Effectiveness and implementation of simulation training in obstetric and gynecological surgery education: systematic review and meta-analysis

This systematic review and meta-analysis evaluated the effectiveness and implementation of simulation-based training in obstetrics and gynecology surgical education. Following PRISMA 2020 guidelines, multiple databases were searched through December 2024, ultimately including 30 randomized controlled trials involving 1,247 participants. Random-effects meta-analysis was conducted to assess technical skills, operative time, learner confidence, and patient outcomes. The analysis revealed that simulation training significantly improved surgical skill scores compared to traditional teaching (SMD = 0.82, 95% CI: 0.64-1.00, <i>P</i> < 0.001), reduced operative time (SMD = -0.62, 95% CI: -0.81 to -0.43, <i>P</i> < 0.001), and enhanced learner confidence (SMD = 0.71, 95% CI: 0.49-0.93, <i>P</i> < 0.001). Both high-fidelity virtual reality simulators and low-fidelity box trainers demonstrated comparable effectiveness in skill enhancement (<i>P</i> = 0.28). Proficiency-based training exhibited lower heterogeneity (<i>I</i> ² = 32.4%) compared to fixed-repetition training (<i>I</i> ² = 58.7%). However, patient-related outcomes were severely underreported, with only 3 studies (10.0%) documenting complications or blood loss. Implementation analysis identified high equipment costs, lack of protected training time, and insufficient faculty expertise as primary barriers. This study provides robust evidence supporting simulation training integration into residency curricula while highlighting critical gaps in patient outcome assessment and implementation research requiring future investigation.