title: In Situ Operating Room-Based Simulation: A Review.
abstract: OBJECTIVE
  To systematically review the literature surrounding operating room-based in situ training in surgery.
  
  
  METHODS
  A systematic review was conducted of MEDLINE. The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, and employed the Population, Intervention, Comparator, Outcome (PICO) structure to define inclusion/exclusion criteria. The Kirkpatrick model was used to further classify the outcome of in situ training when possible.
  
  
  RESULTS
  The search returned 308 database hits, and ultimately 19 articles were identified that met the stated PICO inclusion criteria. Operating room-based in situ simulation is used for a variety of purposes and in a variety of settings, and it has the potential to offer unique advantages over other types of simulation. Only one randomized controlled trial was conducted comparing in situ simulation to off-site simulation, which found few significant differences. One large-scale outcome study showed improved perinatal outcomes in obstetrics.
  
  
  CONCLUSIONS
  Although in situ simulation theoretically offers certain advantages over other types of simulation, especially in addressing system-wide or environmental threats, its efficacy has yet to be clearly demonstrated.
authors.affiliation: Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Lily
authors.initials: L
authors.lastname: Owei
authors.affiliation: Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Neylan
authors.affiliation: Division of Surgical Education, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Raghavendra
authors.initials: R
authors.lastname: Rao
authors.affiliation: Division of Surgical Education, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Simulation Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Caskey
authors.affiliation: Division of Surgical Education, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jon B
authors.initials: JB
authors.lastname: Morris
authors.affiliation: Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Richard
authors.initials: R
authors.lastname: Sensenig
authors.affiliation: Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Ari D
authors.initials: AD
authors.lastname: Brooks
authors.affiliation: Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Dempsey
authors.affiliation: Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Surgical Education, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Noel N
authors.initials: NN
authors.lastname: Williams
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Joshua H
authors.initials: JH
authors.lastname: Atkins
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Dimitry Y
authors.initials: DY
authors.lastname: Baranov
authors.affiliation: Division of Surgical Education, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Simulation Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: dumonk@uphs.upenn.edu.
authors.forename: Kristoffel R
authors.initials: KR
authors.lastname: Dumon
mesh_terms: D002983:Clinical Competence; D013502:General Surgery / Q000193:education*; D006801:Humans; D009873:Operating Rooms; D000066908:Simulation Training
keywords: Interpersonal and Communication Skills; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; in situ; operating room; simulation; systematic review