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Technology-Enhanced Simulation and Pediatric Education: A Meta-analysis.
Cheng, A et al. Pediatrics 2014;133:e1313-1323.
Reviewed by Michele Haight


What was the study question?
What are the characteristics of pediatric-related Technology-Enhanced Simulation (TES) studies and what is the effectiveness of TES as an educational modality for educating health professionals caring for children?

How was the study done?
This was a systematic review of the literature according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards. 57 pediatric simulation studies (N=3666 learners) were included in the meta-analysis. Studies making comparisons with no intervention, an alternate instructional modality, or another form of TES were included. Effect sizes were calculated for each comparison group. Eligible studies were determined through multiple levels of duplicate reviewer screening.

What were the results?
For no intervention, the effect sizes favored simulation for knowledge and skills with smaller effects for learner behaviors and patient effects. Large inconsistency between studies was noted. For alternate instructional modalities, negligible knowledge outcomes and a small effect favoring simulator training were demonstrated. For other TES techniques, high physical realism simulators demonstrated small to moderate benefits. Favorable instructional design features included: a.) video instruction (vs. instructor-led) followed by self-directed mannequin practice b.) self-directed, hands on practice (vs. expert modeling), and c.) combining instructor and automated feedback (vs. instructor only feedback). In summary, simulation training for pediatrics is associated with effects that are favorable but variable in magnitude.

What are the implications of these findings?
TES is an effective educational modality for pediatrics and supports continued implementation of TES in pediatric education programs. The use of high realism vs. low realism simulators enhances learning outcomes.

Editor's note: Of particular significance are the "favorable instructional design features" noted above for those who use or want to use TES. (RR)

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