Simulation to Scalpel: A Systematic Review of True Evidence of Skills Transfer as Seen Through the Lens of Patient Outcomes.

Introduction: Simulation-based training (SBT) has become an essential component of surgical education. However, the definitive evidence for dissrect patient outcomes remains inconsistent. This prompted us to conduct this systematic review and meta-analysis to evaluate Kirkpatrick Level 4 evidence on whether SBT translates into clinical benefits and improves patient outcomes.

Methods: We designed a search protocol a priori and followed PRISMA guidelines for systematic reviews. Medline (via PubMed), Cochrane Library, online clinical trial registers, and websites were reviewed from their inception until 31 October 2024. Included studies were randomized controlled trials with patients undergoing any invasive intervention involving manual skills after SBT compared to the same intervention involving manual skills without SBT and comparing Clavien-Dindo complication grades. The methodological quality of included studies was assessed using the Cochrane's revised tool to assess the risk of bias in randomized trials. The Cochrane Collaboration's Review Manager software version 5.3 was utilized for data analysis. The grading of recommendation, assessment, development, and evaluation (GRADE) instrument was used for recommendation strength in the included studies in the meta-analysis.

Results: Ten studies were included in the final meta-analysis; all were rated as low risk of bias. The results favored simulation, but no statistically significant difference was observed between simulation and conventional training. The GRADE assessment reflected moderate certainty.

Discussion: We evaluated the effectiveness of simulation-based training (SBT) in improving patient-centric outcomes, classified by Clavien-Dindo complication grades using Kirkpatrick Level 4 evidence from randomized controlled trials, and discovered that results were comparable to traditional training. Future studies are needed to address this limitation in the current evidence base for simulation-based training to confirm and maximize its patient-centered benefits.