Table 2

Summary of the articles about the use of simulations in hospital pharmaceutical technologies continuing education

Article information*Article profileOutcomeResults before and after simulationOther key information
Loboda et al21
J Oncol Pharm Pract (2017; France)
Assessing pharmaceutical assistants’ (PA) knowledge level in chemotherapy preparation according to their capacity to detect errors in preparation simulations
Participants: 15 PA
Participation: NM
Simulated training room
Equipment: Laminar flow hood
Topic: Chemo
Average score in finding errors (score/20)Before: NA
After: 59% (35–80%)
Positive staff feedback
Negative comments: discrepancy between role-playing and reality +lack of feedback
Study time: 1 year
Simulation time: 20 min
Kirkpatrick level: 1
Detection rate of major errors (ME)Before: NA
After: Satisfactory for 2 out of 3 major errors
Cotteret et al22
J Oncol Pharm Pract (2019; France)
Investigating pharmacy staff’s backgrounds and knowledge by replicating a cytotoxic preparation unit and 14 situations involving errors
Participants: 20 pharmacists and pharmacy technicians (PT)
Participation: Voluntary
Simulated training room
Equipment: Isolator
Topic: Chemo
Rate of correct answers (score/14)Before: NA
After: 58% (39–77%)
Satisfaction level: 8.7±1.0 out of 10
All respondents were satisfied/very satisfied: workshop considered relevant and improving expertise
Study time: 1 month
Kirkpatrick level: 1
Expert group: 2 senior hospital pharmacists and a pharmacy student
Which professional identifies which type of error?Errors in dispensing steps: more were identified by pharmacists
Errors in chemical contamination: more were identified by PT
Sarfati et al23
J Clin Pharm Ther (2014; France)
Assessing the effectiveness of a simulation-based learning programme for preventing errors in the preparation of injectable antineoplastic agents
Participants: 12 pharmacy professionals
Participation: NM
Real-life room in daily use
Equipment: NM
Topic: Chemo
Detection of errors (score/25)First simulation: 52%
Second simulation: 80% (p=0.04)
1 year later: 84%
1 year +3 months later: 80%24
Study time: 5 months
Expert group: 5 senior hospital pharmacists, experts in oncology
Impact: awareness of risks during the preparation of injectable cancer drugs
Kirkpatrick level: 2
Berthod et al25
J Oncol Pharm Pract (2019; Switzerland)
Evaluating improvements in knowledge about GMP and assessing participants’ increase in certainty (personal confidence) and their appreciation of the programme
Participants: 72 professionals
Participation: Voluntary
Training room
Equipment: Vertical hood
Topic: Chemo
Correct answersFirst questionnaire: 57%
Third questionnaire: 80% (p<0.001)
81%: experience would improve daily practice
17%: not relevant for daily work
27%: a few questions were ambiguous
Study design and setting: many weeks
Expert group: 4 senior pharmacists, 1 PT Kirkpatrick level: 1, 2
Weighted scoreBefore: 229/460
After: 322/460
Degree of certainty (personal confidence)Before: 3.9/6
After: 5.1/6 (p<0.001)
Denami32
Pharm Technol Hosp Pharm (2016; France)
Design and develop a cleanroom simulator, LabQuest (LQ), and show that professionals trained with LQ perform better than those trained using traditional methods (videos, QCM, PPT)
Participants: 45 professionals
Participation: NM
Virtual room
Equipment: Aseptic filling machine
Topic: As. Tech
Accomplishing gestures and proceduresTraditional: 57.5%
LabQuest: 87.6%
Expert group: NM
Kirkpatrick level: 2
Detection of relevant errorsTraditional: 52.2%
LabQuest: 89.3%
Harrison et al35
Am J Health Syst Pharm (1996; USA)
Provide direct observation and feedback to assess proper techniques for handling cytotoxic agents using a fluorescein test (0.5 mg/mL)
Participants: 13 professionals
Participation: NM
Real-life room in daily use
Equipment: Vertical hood
Topic: As. Tech
Average scoreBefore: 61±11%
After 3 months: 84±14% (p=0.006)
Expert group: NM
Timing: 26 hours to conduct the study
Kirkpatrick level: 2
Positive contaminationBefore: 92%
After: 23% (p<0.008)
Written test scoresBefore: 89±8.6%
After: 85±5.9% (NS)
Favier et al36
J Pharm Clin (2003; France)
Prove the benefits of using a fluorescein test to evaluate how procedures are followed and raise awareness about causes of environmental contamination by cytotoxic drugs
Participants: 9 professionals
Participation: NM
Real-life room in daily use
Equipment: Hood
Topic: As. Tech
Average scoreBefore: 75% (E1)
After: 88% (E4)
Expert group: NM
Timing: significant investment in time for the pharmacist
Kirkpatrick level: 2
Sadeghipour et al40
J Oncol Pharm Pract (2012; Switzerland)
Using quinine as a tracer to evaluate contamination levels by simulating the preparation of injectable cytotoxic drugs and designing a procedure to check pharmacy technicians’ ability to work in a clean manner
Participants: 29 professionals
Participation: NM
Real-life room in daily use
Equipment: Isolator
Topic: As. Tech
Mean accumulated quantities of contaminationBefore: NA
After: 6.2 µL (0.6–23.8) and >10 spots (any pharmacy technician with a contamination level superior to mean level was a candidate for a new training programme)
Expert group: NM
Timing: NM
Kirkpatrick level: none
Sigward et al42
Am J Health Syst Pharm (2012; France)
Improving media-fill tests results by introducing bacterial contamination to the upper surfaces of vial stoppers for the validation of pharmacy technicians
Participants: 10 professionals
Participation: NM
Training room
Equipment: Workbench
Topic: As. Tech
Contamination rate of 300 preparationsBefore: NA
After: 2.3%
Expert group: NM
Timing: NM
Kirkpatrick level: none
Savry et al43
Am J Health Syst Pharm (2014; France)
Validate manufacturing processes and pharmacy technicians’ performances using MFT methods and develop an isolator blackout emergency procedure
Participants: 12 professionals
Participation: NM
Room: Real-life room in daily use
Equipment: Isolator
Topic: As. Tech
Validation of production equipmentBefore: NA
After: NM
Expert group: NM
Timing: NM
Kirkpatrick level: none
Validation of isolator blackout procedureBefore: NA
After: NM
Validation of manufacturing processesBefore: NA
After: NM
  • *Article information: author, journal, year, country, type of education (continuing education or initial education), study’s objective

  • As. Tech, aseptic technique; Chemo, chemotherapy; GMP, good manufacturing practices; MFT, media-fill test; NA, not applicable; NE, not evaluated; NM, not mentioned; NS, non-significant; PPT, PowerPoint; QCM, multiple choice question.