Simulation-Based Skill Training for Trainees in Cardiac Surgery: A Systematic Review.

Background: Simulation-based training has been an important part of the solution to address the shortfalls in cardiac surgery training. This review was conducted to identify and systematically summarize existing evidence on outcomes and methodological quality of simulation-based skills training for cardiac surgery trainees.

Methods: MEDLINE, Embase, and ERIC (Education Resources Information Center) databases were searched. Studies included peer-reviewed publications with simulation-based skill training in cardiac surgery programs with outcome measures of performance. Data extraction covered the type of skills training, simulator type and fidelity, the level of trainees, assessment tools, assessors, study design and its components, strengths and limitations, and elements required for the Medical Education Research Study Quality Instrument score. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Of 16 studies that met the criteria, only four (25%) randomized controlled trials were identified, and the remaining were observational studies. Seven observational studies (43.7%) were single-group pre-post tests. The mean number of trainees was 20.4 (SD, 14.1). Low-fidelity simulators were used in 13 studies (81.2%). Most of the studies (81.3%) were high quality based on a Medical Education Research Study Quality Instrument score of 12 or more. Evidence of assessment tool validation was absent among all studies. No study outcome measures were directed to skills transfer to the operating room or patient outcomes. Overall learning outcomes' effect sizes were consistently high (2.2; SD, 1.6), with junior residents benefitting most (effect size, 2.8; SD, 2.2) CONCLUSIONS: Simulation-based skill training is associated with improved learning outcomes for cardiac surgery trainees with large effect sizes, but more behavior-level outcomes are required to fully assess its value.