The Use of Simulation Training to Improve Knowledge, Skills, and Confidence Among Healthcare Students: A Systematic Review

Purpose: The use of simulation has become a routine part of education and training for health professionals in many health education facilities. The increased awareness of patient safety and recent advances in technology are the main incentives to use simulation to teach and evaluate clinical competencies. The primary purpose of this study was to review the best available evidence (level and quality) for the use of simulation training to improve clinical skills, knowledge, and self-confidence among healthcare students. Method: A systematic review of qualitative and quantitative literature published between 2000 and 2016 was undertaken using databases including PubMed, CINAHL®, and PsycINFO® databases as well as three journal collections within ProQuest. In addition to the database search, the literature search for this study included two additional activities: search results were compared against the bibliographies of the reviewed studies, and Google Scholar was used to search the Internet for relevant publications. Data from studies meeting inclusion criteria was extracted and summarized. The level and strength of evidence was rated for each study. Results: Of 1412 studies identified via the search strategy, 30 met the inclusion criteria for this systematic review. A wide variety of study designs, interventions, measurements, and simulation types were represented. Data for study location, health profession, sample size, purpose, simulation type, intervention, and outcome measure are presented via evidence tables by authors. Statistically and/or clinically significant improvements in knowledge, skills, and/or self-confidence following simulation training were reported. Primary and secondary outcomes were identified and summarized. Conclusions: Evidence demonstrates that the use of simulation in student education significantly improves knowledge, skills, and self-confidence. A quality improvement framework of five best practice components for application in simulation research is proposed, generated from the findings of this review. Future research employing high quality research designs focusing on debriefing practices, interprofessional education applications, validation of outcome measures, student satisfaction, and long-term information retention will contribute to the growing body of literature supporting best practices for simulation training in healthcare.