Impact Of Simulation Training Research Articles

Impact of Simulation Training on Diagnostic Arthroscopy Performance: A Randomized Controlled Trial

PurposeTo determine the impact of training on a virtual reality arthroscopy simulator on both simulator and cadaveric performance in novice trainees.MethodsA randomized controlled trial of 28 participants without prior arthroscopic experience was conducted. All participants received a demonstration of how to use the ArthroVision Virtual Reality Simulator and were then randomized to receive either no training (control group, n = 14) or a fixed protocol of simulation training (n = 14). All participants took a pretest on the simulator, completing 9 tasks ranging from camera-steadying tasks to probing structures. The training group then trained on the simulator (1 time per week for 3 weeks). At week 4, all participants completed a 2-part post-test, including (1) performing all tasks on the simulator and (2) performing a diagnostic arthroscopy on a cadaveric knee and shoulder. An independent, blinded observer assessed the performance on diagnostic arthroscopy using the Arthroscopic Surgical Skill Evaluation Tool scale. To compare differences between non–normally distributed groups, the Mann-Whitney U test was used. An independent-samples t test was used for normally distributed groups. The Friedman test with pair-wise comparisons using Bonferroni correction was used to compare scores within groups at multiple time points. Bonferroni adjustment was applied as a multiplier to the P value; thus, the α level remained consistent. Significance was defined as P < .05.ResultsIn both groups, all tasks except task 5 (in which completion time was relatively fixed) showed a significant degree of correlation between task completion time and other task-specific metrics. A significant difference between the trained and control groups was found for post-test task completion time scores for all tasks. Qualitative analysis of box plots showed minimal change after 3 trials for most tasks in the training group. There was no statistical correlation between the performance on diagnostic arthroscopy on either the knee or shoulder and simulation training, with no difference in Arthroscopic Surgical Skill Evaluation Tool scores in the training group compared with controls.ConclusionsOur study suggests that an early ceiling effect is shown on the evaluated arthroscopic simulator model and that additional training past the point of proficiency on modern arthroscopic simulator models does not provide additional transferable benefits on a cadaveric model.Level of EvidenceLevel I, randomized controlled trial.

Impact of Simulation Training for Obstetrics-gynecology Residents.

Impact of Simulation Training for Obstetrics-gynecology Residents.

Simulation-enhanced nurse mentoring to improve preeclampsia and eclampsia care: an education intervention study in Bihar, India

BackgroundInadequately treated, preeclampsia and eclampsia (PE/E) may rapidly lead to severe complications in both mothers and neonates, and are estimated to cause 60,000 global maternal deaths annually. Simulation-based training on obstetric and neonatal emergency management has demonstrated promising results in low- and middle-income countries. However, the impact of simulation training on use of evidence-based practices for PE/E diagnosis and management in low-resource settings remains unknown.MethodsThis study was based on a statewide, high fidelity in-situ simulation training program developed by PRONTO International and implemented in collaboration with CARE India on PE/E management in Bihar, India. Using a mixed methods approach, we evaluated changes over time in nurse mentees’ use of evidence-based practices during simulated births at primary health clinics. We compared the proportion and efficiency of evidence-based practices completed during nurse mentees’ first and last participation in simulated PE/E cases. Twelve semi-structured interviews with nurse mentors explored barriers and enablers to high quality PE/E care in Bihar.ResultsA total of 39 matched first and last simulation videos, paired by facility, were analyzed. Videos occurred a median of 62 days apart and included 94 nurses from 33 primary health centers. Results showed significant increases in the median number of ‘key history questions asked,’ (1.0 to 2.0, p = 0.03) and ‘key management steps completed,’ (2.0 to 3.0, p = 0.03). The time from BP measured to magnesium sulfate given trended downwards by 3.2 min, though not significantly (p = 0.06). Key barriers to high quality PE/E care included knowledge gaps, resource shortages, staff hierarchy between physicians and nurses, and poor relationships with patients. Enablers included case-based and simulation learning, promotion of teamwork and communication, and effective leadership.ConclusionSimulation training improved the use of evidence-based practices in PE/E simulated cases and has the potential to increase nurse competency in diagnosing and managing complex maternal complications such as PE/E. However, knowledge gaps, resource limitations, and interpersonal barriers must be addressed in order to improve care. Teamwork, communication, and leadership are key mechanisms to facilitate high quality PE/E care in Bihar.

