虚拟模拟与人体模型及真人在医学和护理教育中的有效性：随机对照试验的荟萃分析和试验序贯分析

Effectiveness of Virtual Simulations Versus Mannequins and Real Persons in Medical and Nursing Education: Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials.

作者信息

Jiang Nan, Zhang Yuelun, Liang Siyu, Lyu Xiaohong, Chen Shi, Huang Xiaoming, Pan Hui

机构信息

4 + 4 Medical Doctor Program, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

J Med Internet Res. 2024 Dec 5;26:e56195. doi: 10.2196/56195.

DOI:10.2196/56195

PMID:39636688

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11659697/

Abstract

BACKGROUND

Virtual simulation (VS) is a developing education approach with the recreation of reality using digital technology. The teaching effectiveness of VSs compared to mannequins and real persons (RPs) has never been investigated in medical and nursing education.

OBJECTIVE

This study aims to compare VSs and mannequins or RPs in improving the following clinical competencies: knowledge, procedural skills, clinical reasoning, and communication skills.

METHODS

Following Cochrane methodology, a meta-analysis was conducted on the effectiveness of VSs in pre- and postregistration medical or nursing participants. The Cochrane Library, PubMed, Embase, and Educational Resource Information Centre databases were searched to identify English-written randomized controlled trials up to August 2024. Two authors independently selected studies, extracted data, and assessed the risk of bias. All pooled estimates were based on random-effects models and assessed by trial sequential analyses. Leave-one-out, subgroup, and univariate meta-regression analyses were performed to explore sources of heterogeneity.

RESULTS

A total of 27 studies with 1480 participants were included. Overall, there were no significant differences between VSs and mannequins or RPs in improving knowledge (standard mean difference [SMD]=0.08; 95% CI -0.30 to 0.47; I=67%; P=.002), procedural skills (SMD=-0.12; 95% CI -0.47 to 0.23; I=75%; P<.001), clinical reasoning (SMD=0.29; 95% CI -0.26 to 0.85; I=88%; P<.001), and communication skills (SMD=-0.02; 95% CI: -0.62 to 0.58; I=86%; P<.001). Trial sequential analysis for clinical reasoning indicated an insufficient sample size for a definitive judgment. For procedural skills, subgroup analyses showed that VSs were less effective among nursing participants (SMD=-0.55; 95% CI -1.07 to -0.03; I=69%; P=.04). Univariate meta-regression detected a positive effect of publication year (β=.09; P=.02) on communication skill scores.

CONCLUSIONS

Given favorable cost-utility plus high flexibility regarding time and space, VSs are viable alternatives to traditional face-to-face learning modalities. The comparative effectiveness of VSs deserves to be followed up with the emergence of new technology. In addition, further investigation of VSs with different design features will provide novel insights to drive education reform.

TRIAL REGISTRATION

PROSPERO CRD42023466622; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=466622.

摘要

背景

虚拟模拟（VS）是一种利用数字技术再现现实的新兴教育方法。在医学和护理教育中，从未对虚拟模拟与人体模型及真实人物（RP）的教学效果进行过研究。

目的

本研究旨在比较虚拟模拟与人体模型或真实人物在提高以下临床能力方面的效果：知识、操作技能、临床推理和沟通技巧。

方法

按照Cochrane方法，对虚拟模拟在注册前和注册后的医学或护理参与者中的有效性进行了荟萃分析。检索了Cochrane图书馆、PubMed、Embase和教育资源信息中心数据库，以确定截至2024年8月的英文随机对照试验。两位作者独立选择研究、提取数据并评估偏倚风险。所有汇总估计均基于随机效应模型，并通过试验序贯分析进行评估。进行了留一法、亚组和单变量元回归分析，以探索异质性来源。

结果

共纳入27项研究，1480名参与者。总体而言，在提高知识（标准化均数差[SMD]=0.08；95%CI -0.30至0.47；I²=67%；P=.002）、操作技能（SMD=-0.12；95%CI -0.47至0.23；I²=75%；P<.001）、临床推理（SMD=0.29；95%CI -0.26至0.85；I²=88%；P<.001）和沟通技巧（SMD=-0.02；95%CI：-0.62至0.58；I²=86%；P<.001）方面，虚拟模拟与人体模型或真实人物之间没有显著差异。临床推理的试验序贯分析表明，样本量不足以做出确定性判断。对于操作技能，亚组分析显示，虚拟模拟在护理参与者中效果较差（SMD=-0.55；95%CI -1.07至-0.03；I²=69%；P=.04）。单变量元回归检测到发表年份对沟通技能得分有积极影响（β=.09；P=.02）。