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Simulation-Based Training for Cardiac Auscultation Skills: Systematic Review and Meta-Analysis

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ABSTRACT

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; I2 = 92.4 %) for knowledge outcomes and 0.87 (95 % CI 0.52–1.22; p < 0.001; I2 = 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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Acknowledgements

The authors thank Ryan Brydges, Patricia Erwin, Stanley J. Hamstra, Jason Szostek, Amy Wang, and Ben Zendejas for their assistance with literature searching, abstract reviewing, and data extraction.

Funding/Support

This work was supported by intramural funds, including an award from the Division of General Internal Medicine, Mayo Clinic.

Role of Sponsors

The funding sources for this study played no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation of the manuscript. The funding sources did not review the manuscript.

Conflict of Interest

The authors declare that they do not have a conflict of interest. There was no industry relationship with this work.

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Authors and Affiliations

  1. Department of Medicine, University of British Columbia, Vancouver, BC, Canada

    James McKinney MD, MSc, FRCPC, David Wood MD, FRCPC & Rose Hatala MD, MSc, FRCPC

  2. Office of Education Research, Mayo Medical School, Rochester, MN, USA

    David A. Cook MD, MHPE

  3. Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA

    David A. Cook MD, MHPE

  4. St. Paul’s Hospital, Suite 5907 Burrard Bldg, 1081 Burrard St., Vancouver, BC, Canada, V6Z 1Y6

    Rose Hatala MD, MSc, FRCPC

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  1. James McKinney MD, MSc, FRCPC
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  2. David A. Cook MD, MHPE
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  3. David Wood MD, FRCPC
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  4. Rose Hatala MD, MSc, FRCPC
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Correspondence to Rose Hatala MD, MSc, FRCPC.

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McKinney, J., Cook, D.A., Wood, D. et al. Simulation-Based Training for Cardiac Auscultation Skills: Systematic Review and Meta-Analysis. J GEN INTERN MED 28, 283–291 (2013). https://doi.org/10.1007/s11606-012-2198-y

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