The Use of Human Simulation to Teach Acute Care Skills in a Cardiopulmonary Course: A Case Report

Abstract

BACKGROUND AND PURPOSEDespite its relatively recent application to physical therapist education, simulation as an educational tool is not a new concept. The history of simulation can be traced back to its use in hazardous and complex industries such as aviation.1 Thus it comes as no surprise that this teaching methodology soon found application in the training of health care professionals. An early application of simulation in training health care professionals was evident when life-size mannequins were added to cardiopulmonary resuscitation instruction over 30 years ago.2 Simulation technology has since advanced to include computerized, interactive features programmed to provide realistic patient responses and outcomes to care, now known as high-fidelity simulation (HFS).HFS has emerged as a significant learning aid in medical education. Issenberg et al3 completed a systematic review of 109 studies which found that HFS does facilitate learning in medical education under certain conditions. The conditions, ranked by frequency found in the review, include: (1) the presence of feedback during or after the experience, (2) an opportunity for repetitive practice, (3) integration of the simulation experiences into the professional curriculum, (4) a range of difficulty in skill levels available, (5) adaptability to multiple learning strategies, (6) representation of clinical variation, (7) a controlled environment, (8) individual active learning, (9) defined outcomes, and (10) the degree of realism the experience provides. Ranked first is the importance of feedback, which is often completed through debriefing following a simulation experience. Fanning and Gaba4 advocate for reflection and analysis as key aspects in experiential learning, such as with HFS. Through facilitation, students are encouraged to integrate their recent experience into their current body of knowledge.Looking specifically into nursing literature at the effect of HFS on student clinical confidence, Thomas and Mackey5 conducted a quasi-experimental study with 24 baccalaureate nursing students. Using a pretestposttest design, the researchers compared a control group who participated in a traditional clinical course with students who participated in an elective course that included HFS. Although the control group reported significantly higher levels of confidence on the pretest, the intervention group was found to have significantly higher levels of change on the posttest related to: (1) recognizing a change in condition, (2) performing an assessment for that condition, (3) identifying interventions for that condition, and (4) evaluating effectiveness of that intervention.To our knowledge, there are only 3 studies in the physical therapist education literature6'8 that document experiences and outcomes using simulation. Shoemaker and colleagues6 published their experiences with HFS with a focus on the clinical decision-making of students. In an attempt to increase the opportunities to apply knowledge and skills learned in cardiopulmonary coursework, the authors created a single simulation experience as a laboratory activity. Students were responsible for assessing the simulated patient both at rest and with mobilization to the edge of bed, while responding to equipment alarms throughout the scenario. No specific measure of student performance was utilized; however, informal feedback from the students regarding the experience was positive. Smith and colleagues7 more recently investigated the use of standardized patients versus simulation. Specifically, the authors set out to determine which teaching methodology best improves student confidence in the particular skill of electrocardiography recognition and interpretation. The results showed that students preferred simulation to standardized patients. The authors suggest that this preference may be related to the ability of HFS to provide more physiologically real responses. Most recently, Ohtake and colleagues8 used a pretest-posttest self-assessment of confidence in technical, behavioral, and cognitive skill performance and satisfaction after a single simulation scenario in the intensive care unit (ICU) setting. …