All 3 groups significantly improved based on written posttest scores ( P < 0.0001 ) ; however , pretest to posttest improvement among the 3 training arms was not significantly different : low-fidelity = 42.3 ( 95 % CI , 35.7-48 .9 ) ; mid-fidelity = 41.3 ( 95 % CI , 34.7-47 .9 ) ; high-fidelity = 40.8 ( 95 % CI , 34.3-47 .5 ; P = 0.95 ) .