The effectiveness and perceived value of feedback used in cardiac arrest simulation education: a mixed-method systematic review

Objectives: This review evaluated the effectiveness and perceived value of feedback methods in cardiac arrest simulation-based education for healthcare, nursing, medical students and professionals. Methods: A mixed-method systematic review was conducted, incorporating quantitative, qualitative, and mixed-method studies on feedback provided before, during, or after cardiac arrest simulations. Studies focusing on non-cardiac arrest simulations, not focusing on feedback outcomes, or reporting on real cardiac arrest experiences were excluded. A convergent integrated approach to data synthesis was used, with quantitative findings "qualitised" and a qualitative content analysis providing a narrative synthesis. Results: Out of 3455 articles screened, 203 were assessed for eligibility, and 160 were included (154 quantitative, 3 qualitative, 3 mixed method). Three themes emerged regarding feedback effectiveness and value in cardiac arrest simulation education. All feedback, whether human or device-based, improves performance. However, objective, device-based feedback is preferred. Current literature primarily focuses on technical skills measured by quantitative methods, with limited research on non-technical aspects and qualitative explorations of participant experiences. Conclusion: Feedback in cardiac arrest simulation education is just as important as the simulation itself and should align with the learner’s educational objectives. There is a notable underreporting of integral non-technical aspects of cardiac arrest management and the use of appropriate use of qualitative methodologies to investigate them. To gain the necessary insights into both the technical and non-technical skill acquisition recommended in resuscitation guidelines, future research needs to integrate quantitative and qualitative approaches.