Al Asmri Mansour A, Ennis James, Stone Robert John, Bello Fernando, Haque M Sayeed, Parle Jim
Department of Electronic, Electrical and Systems Engineering, University of Birmingham, Birmingham, UK.
Clinical Simulation Training Centre, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia.
BMJ Simul Technol Enhanc Learn. 2020 Aug 1;7(5):414-421. doi: 10.1136/bmjstel-2020-000587. eCollection 2021.
Digital rectal examination (DRE) is a challenging examination to learn.
To synthesise evidence regarding the effectiveness of technology-enhanced simulation (TES) for acquiring DRE skills.
EMBASE, Medline, CINAHL, Cochrane, Web of Knowledge (Science and Social Science), Scopus and IEEE Xplore were searched; the last search was performed on 3 April 2019. Included were original research studies evaluating TES to teach DRE. Data were abstracted on methodological quality, participants, instructional design and outcomes; a descriptive synthesis was performed. Quality was assessed using a modified Medical Education Research Study Quality Instrument. The study design domain was modified by scoring the papers based on (1) evaluation of risk of bias for randomised controlled trials, (2) description of participants and (3) assessment of robustness and degree of simulation fidelity of the assessments used to evaluate learning.
863 articles were screened; 12 were eligible, enrolling 1507 prequalified medical/clinical students and 20 qualified doctors. For skill acquisition, role player was statistically significantly superior to a static manikin (2 studies). For knowledge acquisition, manikin use was significantly superior to role player (1 study); 2 studies showed no difference. For confidence, manikin use was significantly superior to no manikin (4 studies). For comfort, manikin use was significantly superior to no manikin (2 studies). For anxiety, role player was significantly superior to manikin (1 study).
Median overall quality score (QS) was 48% (27-62). Highest median QS was 73% (33-80) for data analysis; lowest median QS was 20% (7-40) for the validity of instrument. Six papers scored over 50% of the maximum score for overall quality.
TES training is associated with improved DRE skills and should be used more widely.
直肠指检（DRE）是一项颇具挑战性的检查项目，学习起来并不容易。
综合关于技术增强模拟（TES）在获取直肠指检技能方面有效性的证据。
检索了EMBASE、Medline、CINAHL、Cochrane、Web of Knowledge（科学与社会科学）、Scopus和IEEE Xplore；最后一次检索于2019年4月3日进行。纳入的是评估TES用于教授直肠指检的原始研究。提取了关于方法学质量、参与者、教学设计和结果的数据；进行了描述性综合分析。使用改良的医学教育研究质量工具评估质量。通过基于以下方面对论文进行评分来修改研究设计领域：（1）对随机对照试验偏倚风险的评估，（2）参与者的描述，（3）对用于评估学习的评估的稳健性和模拟逼真度的评估。
筛选了863篇文章；12篇符合条件，纳入了1507名预合格的医学/临床学生和20名合格医生。在技能获取方面，角色扮演在统计学上显著优于静态人体模型（2项研究）。在知识获取方面，使用人体模型显著优于角色扮演（1项研究）；2项研究显示无差异。在信心方面，使用人体模型显著优于不使用人体模型（4项研究）。在舒适度方面，使用人体模型显著优于不使用人体模型（2项研究）。在焦虑方面，角色扮演显著优于人体模型（1项研究）。
总体质量评分（QS）中位数为48%（27 - 62）。数据分析的最高QS中位数为73%（33 - 80）；工具有效性的最低QS中位数为20%（7 - 40）。6篇文章的总体质量得分超过最高分的50%。
TES培训与直肠指检技能的提高相关，应更广泛地应用。
