title: Technology-enhanced simulation and pediatric education: a meta-analysis.
abstract: OBJECTIVE
  Pediatrics has embraced technology-enhanced simulation (TES) as an educational modality, but its effectiveness for pediatric education remains unclear. The objective of this study was to describe the characteristics and evaluate the effectiveness of TES for pediatric education.
  
  
  METHODS
  This review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards. A systematic search of Medline, Embase, CINAHL, ERIC, Web of Science, Scopus, key journals, and previous review bibliographies through May 2011 and an updated Medline search through October 2013 were conducted. Original research articles in any language evaluating the use of TES for educating health care providers at any stage, where the content solely focuses on patients 18 years or younger, were selected. Reviewers working in duplicate abstracted information on learners, clinical topic, instructional design, study quality, and outcomes. We coded skills (simulated setting) separately for time and nontime measures and similarly classified patient care behaviors and patient effects.
  
  
  RESULTS
  We identified 57 studies (3666 learners) using TES to teach pediatrics. Effect sizes (ESs) were pooled by using a random-effects model. Among studies comparing TES with no intervention, pooled ESs were large for outcomes of knowledge, nontime skills (eg, performance in simulated setting), behaviors with patients, and time to task completion (ES = 0.80-1.91). Studies comparing the use of high versus low physical realism simulators showed small to moderate effects favoring high physical realism (ES = 0.31-0.70).
  
  
  CONCLUSIONS
  TES for pediatric education is associated with large ESs in comparison with no intervention. Future research should include comparative studies that identify optimal instructional methods and incorporate pediatric-specific issues into educational interventions.
authors.affiliation: Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Canada; chenger@me.com.
authors.forename: Adam
authors.initials: A
authors.lastname: Cheng
authors.affiliation: Division of Neonatology, Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota;
authors.forename: Tara R
authors.initials: TR
authors.lastname: Lang
authors.affiliation: Department of Pediatric and Adolescent Medicine, and.
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Starr
authors.affiliation: Office of Medical Education, Division of Educational Informatics, New York University School of Medicine, New York, New York.
authors.forename: Martin
authors.initials: M
authors.lastname: Pusic
authors.affiliation: Department of Medicine and Office of Education Research, Mayo Clinic College of Medicine, Rochester, Minnesota; and.
authors.forename: David A
authors.initials: DA
authors.lastname: Cook
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003198:Computer Simulation; D003194:Computer-Assisted Instruction; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008348:Manikins; D016544:Patient Simulation; D010372:Pediatrics / Q000193:education*; D014584:User-Computer Interface
keywords: education; pediatric; simulation; systematic review; technology-enhanced