SIMULATIOM BASED EDUCATION AS TOOL IN EMERGENCY MEDICINE: A SYSTEMATIC REVIEW

INTRODUCTION: Realistic simulation is increasingly present in academic curricula. The traditional method of teaching is being gradually replaced by new methodological approaches, which reliably reproduce real situations and produce technical knowledge and skills in medical students in the medical emergency.Realistic simulation is increasingly present in the academic curriculum. The traditional method of teaching is being gradually replaced by new methodological approaches, which reliably reproduce real situations and produce technical knowledge and skills in medical students in the medical emergency. The aim of this study was to carry out a systematic review of articles on realistic simulation as an educational tool in emergency medicine. A systematic review of articles on realistic simulation as an educational tool in emergency medicine, published in the corresponding period from January 1th, 2014 to October 28, 2018, was carried out in the SCOPUS database. The keywords were "simulation training", "medical students" and "emergency medicine". The research strategy resulted in 124 references. After the search for the title and summary of the citations considered for eligibility based on the inclusion criteria of the study, 106 articles were excluded, and 18 articles were retrieved and included in the final sample. The studies were distributed in 5 categories to better systematic review of the organizational quality, they are: Realistic simulation associated with the ultrasonography in the emergency; Realistic simulation and electronic devices; The effectiveness of realistic simulation in resource optimization; Impact of simulated training on student confidence; Realistic simulation as a tool in the development of skills and knowledge. This study presents the main aspects of realistic simulation as an educational tool in emergency medicine. It can be concluded that this new teaching approach has several benefits for students to learn, such as: stimulating students in the learning process, retaining technical skills in procedures, providing a safe environment for users to repeat optimization of time and financial resources.Keywords: realistic simulation, emergency medicine, educational, systematic review

Impact of simulation training on performance and outcomes of endobronchial ultrasound-guided transbronchial needle aspiration performed by trainees in a tertiary academic hospital.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has a high diagnostic yield and low complication rate. Whilst it has been included in international guidelines for the diagnosis and staging of lung cancer, current results are mostly based on EBUS experts performing EBUS-TBNA in centres of excellence. The impact of simulation training on diagnostic yield, complications, scope damage and repair cost in a real-world teaching hospital is unclear. A review of our hospital EBUS-TBNA registry from August 2008 to December 2016 was performed. A positive diagnosis was defined as a confirmed histological or microbiological diagnosis based on EBUS sampling. Complications were classified as major or minor according to the British Thoracic Society guidelines. In addition, we assessed the cost of repairs for scope damage before and after simulation training was implemented. Using CUSUM analysis, the learning curves of individual trainees and the institution were plotted. There were 608 EBUS-TBNA procedures included in the study. The number of procedures performed by trainees who underwent conventional training was 331 and those who underwent simulation training performed 277 procedures. Diagnostic yield for trainees without simulation training was 88.2% vs. 84.5% for trainees with simulation training (P=0.179). There was no statistical difference in the diagnostic yield between the groups of trainees (OR: 0.781, 95% CI: 0.418-1.460, P=0.438) after adjusting for risk factors. There was an increase in overall complications from 13.6% to 16.6% (OR: 2.247, 95% CI: 1.297-3.891, P=0.004) after introduction of the simulation training, but a trend to decrease in major complications 3.6% to 0.7% (P=0.112). The cost for scope repairs for the trainees without simulation training was SGD 413.88 per procedure vs. SGD 182.79 per procedure for the trainees with simulation training, with the mean difference being SGD 231.09 per procedure (95% CI: 178.40-640.60, P=0.268). CUSUM analysis showed an increasing learning curve for the trainees with simulation training after an initial competency period. There was no statistical difference in diagnostic yield from EBUS-TBNA and cost of scope damage after simulation training was introduced into our training program. Interestingly, there was an increase in minor complications. CUSUM analysis can provide additional information on institutional learning curves. The value of simulation training in EBUS-TBNA remains uncertain.

Interprofessional simulation training for community mental health teams: Findings from a mixed methods study

