Systematic Review of Assessments That Evaluate Clinical Decision Making, Clinical Reasoning, and Critical Thinking Changes After Simulation Participation

Abstract

Background and Purpose. Increasingly, simulation experiences are augmenting and replacing portions of classroom and clinical education time. The purposes of this systematic review were to (1) systematically review the literature to determine whether simulated experiences impact the development of clinical decision making (CDM), clinical reasoning (CR), or critical thinking (CT) in students in health professional educational programs, (2) assess the quality of evidence for the effectiveness of simulation in developing CDM, CR, or CT in health professions students, (3) compare the effectiveness of simulated experiences to usual teaching methods in developing CDM, CR, and CT in health profession education students, and (4) identify and characterize assessment tools used to measure CDM, CR, and CT in the selected studies. Methods. The study design was a systematic review. PubMed, Ovid, Cochrane Database of Systematic Reviews, Google Scholar, EdITLib, and ERIC were searched for articles published in English from January 2000 until March 2017. Thirty-one articles met the inclusion criteria: 1 mixed methods study, 3 qualitative studies, and 27 quantitative studies. Articles were assessed using the Mixed Methods Appraisal Tool for the mixed methods study, the McMaster University Critical Review Form—Qualitative Studies for qualitative studies, and the Evaluation Guidelines for Rating the Quality of an Intervention Study. Results. The results demonstrate that simulation improves CDM, CT, or CR. The outcomes from the studies revealed that more repetitions in a simulated environment produced greater changes. Six outcome measures were identified, which assessed the desired constructs. Discussion and Conclusion. Future research investigating each tool across health care disciplines is needed. The optimal number of simulated encounters needed for improvement in decision making, thinking, and reasoning in physical therapy will be beneficial.