Mitchell Aaron A, Ivimey-Cook Edward R
School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom.
Front Med (Lausanne). 2023 Apr 17;10:1149048. doi: 10.3389/fmed.2023.1149048. eCollection 2023.
There have been substantial changes in the simulation technology landscape, in particular virtual reality (VR), during the past decade, which have resulted in increased abundance and decreased cost. We therefore updated a previous meta-analysis conducted in 2011, aiming to quantify the impact of digital technology-enhanced simulation (T-ES) compared with traditional teaching in physicians, physicians-in-training, nurses, and nursing students.
We conducted a meta-analysis consisting of randomized controlled trials published in English between January 2011 and December 2021 in peer-reviewed journals indexed in seven databases. Moderators for study duration, instruction, type of healthcare worker, type of simulation, outcome measure, and study quality rated by Medical Education Research Study Quality Instrument (MERSQI) score were included in our model and used to calculate estimated marginal means (EMMs).
The overall effect of T-ES was positive across the 59 studies included in the analysis compared with traditional teaching [overall effect size 0.80 (95% CI 0.60, 1.00)]. This indicates that T-ES is effective in improving outcomes across a wide variety of settings and participants. The impact of T-ES was found to be greatest for expert-rated product metrics such as procedural success, and process metrics such as efficiency, compared with knowledge and procedure time metrics.
The impacts of T-ES training on the outcome measures included in our study were greatest in nurses, nursing students and resident physicians. T-ES was strongest in studies featuring physical high-fidelity mannequins or centers, compared with VR sensory environment T-ES, though there was considerable uncertainty in all statistical analyses. Further high-quality studies are required to assess direct effects of simulation training on patient and public health outcomes.
在过去十年中，模拟技术领域发生了重大变化，尤其是虚拟现实（VR）技术，这使得模拟技术的资源更加丰富，成本降低。因此，我们更新了2011年进行的一项荟萃分析，旨在量化数字技术增强模拟（T-ES）与传统教学相比，对医生、实习医生、护士和护生的影响。
我们进行了一项荟萃分析，纳入了2011年1月至2021年12月期间在七个数据库索引的同行评审期刊上发表的英文随机对照试验。我们的模型纳入了研究持续时间、教学方式、医护人员类型、模拟类型、结局指标以及由医学教育研究质量工具（MERSQI）评分的研究质量等调节因素，并用于计算估计边际均值（EMM）。
与传统教学相比，纳入分析的59项研究中T-ES的总体效果为阳性[总体效应量0.80（95%CI 0.60，1.00）]。这表明T-ES在改善各种环境和参与者的结局方面是有效的。与知识和操作时间指标相比，发现T-ES对专家评定的产品指标（如操作成功率）和过程指标（如效率）的影响最大。
T-ES培训对我们研究中纳入的结局指标的影响在护士、护生和住院医生中最为显著。与VR感官环境T-ES相比，在以物理高保真人体模型或中心为特色的研究中，T-ES的效果最强，尽管所有统计分析中都存在相当大的不确定性。需要进一步的高质量研究来评估模拟培训对患者和公众健康结局的直接影响。
