Prioritize rigorous RCTs with retention tests and transfer measures before expanding distance simulation programs¶

Strategy · All strategies
Evidence · 2 claims (2 for) · 2 studies (2 review), q2–q3 · 0 of 2 report an effect size · 2 claims rest on one study

Description¶

Based on the evidence gaps it identifies, the review recommends that future work use more rigorously designed randomized controlled trials to assess long-term skill retention and transferability to clinical practice, and suggests a focused systematic review restricted to high-quality comparative studies. It also recommends developing more simulators specifically tailored for distance simulation to address a wider range of subspecialty educational needs, and acknowledges that barriers such as variable Internet connectivity and setup costs must be addressed for sustainable, equitable programs.

Design Implications¶

Context¶

Requirements¶

• Studies should include retention tests and clinical transfer (Kirkpatrick level 3) outcome measures rather than relying on learner satisfaction

Constraints¶

• The review notes its findings may not generalize to nurses, paramedics, or midwives, and that benefits may not be universally achievable in resource-limited settings

Target Learners¶

• medical students
• residents
• doctors

Target Learning Goals¶

• durable technical skill acquisition and transfer to clinical practice

Claims¶

• Evidence on transfer to clinical behavior and patient outcomes is scarce: only 2 studies reached Kirkpatrick level 3 and 1 reached level 4 [+W]
• The review suggests current observational evidence may overestimate simulation's impact, since more rigorous cluster-RCTs showed only time-limited mortality reductions or nonsignificant results [+W]

Related Strategies¶

• Future HFS trials for practising nurses need larger samples, rigorous randomised design and standardised, fully reported measures
• Integrate quantitative and qualitative approaches in future cardiac arrest simulation feedback research
• Future active-learning research should use randomised controlled designs with larger samples and standardised outcome measures
• Future research should include long-term RCTs with adequate sample sizes, standardized outcome measures, and cost-effectiveness analyses
• Use cluster randomized clinical trials and blinded simulation-based behavior assessment to strengthen NTS training evidence
• Engage target learners to identify needs before designing XR educational tools
• Future simulation research should use rigorous designs, standardized tools, and transparent reporting
• Prioritise longitudinal research and cost analysis when evaluating digital clinical skills modalities
• Conduct well-blinded randomized controlled trials of high-fidelity computer-based simulations, including evaluations at behaviour and results levels and of affective-domain outcomes
• Require adequately powered studies of skill retention and transfer before recommending major investment in cadaveric simulation
• Future online-training trials should follow TIDieR reporting, match comparison arms on duration and content, use Kirkpatrick's outcome hierarchy, and run factorial experiments optimising online features
• Prioritize larger sample sizes, multicentre designs, and rigorous reporting in future simulation-based CRM transfer and patient-outcome research

Examples¶

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Key Sources¶

• Wei W, Nielsen MS, Nielsen AB, Han Y, Russell L, Konge L, Cold KM. (2026). Hands-on Distance Simulation of Technical Skills: A Systematic Review. Simulation in Healthcare. https://doi.org/10.1097/SIH.0000000000000881