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In situ simulation and its effects on patient outcomes: a systematic review
  1. Daniel Goldshtein1,
  2. Cole Krensky2,
  3. Sachin Doshi2,
  4. Vsevolod S. Perelman1,3,4
  1. 1 SimSinai Center, Sinai Health System, Toronto, Ontario, Canada
  2. 2 Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3 Department of Family and Community Medicine, Division of Emergency Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  4. 4 Schwartz-Reisman Emergency Medicine Centre, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
  1. Correspondence to Dr Vsevolod S. Perelman, Faculty of Medicine, University of Toronto, Schwartz-Reisman Emergency Centre, SimSinai Centre, Sinai Health System,Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada; sev.perelman{at}


Background The use of in situ simulation has previously been shown to increase confidence, teamwork and practical skills of trained professionals. However, a direct benefit to patient outcomes has not been sufficiently explored. This review focuses on the effect of in situ simulation training in a hospital setting on morbidity or mortality.

Methods A combined search was conducted in PUBMED, OVID, WEB OF SCIENCE, CINAHL, SCOPUS and EMBASE. 478 studies were screened with nine articles published between 2011 and 2017 meeting the inclusion criteria for analysis.

Results This review selected eight prospective studies and one prospective-retrospective study. Three studies isolated in situ simulation as an experimental variable while the remaining studies implemented in situ programmes as a component of larger quality improvement initiatives. Seven studies demonstrated a significant improvement in morbidity and/or mortality outcomes following integrated in situ simulation training.

Conclusion Existing literature, albeit limited, demonstrates that in situ training improves patient outcomes either in isolation or within a larger quality improvement programme. However, existing evidence contains difficulties such as isolating the impact of in situ training from various potential confounding factors and potential for publication bias.

  • simulation
  • team training
  • patient safety
  • medical education
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  • Contributors DG and CK designed the search query, conducted the search, analysed the data, drafted and revised the paper. SD drafted and revised the paper. SP initiated the project and revised the paper. DG and CK contributed equally to this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The authors did not seek ethical approval as the systematic review did not meet the criteria of human subject research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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