Manikin physical realism for resuscitation education: A systematic review

To evaluate the impact of higher physical realism of manikins on educational and clinical outcomes during life support education.

This systematic review was conducted as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR). A search of PubMed, Embase, and Cochrane was conducted from January 1, 2005 until April 30, 2024. Studies comparing training with higher physical realism manikins and lower realism manikins were eligible for inclusion. Studies comparing manikins to other forms of training (e.g. screen-based, virtual reality) were excluded. Risk of bias was assessed using Cochrane Risk of Bias 2 (RoB 2) for randomized trials and Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) for observational studies. For outcomes reported by four or more randomized studies, random effects meta-analysis using standardized mean difference was performed.

Of the 1276 articles identified and screened, 21 articles comprised the final review (19 randomized trials, 2 observational studies). Meta-analysis of eight RCTs reporting simulation skill performance in a simulated clinical scenario at course conclusion demonstrated a benefit from the use of higher- realism manikins compared with lower realism manikins (standardized mean difference 0.66, 95% CI 0.08 - 1.25). Meta-analysis of seven RCTs reporting knowledge at course conclusion showed no significant difference between the use of both types of manikins. Significant risk of bias and a high degree of heterogeneity were found among the included studies.

This systematic review found that higher manikin realism during resuscitation training was associated with improved simulated clinical scenario performance at course conclusion; without an effect on knowledge at course conclusion. Future studies should examine the impact of resource requirements for high realism simulation on generalizability and implementation.