Effectiveness of Simulation-Based Training for Thoracentesis - A Systematic Review and Meta-Analysis

Thoracentesis is a common bedside procedure. Complication rates are, among other factors, associated with the clinicians' skills. Simulation-based training (SBT) for teaching procedural skills is widely recommended in medical education. However, the current evidence on the effectiveness of SBT for thoracentesis and the impact of different instructional features has not yet been comprehensively reviewed.

To summarize and critically appraise the current evidence on the effectiveness of SBT for thoracentesis in improving educational and patient outcomes, and to examine the instructional characteristics of effective training programs.

A systematic review of the published literature on effectiveness of SBT for thoracentesis was performed and is reported according to PRISMA guidelines. Methodological quality was assessed using the MERSQI and the risk of bias of the included studies was evaluated. Extracted data were analyzed descriptively and random-effects meta-analyses were used to calculate the pooled correlation for self-confidence and performance scores.

Of the 17 studies included in the review, 14 used a pretest-posttest design and 15 investigated the effectiveness of high-fidelity simulation. Instructional features and outcome measures varied considerably across studies and no association was recognized. The majority of the reported outcomes were positive. The pooled correlation for self-confidence was 1.59 (95% confidence interval [CI] 0.94-2.24; n = 5 studies), and for performance scores 23.94 (95% CI 8.83-39.05, n = 5).

SBT for thoracentesis using high-fidelity simulators is effective in improving procedural skills and self-confidence. More evidence is needed to demonstrate a potential positive impact on behavioral and patient-related outcomes.

PROSPERO; No.: CRD420251064566; URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251064566.