Más allá del realismo tecnológico: simulación clínica de alta fidelidad para la formación por competencias en estudiantes de Medicina. Revisión sistemática.
Resumo
Introducción: La simulación clínica de alta fidelidad se usa para adiestrar habilidades complejas antes de interactuar con pacientes autónomamente, aunque aún subsiste la duda acerca del valor extra que el realismo tecnológico tiene sobre diseños pedagógicos más económicos. Objetivo: Determinar la eficacia de la simulación clínica de alta fidelidad en el desarrollo de habilidades en alumnos de Medicina y reconocer las condiciones pedagógicas que se asocian con un mejor rendimiento. Métodos: Análisis sistemático de acuerdo a PRISMA 2020. Se investigaron investigaciones que se hayan publicado en PubMed/MEDLINE, Scopus, Web of Science, ERIC, CINAHL, SciELO y LILACS desde enero de 2010 hasta el 2 de agosto de 2026. Se incorporaron investigaciones cuasiexperimentales y experimentales con alumnos de la carrera de Medicina. La síntesis se llevó a cabo de manera narrativa, utilizando SWiM. Se utilizó RoB 2 o ROBINS-I para evaluar el riesgo de sesgo. Resultados: Se encontraron 300 registros y se incorporaron 30 estudios que contenían un total de 4,216 alumnos. La alta fidelidad mostró beneficios constantes en el trabajo colaborativo, el razonamiento clínico, la identificación del deterioro y la eficacia en los procedimientos, especialmente cuando involucró la práctica intencionada, las observaciones y el debriefing. Pero en la comparación directa con estrategias activas o de baja fidelidad, la superioridad era variable. La retención fue evaluada por diez estudios, y los resultados clínicos y la transferencia a pacientes reales fueron excelentes. Un exceso de confianza y el estrés eran consecuencias que podían ser dañinas. Conclusiones: En cuanto a habilidades individuales, la simulación de alta fidelidad es más beneficiosa para habilidades integradas y dinámicas. La eficacia depende sobre todo de la coherencia entre los objetivos, el debriefing, la evaluación, la dificultad y la práctica. Se recomienda elegir la fidelidad mínima que se requiere para la competencia, y verificar la transferencia y retención.
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