable (n = 37). Using the modified Kirkpatrick scale for impact of educational intervention, the most frequent classification was for modification of knowledge and/or skills (Level 2b) (n = 52). Abstracts assessed skills (n = 47), knowledge (n = 32), and attitude (n = 15) with the majority demonstrating improvements after simulation-based interventions. Studies focused on immediate gains and skills assessments were usually conducted in simulation.
The current state of the science finds that simulation usually leads to improved knowledge and skills. Learners and instructors express high levels of satisfaction with the method. While most studies focus on short-term gains attained in the simulation setting, a small number support the transfer of simulation learning to clinical practice. Further study is needed to optimize the alignment of learner, instructor, simulator, setting, and simulation for learning and teaching procedural skills. Instructional design and educational theory, contextualization, transferability, accessibility, and scalability must all be considered in simulation-based education programs. More consistently, robust research designs are required to strengthen the evidence.
模拟越来越多地被用于支持程序性技能的学习。我们的小组负责总结“最佳证据”。我们提出了以下问题：模拟在多大程度上支持程序性技能的学习和教学？
我们使用 Medline、CINAHL、ERIC 和 PSYCHINFO 数据库进行了 2000 年至 2010 年的文献检索。制定了纳入标准，然后根据几个类别从摘要中提取数据。尽管从关键信息提供者和“研究共识峰会：科学现状”的参与者那里获取了二级文献来源，但它们未包含在数据提取过程中，而是用于提供讨论信息。
1575 篇摘要中有 81 篇符合纳入标准。模拟用于学习和教学程序性技能的用途多种多样。最常报告的模拟器类型是人体模型（n=17），其次是模拟患者（n=14）、解剖模拟器（例如部分任务）（n=12）和其他模拟器。对于研究设计，大多数摘要（n=52）属于国家卫生和医学研究委员会分类的第四级（即病例系列、后测或前测/后测，没有对照组、叙述性综述和社论）。最佳证据医学教育排名最频繁的是结论可能（n=37）。使用教育干预影响的改良柯克帕特里克量表，最常见的分类是知识和/或技能的改变（2b 级）（n=52）。摘要评估了技能（n=47）、知识（n=32）和态度（n=15），大多数模拟干预后都显示出了提高。研究重点是在模拟环境中获得即时收益和技能评估。
当前科学状态发现，模拟通常会导致知识和技能的提高。学习者和教师对该方法表示高度满意。虽然大多数研究都集中在模拟环境中获得的短期收益，但少数研究支持将模拟学习转移到临床实践中。为了优化学习者、教师、模拟器、环境和模拟在程序性技能的学习和教学中的一致性，还需要进一步研究。教学设计和教育理论、情境化、可转移性、可及性和可扩展性都必须在基于模拟的教育计划中加以考虑。需要更一致地采用强有力的研究设计来加强证据。
