title: The use of high-fidelity manikins for advanced life support training--A systematic review and meta-analysis.
abstract: OBJECTIVE
  The objective of this study was to evaluate the effectiveness of high versus low fidelity manikins in the context of advanced life support training for improving knowledge, skill performance at course conclusion, skill performance between course conclusion and one year, skill performance at one year, skill performance in actual resuscitations, and patient outcomes.
  
  
  METHODS
  A systematic search of Pubmed, Embase and Cochrane databases was conducted through January 31, 2014. We included two-group non-randomized and randomized studies in any language comparing high versus low fidelity manikins for advanced life support training. Reviewers worked in duplicate to extract data on learners, study design, and outcomes. The GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach was used to evaluate the overall quality of evidence for each outcome.
  
  
  RESULTS
  3840 papers were identified from the literature search of which 14 were included (13 randomized controlled trials; 1 non-randomized controlled trial). Meta-analysis of studies reporting skill performance at course conclusion demonstrated a moderate benefit for high fidelity manikins when compared with low fidelity manikins [Standardized Mean Difference 0.59; 95% CI 0.13-1.05]. Studies measuring skill performance at one year, skill performance between course conclusion and one year, and knowledge demonstrated no significant benefit for high fidelity manikins.
  
  
  CONCLUSIONS
  The use of high fidelity manikins for advanced life support training is associated with moderate benefits for improving skills performance at course conclusion. Future research should define the optimal means of tailoring fidelity to enhance short and long term educational goals and clinical outcomes.
authors.affiliation: University of Calgary, KidSim-ASPIRE Research Program, Section of Emergency Medicine, Department of Pediatrics, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, Alberta T3B 6A8, Canada. Electronic address: chenger@me.com.
authors.forename: Adam
authors.initials: A
authors.lastname: Cheng
authors.affiliation: Consultant in Emergency Medicine, Calderdale & Huddersfield NHS Trust, Salterhebble, Halifax HX3 0PW, UK. Electronic address: Andrew.lockey@cht.nhs.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lockey
authors.affiliation: Montreal Children's Hospital, McGill University, 2300 Tupper St, Montreal, QC H3H 1P3, Canada. Electronic address: farhan.bhanji@mcgill.ca.
authors.forename: Farhan
authors.initials: F
authors.lastname: Bhanji
authors.affiliation: KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta T3B 6A8, Canada. Electronic address: jeffylin@hotmail.com.
authors.forename: Yiqun
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children's Center, Division of Pediatric Anesthesiology and Critical Care Medicine, 1800 Orleans Street/Room 6321, Baltimore, MD 21287, USA. Electronic address: ehunt@jhmi.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hunt
authors.affiliation: Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Unit 1633, 1632 14 Avenue NW, Calgary, Alberta T2N 1M7, Canada. Electronic address: eddy.lang@albertahealthservices.ca.
authors.forename: Eddy
authors.initials: E
authors.lastname: Lang
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education*; D002983:Clinical Competence; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D008348:Manikins; D013663:Teaching / Q000379:methods / Q000592:standards
keywords: Advanced life support training; Cardiopulmonary resuscitation; Meta-analysis; Simulation; Systematic review