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Educational and Patient Care Impacts of In Situ Simulation in Healthcare: A Systematic Review
Aaron W Calhoun1, David A Cook, Gina Genova
1From the University of Louisville (A.C., G.G., A.H.), Louisville, KY; Mayo Multidisciplinary Simulation Center (D.A.C.), Mayo Clinic College of Medicine and Science, Rochester, MN; Indiana University School of Medicine (S.M.K.M.), Indianapolis, IN; Lincoln Medical Center (M.W.), Bronx New York, NY; University of Saskatchewan (R.C.), Saskatoon, Canada; The Chinese University of Hong Kong (J.C.K.C.), Hong Kong SAR; Center for Clinical Excellence (C.C., T.M.), Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH; Pediatric Critical Care Medicine (I.H.-G.), Bernard and Millie Duker Children's Hospital, Albany, NY; Boston University Chobanian & Avedisian School of Medicine (B.W.), Boston, MA; University of Alabama at Birmingham (M.W.), Birmingham, AL; Cincinnati Children's Hospital (G.G.), Cincinnati, OH; Center for Simulation, Advanced Education, and Innovation (A.M.M.), Children's Hospital of Philadelphia, Philadelphia, PA; University of Ottawa Skills & Simulation Centre (G.P.), University of Ottawa, Ontario, Canada; Department of Critical Care (D.L.L.), Zhongnan Hospital of Wuhan University, Wuhan, China; and University of Calgary (Y.L.), Calgary, Canada.
Abstract:
This systematic review was performed to assess the effectiveness of in situ simulation education. We searched databases including MEDLINE and Embase for studies comparing in situ simulation with other educational approaches. Two reviewers screened articles and extracted information. Sixty-two articles met inclusion criteria, of which 24 were synthesized quantitatively using random effects meta-analysis. When compared with current educational practices alone, the addition of in situ simulation to these practices was associated with small improvements in clinical outcomes, including mortality [odds ratio, 0.66; 95% confidence interval (CI), 0.55 to 0.78], care metrics (standardized mean difference, -0.34; 95% CI, -0.45 to -0.21), and nontechnical skills (standardized mean difference, -0.52; 95% CI, -0.99 to -0.05). Comparisons between in situ and traditional simulation showed mixed learner preference and knowledge improvement between groups, while technical skills showed improvement attributable to in situ simulation. In summary, available evidence suggests that adding in situ simulation to current educational practices may improve patient mortality and morbidity.
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