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A Systematic Review and Meta-analysis on the Impact of Proficiency-based Progression Simulation Training on Performance Outcomes
Open accessAbstract
Objective: To analyze all published prospective, randomized, and blinded clinical studies on the proficiency-based progression (PBP) training using objective performance metrics. Background: The benefit of PBP methodology to learning clinical skills in comparison to conventional training is not settled. Methods: Search of PubMed, Cochrane library's Central, EMBASE, MEDLINE, and Scopus databases, from inception to 1st March 2020. Two independent reviewers extracted the data. The Medical Education Research Study Quality Instrument (MERSQI) was used to assess the methodological quality of included studies. Results were pooled using biased corrected standardized mean difference and ratio-of-means. Summary effects were evaluated using a series of fixed and random effects models. The primary outcome was the number of procedural errors performed comparing PBP and non-PBP-based training pathways. Secondary outcomes were the number of procedural steps completed and the time to complete the task/procedure. Results: From the initial pool of 468 studies, 12 randomized clinical studies with a total of 239 participants were included in the analysis. In comparison to the non-PBP training, ratio-of-means results showed that PBP training reduced the number of performance errors by 60% ( P < 0.001) and procedural time by 15% ( P = 0.003) and increased the number of steps performed by 47% ( P < 0.001). Conclusions and Relevance: Our systematic review and meta-analysis confirms that PBP training in comparison to conventional or quality assured training improved trainees’ performances, by decreasing procedural errors and procedural time, while increasing the number of correct steps taken when compared to standard simulation-based training.
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Immediate feedback during simulations is a crucial factor in improvements, enabling learners to correct errors promptly and avoid the formation of bad habits.
“Immediate feedback during simulations was identified as a crucial factor in these improvements, enabling learners to correct errors promptly and avoid the formation of bad habits.”
From Formative assessment and feedback in medical education: A practical guide: AMEE Guide No. 189 (2026) · cites this paper as [104]
Simulation-based training significantly enhances clinical competence compared to traditional instructional methods.
“A meta-analysis by Mazzone et al. [104] demonstrated that simulation-based training significantly enhances clinical competence compared to traditional instructional methods.”
From Formative assessment and feedback in medical education: A practical guide: AMEE Guide No. 189 (2026) · cites this paper as [104]
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Formative assessment and feedback in medical education: A practical guide: AMEE Guide No. 189
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Metadata
- Authors
- Mazzone, E., Puliatti, S., Amato, M., Bunting, B., Rocco, B., Montorsi, F., Mottrie, A., & Gallagher, A. G.
- Affiliations
- Vita-Salute San Raffaele University (IT)
- University of Modena and Reggio Emilia (IT)
- University of Ulster (GB)
- Onze Lieve Vrouwziekenhuis Hospital (BE)
- Corresponding author
- Mazzone, Elio
- Montorsi, Francesco
- ORCID
- Venue
- Annals of Surgery
- Published
- 2020-12-22
- Volume
- 274
- Issue
- 2
- Pages
- 281-289
- ISSN
- 0003-4932 (ISSN-L)
- 1528-1140
- OpenAlex
- W3115401297
- Cited by
- 148
- References
- 72
- Citations by year
- 2026: 24 · 2025: 42 · 2024: 25 · 2023: 18 · 2022: 33 · 2021: 6
- FWCI
- 3.23
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Annals of Surgery (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by-nc-nd)
- PubliCatt (Università Cattolica del Sacro Cuore) (submittedVersion, other-oa)
- Ulster University Research Portal (Ulster University) (submittedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Surgery › Surgical Simulation and Training
- Social Sciences › Education › Innovations in Medical Education
- Social Sciences › Education › Simulation-Based Education in Healthcare
- Keywords
- proficiency-based progression, simulation-based training, procedural training, procedural errors, procedure time, skill acquisition, surgical training
- MeSH terms
- Simulation Training, Clinical Competence, Education, Medical, Feedback, Humans, General Surgery
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