This article addresses the comparative effectiveness of traditional methods of clinical medical education, especially the Halstedian “see one, do one, teach one” approach,1
versus simulation-based medical education (SBME) with deliberate practice (DP). SBME2–4
engages learners in lifelike experiences with varying fidelity designed to mimic real clinical encounters. DP embodies strong and consistent educational interventions grounded in information processing and behavioral theories of skill acquisition and maintenance.5–8
DP has at least nine elements (List 1).
The goal of DP is constant skill improvement, not just skill maintenance. The power of DP has been demonstrated in many professional domains including sports, commerce, performing arts, science, and writing.9
Research shows that DP is a much more powerful predictor of professional accomplishment than experience or academic aptitude.6
Comparative effectiveness research (CER), also known as patient-centered outcomes research, refers to studies that compare the benefits and liabilities of different interventions and strategies to prevent, diagnose, treat, and monitor health conditions.10–12
The aim is to “make head-to-head comparisons of different health care interventions [that] outline the effectiveness—or benefits and harms—of treatment options.”13
Conventional clinical treatment options include drugs, surgery, rehabilitation, and preventive interventions that (1) improve patient health, (2) contribute to quality of life, and (3) boost longevity. Treatment options grounded in comparative research have efficacy
in controlled laboratory settings and are also effective
in clinical patient care where health care delivery, its receipt, and patient adherence vary widely.14
U.S. CER policies have been published recently by the Institute of Medicine (IOM) under the title, Knowing What Works in Health Care: A Roadmap for the Nation
Complementary work by the U.S. Agency for Healthcare Research and Quality (AHRQ) outlines comparative health care research priorities.16
These expressions of CER policies and priorities focus on conventional treatment options. However, they do not address the value of a skillful medical and health professions workforce and the importance of its education for the delivery of effective health care. We assert that human capital, embodied in competent physicians and other health care professionals, is an essential feature of health care delivery even though IOM policies and AHRQ research priorities are silent about the contribution of health professions education to health care delivery.
The purpose of medical education at all levels is to prepare physicians with the knowledge, skills, and features of professionalism needed to deliver quality patient care. Medical education research seeks to make the enterprise more effective, efficient, and economical. Short and long-run goals of research in medical education are to show that educational programs contribute to physician competence measured in the classroom, simulation laboratory, and patient care settings. Improved patient outcomes linked directly to educational events are the ultimate goal of medical education research and qualify this scholarship as translational science.17
This article reviews and evaluates evidence about the comparative effectiveness of SBME with DP versus traditional clinical education. The goal of the study is to perform a “head-to-head” comparison of these two educational methods toward the goal of clinical skill acquisition. This is a quantitative meta-analysis of SBME research that spans twenty years, from 1990 to 2010. The comparative review is selective and critical. We also believe it is exhaustive because the number of existing comparative studies is small.