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Educational Interventions to Enhance Situation Awareness

A Systematic Review and Meta-analysis

Walshe, Nuala C., RN, MTLHE; Crowley, Clare M., RN, MSc; O'Brien, Sinéad, RN, MSc; Browne, John P., PhD; Hegarty, Josephine M., RN, PhD

doi: 10.1097/SIH.0000000000000376
Review Article: PDF Only

Summary Statement We conducted a systematic review to evaluate the comparative effectiveness of educational interventions on health care professionals' situation awareness (SA). We searched MEDLINE, CINAHL, HW Wilson, ERIC, Scopus, EMBASE, PsycINFO, psycARTICLES, Psychology and Behavioural Science Collection and the Cochrane library. Articles that reported a targeted SA intervention or a broader intervention incorporating SA, and an objective outcome measure of SA were included. Thirty-nine articles were eligible for inclusion, of these 4 reported targeted SA interventions. Simulation-based education (SBE) was the most prevalent educational modality (31 articles). Meta-analysis of trial designs (19 articles) yielded a pooled moderate effect size of 0.61 (95% confidence interval = 0.17 to 1.06, P = 0.007, I2 = 42%) in favor of SBE as compared with other modalities and a nonsignificant moderate effect in favor of additional nontechnical skills training (effect size = 0.54, 95% confidence interval = 0.18 to 1.26, P = 0.14, I2 = 63%). Though constrained by the number of articles eligible for inclusion, our results suggest that in comparison with other modalities, SBE yields better SA outcomes.

From the Clinical Skills Simulation Resource Centre (N.C.W., C.M.C., SO'B), School of Nursing and Midwifery (J.M.H.); and School of Public Health (J.P.B.), University College Cork, Cork, Ireland.

Reprints: Nuala Walshe, RN, MTLHE, School of Nursing and Midwifery, Brookfield Health Science Complex, University College Cork, Cork T12 K8AF, Ireland (e-mail:

The authors declare no conflict of interest.

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© 2019 Society for Simulation in Healthcare