Joint Laboratory of Reproductive Medicine, Key Laboratory of Obstetric, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, SCU-CUHK, Sichuan University, Chengdu, 610041, P. R. China.
Key Laboratory of Reproductive Medicine, Sichuan Provincial Maternity and Child Health Care Hospital, The Affiliated Women's and children's Hospital of Chengdu Medical College, Chengdu, 610045, China.
BMC Med Educ. 2023 Sep 14;23(1):664. doi: 10.1186/s12909-023-04654-x.
Simulation is an increasingly used novel method for the education of medical professionals. This study aimed to systematically review the efficacy of high-fidelity (HF) simulation compared with low-fidelity (LF) simulation or no simulation in advanced life support (ALS) training.
A comprehensive search of the PubMed, Chinese Biomedicine Database, Embase, CENTRAL, ISI, and China Knowledge Resource Integrated Database was performed to identify randomized controlled trials (RCTs) that evaluated the use of HF simulation in ALS training. Quality assessment was based on the Cochrane Handbook for Systematic Reviews of Interventions version 5.0.1. The primary outcome was the improvement of knowledge and skill performance. The secondary outcomes included the participants' confidence and satisfaction at the course conclusion, skill performance at one year, skill performance in actual resuscitation, and patient outcomes. Data were synthesized using the RevMan 5.4 software.
Altogether, 25 RCTs with a total of 1,987 trainees were included in the meta-analysis. In the intervention group, 998 participants used HF manikins, whereas 989 participants received LF simulation-based or traditional training (classical training without simulation). Pooled data from the RCTs demonstrated a benefit in improvement of knowledge [standardized mean difference (SMD) = 0.38; 95% confidence interval (CI): 0.18-0.59, P = 0.0003, I = 70%] and skill performance (SMD = 0.63; 95% CI: 0.21-1.04, P = 0.003, I = 92%) for HF simulation when compared with LF simulation and traditional training. The subgroup analysis revealed a greater benefit in knowledge with HF simulation compared with traditional training at the course conclusion (SMD = 0.51; 95% CI: 0.20-0.83, P = 0.003, I = 61%). Studies measuring knowledge at three months, skill performance at one year, teamwork behaviors, participants' satisfaction and confidence demonstrated no significant benefit for HF simulation.
Learners using HF simulation more significantly benefited from the ALS training in terms of knowledge and skill performance at the course conclusion. However, further research is necessary to enhance long-term retention of knowledge and skill in actual resuscitation and patient's outcomes.
模拟是一种越来越被用于医学专业教育的新颖方法。本研究旨在系统地回顾高保真（HF）模拟与低保真（LF）模拟或无模拟在高级生命支持（ALS）培训中的疗效。
对 PubMed、中国生物医学数据库、Embase、CENTRAL、ISI 和中国知识资源综合数据库进行全面检索，以确定评估 HF 模拟在 ALS 培训中的应用的随机对照试验（RCT）。质量评估基于 Cochrane 干预系统评价手册 5.0.1 版。主要结局是知识和技能表现的改善。次要结局包括课程结束时参与者的信心和满意度、一年后的技能表现、实际复苏中的技能表现以及患者结局。使用 RevMan 5.4 软件对数据进行综合分析。
共有 25 项 RCT 纳入了meta 分析，共纳入了 1987 名受训者。在干预组中，998 名参与者使用了 HF 模型，而 989 名参与者接受了 LF 模拟或传统培训（无模拟的传统培训）。来自 RCT 的汇总数据表明，与 LF 模拟和传统培训相比，HF 模拟在知识[标准化均数差（SMD）=0.38；95%置信区间（CI）：0.18-0.59，P=0.0003，I=70%]和技能表现（SMD=0.63；95%CI：0.21-1.04，P=0.003，I=92%）方面的改善方面具有优势。亚组分析显示，HF 模拟与传统培训相比，在课程结束时在知识方面的获益更大（SMD=0.51；95%CI：0.20-0.83，P=0.003，I=61%）。研究测量了三个月时的知识、一年时的技能表现、团队合作行为、参与者的满意度和信心，发现 HF 模拟没有显著优势。
使用 HF 模拟的学习者在 ALS 培训中的知识和技能表现方面更显著受益于课程结束时的培训。然而，需要进一步研究以增强实际复苏和患者结局中知识和技能的长期保留。
