A systematic review of simulation-based training tools for technical and non-technical skills in ophthalmology

To evaluate all simulation models for ophthalmology technical and non-technical skills training and the strength of evidence to support their validity and effectiveness. A systematic search was performed using PubMed and Embase for studies published from inception to 01/07/2019. Studies were analysed according to the training modality: virtual reality; wet-lab; dry-lab models; e-learning. The educational impact of studies was evaluated using Messick’s validity framework and McGaghie’s model of translational outcomes for evaluating effectiveness. One hundred and thirty-one studies were included in this review, with 93 different simulators described. Fifty-three studies were based on virtual reality tools; 47 on wet-lab models; 26 on dry-lab models; 5 on e-learning. Only two studies provided evidence for all five sources of validity assessment. Models with the strongest validity evidence were the Eyesi Surgical, Eyesi Direct Ophthalmoscope and Eye Surgical Skills Assessment Test. Effectiveness ratings for simulator models were mostly limited to level 2 (contained effects) with the exception of the Sophocle vitreoretinal surgery simulator, which was shown at level 3 (downstream effects), and the Eyesi at level 5 (target effects) for cataract surgery. A wide range of models have been described but only the Eyesi has undergone comprehensive investigation. The main weakness is in the poor quality of study design, with a predominance of descriptive reports showing limited validity evidence and few studies investigating the effects of simulation training on patient outcomes. More robust research is needed to enable effective implementation of simulation tools into current training curriculums. 本文旨在评估所有眼科技术与非技术仿真训练设备的优点, 以找到支持其有效性的证据。使用PubMed和Embase从开始研究至2019年7月1日进行文献检索。研究根据训练模式进行分类: 虚拟现实、实际操作实验室、教学实验室以及跟随电子设备学习。使用Messick有效性框架以及转化医学McGaghie模型评估其有效性。本文共纳入131项研究, 涉及 93种不同的模拟训练设备, 其中53项研究基于虚拟现实设备、47项基于实际操作的实验室模型、26项基于教学实验室模型和5项基于电子设备学习。只有2项研究涉及所有5种模拟设备。最有效的模型有Eyesi眼外科系统、Eyesi直接检眼镜和眼外科技能评估测试系统 (Eye Surgical Skills Assessment Test, ESSAT)。模拟训练设备刺激模型的有效性等级大多限制在2级 (包含有效), Sophocle玻璃体视网膜手术模拟设备显示为3级 (下游效应), 以及白内障手术5级 (靶向效应) 。本文针对大多数模型进行了阐述, 对Eyesi进行了深入探讨。本文的局限性在于纳入的研究实验设计质量差, 描述性报告显示有效性证据有限, 很少有研究调查模拟训练对患者结局的影响。因此需要更有力的研究证据, 以便在现有培训课程中有效地应用仿真训练设备。