The Effect of High-Fidelity Simulation–Based Learning in Acute Cardiorespiratory Physical Therapy—A Mixed-Methods Systematic Review

Abstract

Background and Purpose. Simulation-based learning is commonly used in physical therapy education. However, given the financial cost and resources required to provide high-fidelity simulation (HFS)-based learning, it is necessary to determine its effectiveness. Therefore, the purpose of this study was to investigate the effect of HFS-based learning using computerized mannequins on clinical performance and preparedness of physical therapy students and physical therapists in acute cardiorespiratory physical therapy. Methods. We undertook a mixed-methods systematic review and meta-analysis. Search strategies were used to find articles in electronic databases. Reference lists of studies were also searched. Included studies investigated the effect of HFS-based learning on physical therapy students' and physical therapists' clinical performance and preparedness in acute cardiorespiratory physical therapy and included the use of computerized mannequins. Both quantitative and qualitative studies were considered. Results. A total of 12 trials from 11 articles were included. Quantitative findings of pooled studies indicated a small, but not statistically significant, effect of simulation training on clinical performance of physical therapy students' when compared with traditional learning methods (Hedges' g = 0.18; 95% confidence interval, −0.18 to 0.64; P = .07; I 2 = 57%). Qualitative data were synthesized into 4 themes in which HFS positively impacted students' preparedness: familiarization with the clinical setting, real-world learning in a controlled environment, learning about patient safety, and self-efficacy and confidence. Only the theme of self-efficacy and confidence were able to be integrated with quantitative data, demonstrating a positive effect of HFS on students' and physical therapists' self-efficacy and confidence. Discussion and Conclusion. High-fidelity simulation involving the use of computerized mannequins improves students' preparedness for clinical practice but does not improve students' clinical performance, although limited evidence exists for physical therapists' preparedness and clinical performance, indicating that further research of physical therapy clinicians is required.