Deliberate practice and clinical competence of residents: A systematic review and meta-analysis of randomized controlled trials

Abstract

Abstract OBJECTIVE: To evaluate the effectiveness of deliberate practice (DP) in improving the clinical competence of residents and its superiority over traditional teaching methods through a meta-analysis of randomized controlled trials (RCTs). METHODS: A systematic search was conducted of PubMed, EMBASE, Cochrane Library, and Web of Science for relevant literature published through December 12, 2022. All RCTs reporting relationship between DP and clinical competence were included. Two independent reviewers screened according to inclusion and exclusion criteria, followed by quality evaluation, data extraction, and data analysis. We calculated the pooled mean difference (MD) and 95% confidence interval (CI) for residents’ clinical competencies under the DP intervention versus traditional teaching methods in each study and combined these values using standard meta-analysis methods. RESULTS: Ten RCTs were retrieved with 277 residents. A total of 182 residents were included in the checklist scale. Compared with traditional methods, DP significantly improved the checklist scores and enhanced residents’ clinical competency (MD = 4.44, 95% CI (1.72, 7.15), Z = 3.20, p = 0.001 < 0.05). Further, 66 residents were included in the objective structured assessment of technical skills global rating scale (OSATS GRS). The results showed that there was no significant difference in scores between the intervention group and the blank control group (MD = 1.34, 95% CI (-2.82, 5.51), Z = 0.63, p = 0.53 > 0.05), possibly due to small sample sizes. For other indicators and scales, DP had some effect on improving clinical competence. CONCLUSIONS: DP has a certain role in improving the clinical competence of residents. Due to the different scales used and the bias of loss to follow-up in the included studies, this finding still needs to be further confirmed by high-quality, multi-center, randomized, blinded, and controlled clinical studies. META REGISTRATION: Register name: Jiayin Li; Date of registration: 3, Mar 2023; ID: CRD42023403368