The Impact of the Fidelity of Simulation on Medical Undergraduate Education: A Meta-Analysis

Abstract Background: With the development of science and technology, simulation-based education has also developed rapidly. However, whether the fidelity level of simulators has a positive correlation with medical students' learning outcomes is controversial. This study aims to compare the theoretical knowledge, skill performance and confidence of undergraduate medical students through meta-analysis according to the fidelity level of the simulator.Methods: Two researchers independently searched the PubMed database, the Cochrane Library, and the Embase database through October 20, 2020, to retrieve articles on the differences in effectiveness between high-fidelity simulators and low-fidelity simulators in undergraduate medical education. The Cochrane risk of bias tool was used to evaluate all included literature. Quantitative meta-analysis of the included literature was performed with Review Manager 5.3.Results: Fifteen studies met the inclusion criteria, 11 of which were meta-analysed. Meta-analysis showed whether there were differences in students’ theoretical knowledge [standardized mean difference -0.51; 95% CI -1.30～0.29，P=0.21], skill performance [standardized mean difference -0.26; 95% CI -0.87～0.35, P = 0.40], and confidence [standardized mean difference 2.53; 95% CI -1.05～6.10, P = 0.17]: there were no significant differences between high-fidelity simulators and low-fidelity simulators.Conclusions: In medical undergraduate education, students who experience low-fidelity simulator training are not inferior to students who learn from high-fidelity simulators in their theoretical knowledge, skill performance, or confidence.