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Effectiveness of technology-enhanced simulation in teaching digital rectal examination: a systematic review narrative synthesis
  1. Mansour A Al Asmri1,2,
  2. James Ennis3,
  3. Robert John Stone4,
  4. Fernando Bello5,
  5. M Sayeed Haque6,
  6. Jim Parle7
  1. 1 Department of Electronic, Electrical and Systems Engineering, University of Birmingham, Birmingham, UK
  2. 2 Clinical Simulation Training Centre, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
  3. 3 School of Medicine, University of Chester, Chester, UK
  4. 4 Human Interface Technologies Team, University of Birmingham, Birmingham, UK
  5. 5 Surgery and Cancer, Imperial College London, London, UK
  6. 6 Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  7. 7 Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  1. Correspondence to Jim Parle, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK; J.V.Parle{at}bham.ac.uk

Abstract

Background Digital rectal examination (DRE) is a challenging examination to learn.

Objective To synthesise evidence regarding the effectiveness of technology-enhanced simulation (TES) for acquiring DRE skills.

Study selection EMBASE, Medline, CINAHL, Cochrane, Web of Knowledge (Science and Social Science), Scopus and IEEE Xplore were searched; the last search was performed on 3 April 2019. Included were original research studies evaluating TES to teach DRE. Data were abstracted on methodological quality, participants, instructional design and outcomes; a descriptive synthesis was performed. Quality was assessed using a modified Medical Education Research Study Quality Instrument. The study design domain was modified by scoring the papers based on (1) evaluation of risk of bias for randomised controlled trials, (2) description of participants and (3) assessment of robustness and degree of simulation fidelity of the assessments used to evaluate learning.

Findings 863 articles were screened; 12 were eligible, enrolling 1507 prequalified medical/clinical students and 20 qualified doctors. For skill acquisition, role player was statistically significantly superior to a static manikin (2 studies). For knowledge acquisition, manikin use was significantly superior to role player (1 study); 2 studies showed no difference. For confidence, manikin use was significantly superior to no manikin (4 studies). For comfort, manikin use was significantly superior to no manikin (2 studies). For anxiety, role player was significantly superior to manikin (1 study).

Median overall quality score (QS) was 48% (27–62). Highest median QS was 73% (33–80) for data analysis; lowest median QS was 20% (7–40) for the validity of instrument. Six papers scored over 50% of the maximum score for overall quality.

Conclusions TES training is associated with improved DRE skills and should be used more widely.

  • Clinical competence
  • medical simulation
  • simulation based learning
  • systematic review
  • technology enhanced learning
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Footnotes

  • Contributors MAAA suggested the theme of the review, search protocol, literature review search, abstract and full-text screening, coded studies, quality assessment as well as the initial drafting and redrafting of the manuscript. JP contributed to full-text screening, coded studies, quality assessment, contacted experts to identify papers as well as drafting and redrafting of the manuscript. JE contributed to abstract screening, quality assessment, drafting and redrafting of the manuscript. RJS and FB contributed to quality assessment, drafting and redrafting of the manuscript. SH advised on statistical analysis, evaluated the extracted data for possible meta-analysis, drafting and redrafting of the manuscript.

  • Funding First author (MAAA) is funded for his PhD by Saudi Arabian Ministry of Education. Other authors contributed to the research as part of their regular work duties.

  • Competing interests None declared.

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

  • Data availability statement Data are available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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