Simulation-Based Education of Health Workers in Low- and Middle-Income Countries: A Systematic Review.

IF 2.5 3区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Global Health: Science and Practice Pub Date : 2024-11-07 DOI:10.9745/GHSP-D-24-00187

Samuel J A Robinson, Angus M A Ritchie, Maurizio Pacilli, Debra Nestel, Elizabeth McLeod, Ramesh Mark Nataraja

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Abstract

Introduction: Simulation-based education (SBE) is increasingly used to improve clinician competency and patient care and has been identified as a priority by the World Health Organization for low- and middle-income countries (LMICs). The primary aim of this review was to investigate the global distribution and effectiveness of SBE for health workers in LMICs. The secondary aim was to determine the learning focus, simulation modalities, and additional evaluation conducted in included studies.

Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta Analysis guidelines, searching Ovid (Medline, Embase, and Emcare) and the Cochrane Library from January 1, 2002, to March 14, 2022. Primary research studies reporting evaluation at Level 4 of The Kirkpatrick model were included. Studies on simulation-based assessment and validation were excluded. Quality and risk-of-bias assessments were conducted using appropriate tools. Narrative synthesis and descriptive statistics were used to present the results.

Results: A total of 97 studies were included. Of these, 54 were in sub-Saharan Africa (56%). Forty-seven studies focused on neonatology (48%), 29 on obstetrics (30%), and 16 on acute care (16%). Forty-nine used mannequins (51%), 46 used scenario-based simulation (47%), and 21 used synthetic part-task trainers (22%), with some studies using more than 1 modality. Sixty studies focused on educational programs (62%), while 37 used SBE as an adjunct to broader interventions and quality improvement initiatives (38%). Most studies that assessed for statistical significance demonstrated at least partial improvement in Level 4 outcomes (75%, n=81).

Conclusion: SBE has been widely applied to improve outcomes in a variety of contexts across LMICs. Modalities of simulation are typically low-technology versions. However, there is a lack of standardized reporting of educational activities, particularly relating to essential features of SBE. Further research is required to determine which approaches are effective in specific contexts.

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中低收入国家卫生工作者的模拟教育：系统回顾。

简介：模拟教育（SBE）越来越多地用于提高临床医生的能力和病人护理水平，并已被世界卫生组织确定为中低收入国家（LMICs）的优先事项。本综述的主要目的是调查针对中低收入国家卫生工作者的 SBE 在全球的分布情况和效果。次要目的是确定所纳入研究的学习重点、模拟模式和额外评估：方法：根据《系统综述和元分析首选报告项目》指南，对 2002 年 1 月 1 日至 2022 年 3 月 14 日期间的 Ovid（Medline、Embase 和 Emcare）和 Cochrane 图书馆进行了系统综述。纳入了报告 Kirkpatrick 模型第 4 级评估的初步研究。不包括基于模拟的评估和验证研究。使用适当的工具进行了质量和偏差风险评估。结果采用了叙述性综合和描述性统计：结果：共纳入 97 项研究。结果：共纳入 97 项研究，其中 54 项位于撒哈拉以南非洲（56%）。47 项研究侧重于新生儿科（48%），29 项侧重于产科（30%），16 项侧重于急症护理（16%）。49项研究使用了人体模型（51%），46项研究使用了情景模拟（47%），21项研究使用了合成部分任务训练器（22%），有些研究使用了一种以上的模式。60 项研究侧重于教育项目（62%），37 项研究将 SBE 作为更广泛干预和质量改进措施的辅助手段（38%）。大多数进行统计学意义评估的研究表明，至少部分改善了 4 级结果（75%，n=81）：结论：在低收入和中等收入国家的各种情况下，SBE 已被广泛应用于改善疗效。模拟的方式通常是低技术版本。然而，教育活动缺乏标准化的报告，特别是有关 SBE 基本特征的报告。需要开展进一步研究，以确定哪些方法在特定情况下是有效的。

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来源期刊

Global Health: Science and Practice Medicine-Health Policy

CiteScore

3.50

自引率

7.50%

发文量

178

审稿时长

22 weeks

期刊介绍： Global Health: Science and Practice (GHSP) is a no-fee, open-access, peer-reviewed, online journal aimed to improve health practice, especially in low- and middle-income countries. Our goal is to reach those who design, implement, manage, evaluate, and otherwise support health programs. We are especially interested in advancing knowledge on practical program implementation issues, with information on what programs entail and how they are implemented. GHSP is currently indexed in PubMed, PubMed Central, POPLINE, EBSCO, SCOPUS,. the Web of Science Emerging Sources Citation Index, and the USAID Development Experience Clearinghouse (DEC). TOPICS: Issued four times a year, GHSP will include articles on all global health topics, covering diverse programming models and a wide range of cross-cutting issues that impact and support health systems. Examples include but are not limited to: Health: Addiction and harm reduction, Child Health, Communicable and Emerging Diseases, Disaster Preparedness and Response, Environmental Health, Family Planning/Reproductive Health, HIV/AIDS, Malaria, Maternal Health, Neglected Tropical Diseases, Non-Communicable Diseases/Injuries, Nutrition, Tuberculosis, Water and Sanitation. Cross-Cutting Issues: Epidemiology, Gender, Health Communication/Healthy Behavior, Health Policy and Advocacy, Health Systems, Human Resources/Training, Knowledge Management, Logistics and Supply Chain Management, Management and Governance, mHealth/eHealth/digital health, Monitoring and Evaluation, Scale Up, Youth.