The Effectiveness of Medical Simulation in Teaching Medical Students Critical Care Medicine: A Systematic Review and Meta-analysis

We aimed to assess effectiveness of simulation for teaching medical students critical care medicine and to assess which simulation methods were most useful. We searched AMED, EMBASE, MEDLINE, ERIC, BEI, AEI, plus bibliographies and citations, to July 2013. Randomised controlled trials comparing effectiveness of simulation with another educational intervention, or no teaching, for teaching medical students critical care medicine were included. Assessments for inclusion, quality and data extraction were duplicated and results synthesised using meta-analysis. We included 22 RCTs (n=1325). Fifteen studies comparing simulation with other teaching found simulation to be more effective (SMD 0.84, 95% CI 0.43 to 1.24; p<0.001; I2 89%). High-fidelity simulation was more effective than low-fidelity and subgrouping supported high-fidelity simulation being more effective than other methods. Simulation improved skill acquisition (SMD 1.01, 95% CI 0.49 to 1.53) but was no better than other teaching in knowledge acquisition (SMD 0.41, 95% CI -0.09 to 0.91).