Systematic Review of Live Tissue Versus Simulation Education for Prehospital Trauma Providers

Background: Advanced simulation capabilities have provided medical educators novel approaches for learners. Simulation has successfully replaced many aspects of medical education that previously used animal live-tissue training (LTT) for physician education. However, prehospital trauma providers, such as combat medics, currently used LTT to prepare for patient care. This use of LTT has sparked a debate about the optimal educational modality for this unique learner population. At this time, there is no clear evidence-based recommendation available to recommend either LTT or simulation as a superior modality. Methods: The authors performed a systematic review of observational studies and randomized control trials (RCTs) to examine the use of LTT versus simulation in the trauma education of prehospital providers. The authors judged studies for inclusion and data abstraction independently and in duplicate, while also assessing quality and risk of bias. Since the literature demonstrated a heterogeneous background, no meta-analysis was performed. Results: 12 studies met inclusion criteria: seven RCTs, four prospective cohorts, one cross-sectional study. Two of seven RCTs were presented as abstracts only. Ten of 12 studies were performed in a military setting, whereas two occurred in a civilian setting. Four studies used swine, two used goats, one used swine and goats, one used canines, and four did not specify the animal type. The authors used the Cochrane Collaboration tool to assess RCTs and found a considerable risk of bias. They used the Newcastle-Ottawa score to assess prospective cohorts (mean score of 5.75 +/-.5, range 1-9), and the cross-sectional study (score 4, range 1-9). Conclusion: The existing literature provides limited, low-to-moderate quality outcome data. Evidence does not exist at this time to recommend either LTT or simulation as a superior educational modality for prehospital trauma care providers.