Cognitive simulation for the procedural skills learning of medical students: A systematic review

Background Cognitive simulation, where individuals deliberately rehearse procedural tasks using the mind without physical action, has been demonstrated to improve technical skills across various disciplines such as aviation and elite sport. These practices however are used variably in medical education. Therefore, the efficacy and value of cognitive simulation in improving procedural skills of medical students remains unknown. Methods Medline, Embase, CINAHL, Emcare and the World Health Organisation (WHO) International Clinical Trials Registry Platform databases were searched for articles that explored cognitive simulation approaches for the procedural skills development of medical students. Outcomes of interest included improvements in technical skill and proficiency, non-technical skills such as confidence and stress management and intervention-related outcomes such as practicality and cost. Results 14 studies reporting results from randomised-controlled trials were included in this systematic review. Overall, studies demonstrated mixed results in technical and non-technical skill development across a variety of procedures. However, cognitive simulation offers a practical and cost-effective learning tool that is adaptable to a variety of procedural skills programs in contemporary medical curriculum. Conclusion This systematic review highlights the emerging potential for cognitive simulation to be adapted and integrated into standard procedural skills learning programs for medical students. However, the current evidence lacks robust insights into the efficacy of these programs due to heterogeneity of study design, specifics of the cognitive simulation program and approaches to assessment. Further research is necessary to explore the efficacy of standardised cognitive simulation programs to validate these findings.