Simulation found to be effective in training

Simulation-based training is an effective way to teach physicians, nurses, dentists, emergency medical technicians, and other health professionals, according to an analysis led by Mayo Clinic researchers.

The team reviewed more than 600 studies evaluating the use of technologies such as virtual reality computers, mannequins, and training models to teach skills and procedures including surgery, trauma management, obstetrics, and team communication. Their conclusions were published Sept. 7 in The Journal of the American Medical Association.1

Lead author David Cook, MD, of Department of General Internal Medicine at the Mayo Clinic Rochester (MN), worked with researchers from Mayo, the University of Ottawa (Canada), the University of British COlumbia, Vancouver, Canada, and the University of Toronto in Ontario, Canada. They concluded that training with simulation is consistently better than no instruction, as measured in controlled settings and in practice with actual patients.

"We reviewed hundreds of articles, and, with extremely rare exceptions, we found improved outcomes for those who trained with simulation," Cook says. "This held true across a wide variety of learners, learning contexts, and clinical topics."

However, "we need more effective, more efficient, and safer ways to learn," says Cook citing the increasing volume of medical knowledge, rapidly changing practice environments, and evolving physician-patient relationships. "Simulation-based instruction has unique advantages, including the opportunity to practice without harming patients, repeat training to become more proficient, and structure training for more effective learning."

The study also found a lot of variation in the quality and results of the simulation activities. "Not all training was equally effective," Cook says. "Now that we know that simulation works, the next step is to understand how to use simulation-based instruction effectively and efficiently." He and the others on his team are researching how to use simulation-based teaching most cost-effectively.

The other researchers were Benjamin Zendejas, MD, Jason Szostek, MD, Amy Wang, MD, and Patricia Erwin, all of Mayo Clinic; Stanley Hamstra, PhD, University of Ottawa; Rose Hatala, MD, University of British Columbia; and Ryan Brydges, PhD, University of Toronto.


1. Cook DA, Hatala R, Brydges R, et al. Technology-enhanced simulation for health professions education: a systematic review and meta-analysis. JAMA 2011; 306:978-988. Doi:10.1001/jama.2011.1234.