An overview of realist evaluation for simulation-based education

Alastair C Graham,Sean Mcaleer

doi:10.1186/s41077-018-0073-6

Abstract

This article describes the key features of realist (realistic) evaluation and illustrates their application using, as an example, a simulation-based course for final year medical students. The use of simulation-based education (SBE) is increasing and so too is the evidence supporting its value as a powerful technique which can lead to substantial educational benefits. Accompanying these changes is a call for research into its use to be more theory-driven and to investigate both ‘Did it work?’ and as importantly ‘Why did it work (or not)?’ An evaluation methodology that is capable of answering both questions is realist evaluation.Realist evaluation is an emerging methodology that is suited to evaluating complex interventions such as SBE. The realist philosophy positions itself between positivist and constructivist paradigms and seeks to answer the question ‘What works for whom, in what circumstances and why?’ In seeking to answer this question, realist evaluation sets out to identify three fundamental components of an intervention, namely context, mechanism and outcome. Educational programmes work (successful outcomes) when theory-driven interventions (mechanisms) are applied to groups under appropriate conditions (context). Realist research uses a mixed methods (qualitative and quantitative) approach to gathering data in order to test the proposed context-mechanism-outcome (CMO) configurations of the intervention under investigation.Realist evaluation offers a valuable methodology for researchers investigating interventions utilising simulation-based education. By investigating and understanding the context, mechanisms and outcomes of SBE interventions, realist evaluation can provide the deeper level of understanding being called for.

Highlights

The use of simulation devices in medical education is centuries old and includes anatomical models in the teaching of anatomy, threshold innovations such as Åsmund Lærdal’s Resusci Anne, modern high-fidelity manikins, simulated patients and virtual reality [1]
Examining the features and use of simulation technology, the Best Evidence Medical Education (BEME) review of the literature from 1969 to 2003 [3], the authors concluded that the quality of published research for this period was generally weak
The report recommends that simulation ‘needs to be more fully integrated into the health service’ [6]. This theme was further developed by Khan et al [7] who built an argument for increasing expansion of simulation-based education (SBE) driven by patient safety and improvements in healthcare. They concluded that the continuing advances in simulation technology and an in-depth understanding of educational principles and practical applications of SBE to outcome-based programmes will help bridge the gap between the classroom and clinical environment

Summary

Introduction

The use of simulation devices in medical education is centuries old and includes anatomical models in the teaching of anatomy, threshold innovations such as Åsmund Lærdal’s Resusci Anne, modern high-fidelity manikins, simulated patients and virtual reality [1]. They concluded that the continuing advances in simulation technology and an in-depth understanding of educational principles and practical applications of SBE to outcome-based programmes will help bridge the gap between the classroom and clinical environment.

Results

Conclusion