Simulated Patients in Physical Therapy Education: Systematic Review and Meta-Analysis

Background Traditional models of physical therapy clinical education are experiencing unprecedented pressures. Simulation-based education with simulated (standardized) patients (SPs) is one alternative that has significant potential value, and implementation is increasing globally. However, no review evaluating the effects of SPs on professional (entry-level) physical therapy education is available. Purpose The purpose of this study was to synthesize and critically appraise the findings of empirical studies evaluating the contribution of SPs to entry-level physical therapy education, compared with no SP interaction or an alternative education strategy, on any outcome relevant to learning. Data Sources A systematic search was conducted of Ovid MEDLINE, PubMed, AMED, ERIC, and CINAHL Plus databases and reference lists of included articles, relevant reviews, and gray literature up to May 2015. Study Selection Articles reporting quantitative or qualitative data evaluating the contribution of SPs to entry-level physical therapy education were included. Data Extraction Two reviewers independently extracted study characteristics, intervention details, and quantitative and qualitative evaluation data from the 14 articles that met the eligibility criteria. Data Synthesis Pooled random-effects meta-analysis indicated that replacing up to 25% of authentic patient–based physical therapist practice with SP-based education results in comparable competency (mean difference=1.55/100; 95% confidence interval=−1.08, 4.18; P=.25). Thematic analysis of qualitative data indicated that students value learning with SPs. Limitations Assumptions were made to enable pooling of data, and the search strategy was limited to English. Conclusion Simulated patients appear to have an effect comparable to that of alternative educational strategies on development of physical therapy clinical practice competencies and serve a valuable role in entry-level physical therapy education. However, available research lacks the rigor required for confidence in findings. Given the potential advantages for students, high-quality studies that include an economic analysis should be conducted.