Simulation-based bronchoscopy training: systematic review and meta-analysis.
BACKGROUND
Simulation-based bronchoscopy training is increasingly used, but effectiveness remains uncertain. We sought to perform a comprehensive synthesis of published work on simulation-based bronchoscopy training.


METHODS
We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, and Scopus for eligible articles through May 11, 2011. We included all original studies involving health professionals that evaluated, in comparison with no intervention or an alternative instructional approach, simulation-based training for flexible or rigid bronchoscopy. Study selection and data abstraction were performed independently and in duplicate. We pooled results using random effects meta-analysis.


RESULTS
From an initial pool of 10,903 articles, we identified 17 studies evaluating simulation-based bronchoscopy training. In comparison with no intervention, simulation training was associated with large benefits on skills and behaviors (pooled effect size, 1.21 [95% CI, 0.82-1.60]; n=8 studies) and moderate benefits on time (0.62 [95% CI, 0.12-1.13]; n=7). In comparison with clinical instruction, behaviors with real patients showed nonsignificant effects favoring simulation for time (0.61 [95% CI, -1.47 to 2.69]) and process (0.33 [95% CI, -1.46 to 2.11]) outcomes (n=2 studies each), although variation in training time might account for these differences. Four studies compared alternate simulation-based training approaches. Inductive analysis to inform instructional design suggested that longer or more structured training is more effective, authentic clinical context adds value, and animal models and plastic part-task models may be superior to more costly virtual-reality simulators.


CONCLUSIONS
Simulation-based bronchoscopy training is effective in comparison with no intervention. Comparative effectiveness studies are few.
Division of Pulmonary and Critical Care Medicine, Rochester, MN.
Cassie C
CC
Kennedy
Division of Pulmonary and Critical Care Medicine, Rochester, MN.
Fabien
F
Maldonado
Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Office of Education Research, Mayo Medical School, Mayo Foundation for Medical Education and Research, Rochester, MN. Electronic address: cook.david33@mayo.edu.
David A
DA
Cook
D001999:Bronchoscopy / Q000193:education*; D002983:Clinical Competence; D003198:Computer Simulation; D004502:Education, Medical, Continuing / Q000379:methods; D006801:Humans