JMIR Publications

ABSTRACT

Background:

Despite the economic advantage of digital simulations (DSs), their teaching effectiveness compared to traditional simulations of mannequins and real persons (RPs) has never been investigated.

Objective:

The goal of this study was to compare DSs and mannequins/RPs in medical and nursing education. The outcomes of interest were knowledge, procedural skills, clinical reasoning, and communication skills.

Methods:

We conducted the electronic literature search using the Cochrane Library, PubMed, Embase, and ERIC (Educational Resource Information Centre) to identify relevant randomized controlled trials up to October 2023 that reported objective scores for any of the 4 educational outcomes. 2 independent authors performed the study selection, data extraction, and risk-of-bias assessment following the Cochrane criteria.

Results:

A total of 24 studies, including 1,348 participants, were selected for the final analysis. Overall, we found no significant differences between DSs and mannequins/RPs in knowledge (standard mean difference [SMD]=0.08, 95% confidence interval [CI]: -0.38 to 0.53, I2=74%), procedural skills (SMD=-0.03, 95% CI: -0.35 to 0.28, I2=71%), clinical reasoning (SMD=0.11, 95% CI: -0.49 to 0.71, I2=89%), and communication skills (SMD=-0.20, 95% CI: -0.80 to 0.41, I2=82%). For procedural skills, DSs were inferior among the nursing subgroup (SMD=-0.55, 95% CI: -1.07 to -0.03, I2=69%). For communication skills, DSs were inferior if the latest study was removed (SMD=-0.48, 95% CI: -0.92 to -0.04, I2=65%).

Conclusions:

High heterogeneity between studies might account for insufficient evidence for superiority of DSs, so further rigorously designed large-scale studies are warranted. With the favorable cost-effectiveness, DSs serve as a promising alternative to traditional simulation methods.