Procedural instruction in invasive bedside procedures: a systematic review and meta-analysis of effective teaching approaches

ImportanceOptimal approaches to teaching bedside procedures are unknown.ObjectiveTo identify effective instructional approaches in procedural training.Data sourcesWe searched PubMed, EMBASE, Web of Science and Cochrane Library through December 2014.Study selectionWe included research articles that addressed procedural training among physicians or physician trainees for 12 bedside procedures. Two independent reviewers screened 9312 citations and identified 344 articles for full-text review.Data extraction and synthesisTwo independent reviewers extracted data from full-text articles.Main outcomes and measuresWe included measurements as classified by translational science outcomes T1 (testing settings), T2 (patient care practices) and T3 (patient/public health outcomes). Due to incomplete reporting, we post hoc classified study outcomes as ‘negative’ or ‘positive’ based on statistical significance. We performed meta-analyses of outcomes on the subset of studies sharing similar outcomes.ResultsWe found 161 eligible studies (44 randomised controlled trials (RCTs), 34 non-RCTs and 83 uncontrolled trials). Simulation was the most frequently published educational mode (78%). Our post hoc classification showed that studies involving simulation, competency-based approaches and RCTs had higher frequencies of T2/T3 outcomes. Meta-analyses showed that simulation (risk ratio (RR) 1.54 vs 0.55 for studies with vs without simulation, p=0.013) and competency-based approaches (RR 3.17 vs 0.89, p