Outcomes/Effectiveness Research

Simulation improves caregivers' performance but whether it improves patient outcomes is still uncertain

In today's technology-driven world, simulators have staked their claim in the health care training arena. Because they mimic real-life situations, these devices are touted as tools that improve skills, safety, teamwork, and patient health. To answer the question of whether simulators actually advance care delivery and patient outcomes, Children's Hospital of Philadelphia researchers reviewed numerous journal articles.

The research team looked at simulators for their ability to improve confidence, competence, operational performance, and patient outcomes. The team found that many who used simulators to learn a clinical task reported having increased confidence in their performance. However, this new-found self assurance did not always correlate with an ability to complete the task. Rates use video or sound recordings—often integral parts of simulator training—to evaluate trainees' competence.

Several studies found that raters tended to score performances similarly, making simulators useful tools for measuring skill. Studies that followed trainees from simulator training on airway management, colonoscopy, gallbladder surgery, and other procedures to real clinical settings indicated that simulating procedures did improve actual performance.

However, research has not demonstrated whether patient outcomes are better when simulators are used. This topic is difficult to study because of the large sample sizes needed and the many relevant variables, and research is very much needed in this area, the authors suggest. Their study was funded in part by the Agency for Healthcare Research and Quality (HS16678).

See "Does simulation improve patient safety?: Self-efficacy, competence, operational performance, and patient safety," by Dr. Akira Nishisaki, M.D., Ron Keren, M.D., M.P.H., and Vinay Nadkarni, M.D., in the June 2007 Anesthesiology Clinics 25, pp. 225-236.

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