title: In situ simulation in continuing education for the health care professions: a systematic review.
abstract: BACKGROUND
  Education in the health sciences increasingly relies on simulation-based training strategies to provide safe, structured, engaging, and effective practice opportunities. While this frequently occurs within a simulation center, in situ simulations occur within an actual clinical environment. This blending of learning and work environments may provide a powerful method for continuing education. However, as this is a relatively new strategy, best practices for the design and delivery of in situ learning experiences have yet to be established. This article provides a systematic review of the in situ simulation literature and compares the state of the science and practice against principles of effective education and training design, delivery, and evaluation.
  
  
  METHODS
  A total of 3190 articles were identified using academic databases and screened for descriptive accounts or studies of in situ simulation programs. Of these, 29 full articles were retrieved and coded using a standard data extraction protocol (kappa = 0.90).
  
  
  RESULTS
  In situ simulations have been applied to foster individual, team, unit, and organizational learning across several clinical and nonclinical areas. Approaches to design, delivery, and evaluation of the simulations were highly variable across studies. The overall quality of in situ simulation studies is low. A positive impact of in situ simulation on learning and organizational performance has been demonstrated in a small number of studies.
  
  
  CONCLUSIONS
  The evidence surrounding in situ simulation efficacy is still emerging, but the existing research is promising. Practical program planning strategies are evolving to meet the complexity of a novel learning activity that engages providers in their actual work environment.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA. Mrosen44@jhmi.edu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Rosen
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hunt
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Molly A
authors.initials: MA
authors.lastname: Federowicz
authors.forename: Sallie J
authors.initials: SJ
authors.lastname: Weaver
mesh_terms: D020375:Education, Distance; D004502:Education, Medical, Continuing / Q000379:methods*; D006801:Humans; D016544:Patient Simulation; D018794:Problem-Based Learning / Q000379:methods*; D015397:Program Evaluation