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Educational efficacy of high-fidelity simulation in neonatal resuscitation training: a systematic review and meta-analysis.

ABSTRACT:

Background

The training of neonatal resuscitation is an important part in the clinical teaching of neonatology. This study aimed to identify the educational efficacy of high-fidelity simulation compared with no simulation or low-fidelity simulation in neonatal resuscitation training.

Methods

The PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, Chinese databases (CBM, CNKI, WanFang, and Weipu), ScopeMed and Google Scholar were searched. The last search was updated on April 13, 2019. Studies that reported the role of high-fidelity simulation in neonatal resuscitation training were eligible for inclusion. For the quality evaluation, we used the Cochrane Risk of Bias tool for RCTs and Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for non-RCTs. A standardized mean difference (SMD) with a 95% confidence interval (CI) was applied for the estimation of the pooled effects of RCTs.

Results

Fifteen studies (10 RCTs and 5 single arm pre-post studies) were ultimately included. Performance bias existed in all RCTs because participant blinding to the simulator is impossible. The assessment of the risk of bias of single arm pre-post studies showed only one study was of high quality with a low risk of bias whereas four were of low quality with a serious risk of bias. The pooled results of single arm pre-post studies by meta-analysis showed a large benefit with high-fidelity simulation in skill performance (SMD 1.34; 95% CI 0.50-2.18). The meta-analysis of RCTs showed a large benefit in skill performance (SMD 1.63; 95% CI 0.49-2.77) and a moderate benefit in neonatal resuscitation knowledge (SMD 0.69; 95% CI 0.42-0.96) with high-fidelity simulation when compared with traditional training. Additionally, a moderate benefit in skill performance (SMD 0.64; 95% CI 0.06-1.21) and a small benefit was shown in knowledge (SMD 0.39; 95% CI 0.08-0.71) with high-fidelity simulation when compared with low-fidelity simulation.

Conclusions

Improvements of efficacy were shown both in resuscitation knowledge and skill performance immediately after training. However, in current studies, the long-time retention of benefits is controversial, and these benefits may not transfer to the real-life situations.

SUBMITTER: Huang J

PROVIDER: S-EPMC6716944 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:OBJECTIVES: The current review examines the effectiveness of simulation-based medical education (SBME) for training health professionals in cardiac physical examination and examines the relative effectiveness of key instructional design features. METHODS: Data sources included a comprehensive, systematic search of MEDLINE, EMBASE, CINAHL, PsychINFO, ERIC, Web of Science, and Scopus through May 2011. Included studies investigated SBME to teach health profession learners cardiac physical examination skills using outcomes of knowledge or skill. We carried out duplicate assessment of study quality and data abstraction and pooled effect sizes using random effects. RESULTS: We identified 18 articles for inclusion. Thirteen compared SBME to no-intervention (either single group pre-post comparisons or SBME added to other instruction common to all learners, such as traditional bedside teaching), three compared SBME to other educational interventions, and two compared two SBME interventions. Meta-analysis of the 13 no-intervention comparison studies demonstrated that simulation-based instruction in cardiac auscultation was effective, with pooled effect sizes of 1.10 (95 % CI 0.49-1.72; p?<?0.001; I(2)?=?92.4 %) for knowledge outcomes and 0.87 (95 % CI 0.52-1.22; p?<?0.001; I(2) = 91.5 %) for skills. In sub-group analysis, hands-on practice with the simulator appeared to be an important teaching technique. Narrative review of the comparative effectiveness studies suggests that SBME may be of similar effectiveness to other active educational interventions, but more studies are required. LIMITATIONS: The quantity of published evidence and the relative lack of comparative effectiveness studies limit this review. CONCLUSIONS: SBME is an effective educational strategy for teaching cardiac auscultation. Future studies should focus on comparing key instructional design features and establishing SBME's relative effectiveness compared to other educational interventions.

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