title: Beyond the simulation laboratory: a realist synthesis review of clinical outcomes of simulation-based mastery learning.
abstract: OBJECTIVE
  Translational educational outcomes have been defined as starting in simulation laboratories (T1) and moving downstream to improved patient care practices (T2), patient outcomes (T3), and cost/other value outcomes (T4). The authors conducted a realist synthesis review of the literature to evaluate the translational effect of simulation-based mastery learning (SBML) principles beyond the laboratory. They also sought to address future directions in SBML to improve patient care processes and outcomes and, thus, the quality of health care delivery.
  
  
  METHODS
  The authors searched multiple databases for simulation-based medical education (SBME) studies published through April 2013. They screened articles using the PICO method-population (P), intervention (I), control (C), outcome (O)-to answer the research question: For (P) any health care providers, does the (I) implementation of SBML training, compared with (C) other training methodologies or no extra training, result in (O) a change in patient care practices or T2-T4 outcomes? Studies implementing SBME interventions with training methodologies that met all SBML principles and reporting T2-T4 outcomes were identified.
  
  
  RESULTS
  The 14 included studies used pre/post or cohort study designs; the majority were limited to individual performance and procedural competency. They reported improvement after SBML training in procedure performance, task success, patient discomfort, procedure time, complication rates, or T4 impacts (e.g., cost reduction).
  
  
  CONCLUSIONS
  Findings suggest health professions education conducted using SBML methodology can improve patient care processes and outcomes. Further research is needed to understand the translational impact of SBML for nontechnical skills, including teamwork, and skill retention.
authors.affiliation: S. Griswold-Theodorson is director, Master of Science in Medical and Healthcare Simulation Program, director, Division of Simulation, Department of Emergency Medicine, and professor of emergency medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania. S. Ponnuru is fellowship director, Division of Simulation, Department of Emergency Medicine, and assistant professor of emergency medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania. C. Dong is assistant director of medical education, National University of Singapore Yong Loo Lin School of Medicine, Singapore. D. Szyld is medical director, New York Simulation Center for the Health Sciences, and assistant professor of emergency medicine, New York University School of Medicine, New York, New York. T. Reed is assistant dean and director of clinical simulation and associate professor, Department of Emergency Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois. W.C. McGaghie is professor of medical education, Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Sharon
authors.initials: S
authors.lastname: Griswold-Theodorson
authors.forename: Srikala
authors.initials: S
authors.lastname: Ponnuru
authors.forename: Chaoyan
authors.initials: C
authors.lastname: Dong
authors.forename: Demian
authors.initials: D
authors.lastname: Szyld
authors.forename: Trent
authors.initials: T
authors.lastname: Reed
authors.forename: William C
authors.initials: WC
authors.lastname: McGaghie
mesh_terms: D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods*; D003198:Computer Simulation; D003479:Curriculum; D004059:Diffusion of Innovation; D004501:Education, Medical / Q000379:methods*; D004521:Educational Measurement; D006801:Humans; D017145:Models, Educational; D057170:Translational Research, Biomedical