ABSTRACT Community mental health teams (CMHTs) in England face mounting service pressures due to an increased focus on out-of-hospital care. Interprofessional working is essential to providing good mental healthcare in community settings. Simulation training is underused in mental health, despite strong support for its improvement of clinical skills, confidence, teamwork, and interprofessional collaboration in other healthcare settings. This study aims to evaluate the impact of simulation training on community mental health professionals. An interprofessional simulation training course on assessment and team working skills for community mental health professionals was developed and delivered at a time of service reorganisation in South London services, including changes to job roles and responsibilities. In total, 57 course participants completed a survey that measured perceptions of knowledge and confidence, as well as a general view of the course. Eight participants took part in further semi-structured interviews 2–3 months after the course to provide perceptions about this experience’s subsequent impact. There were statistically significant increases in knowledge and confidence scores with large effect sizes. Thematic analyses of open-text survey and interview data identified emergent themes of interprofessional understanding; attitudes in clinical practice; staff well-being; the value of reflection; opportunity for feedback; and fidelity to clinical practice. Simulation training can improve confidence and knowledge in core skills and team working for CMHTs. Participants reported benefits to key areas of community mental healthcare, such as interprofessional collaboration, reflective practice, and staff well-being. Findings represented individual and team learning, as well as subsequent changes to clinical practice, and were related back to the interactive and reflective nature of the simulation. Implications are highlighted concerning the use of interprofessional simulation training in mental health, particularly relating to staff well-being, attitudes, and interprofessional working.

Impact of simulation training on technical learning of novice nurses in emergency and critical care

Impact of simulation training on technical learning of novice nurses in emergency and critical care

Impact of simulation training on Jordanian nurses' performance of basic life support skills: A pilot study

Providing efficient basic life support (BLS) training is crucial for practicing nurses who provide direct patient care. Nevertheless, data addressing the impact of BLS courses on the skills and performance of Jordanian nurses are scarce. This study aimed to assess the effectiveness of a BLS simulation training on Jordanian nurses' skill improvement in cardiopulmonary resuscitation. A prospective quasi-experimental, single group pretest-posttest design was used to study the effect of BLS simulation; using a 9-item checklist; on the spot training; American Heart Association, on a group of Jordanian nurses. A pre-test was conducted following a CPR scenario to test the skills using 9-item checklist extrapolated from the American Heart Association guidelines. After debriefing, an interactive on spot training was provided. Later, participants undertook an unscheduled post-test after four weeks that included the same nine items. Thirty registered nurses with a mean clinical experience of 6.1years participated in the study. Comparing pre-test (M=4.6, SD=2.9, range=0 to 9) with post-test results (M=7.5, SD=1.7, range=4 to 9) showed an overall improvement in skills and BLS scores after the simulation training program (t=7.4, df=29, p<0.0001). BLS simulation training sessions are associated with significant improvement in skills and performance among Jordanian nurses. A refreshment BLS training session for nurses is highly recommended to guarantee nurses' preparedness in actual CPR scenarios.

Impact of simulation training on self-efficacy of outpatient health care providers to use electronic health records

ObjectivesTo examine whether simulation training enhanced self-efficacy of physicians and nurses who work in the outpatient setting to use electronic medical records, and whether the training changed their perceptions about the importance of electronic medical records (EMRs) in helping patients and improving patients’ safety. MethodsTwo-hundred and ninety-three physicians and 94 nurses participated in the study. Participants first attended two computer classroom training sessions on how to use EMRs. Subsequently, the participants attended simulation training and practiced application of EMRs while encountering standardized patients. They answered questionnaires on a seven-point Likert-type scale prior to and immediately after simulation training. The questionnaires assessed their perceptions about the importance of EMRs in helping patients and improving patients’ safety and their confidence and preparedness level to use EMRs. ResultsThe overall self-efficacy of physicians and nurses to use EMRs increased after simulation training as compared to before simulation training. The physicians’ and nurses’ ratings about importance of EMRs to help patients’ and improve patients’ safety after simulation training were relatively unchanged compared to the ratings before simulation training. Additionally, participants described simulation training as exceptional, because it was an interactive learning opportunity to use EMRs within a simulated clinical setting with a simulated patient. ConclusionsSimulation training in the current study enhanced physicians’ and nurses’ level of self-confidence and preparedness to use EMRs. To train health care providers how to use EMRs, simulation training should be considered as an interactive and effective method of teaching prior to implementation of EMRs in medical institutions.

Impact of Simulator Training on General Laparoscopic and Gynecologic Skills: A Systematic Review

Impact of Simulator Training on General Laparoscopic and Gynecologic Skills: A Systematic Review

400: Impact of simulation training in improving the visual estimation of blood loss

400: Impact of simulation training in improving the visual estimation of blood loss

Impact of Simulation Training on Time to Initiation of Cardiopulmonary Resuscitation for First-Year Pediatrics Residents

Pediatrics residents have few opportunities to perform cardiopulmonary resuscitation (CPR). Enhancing the quality of CPR is a key factor to improving outcomes for cardiopulmonary arrest in children and requires effective training strategies. To evaluate the effectiveness of a simulation-based intervention to reduce first-year pediatrics residents' time for 3 critical actions in CPR: (1) call for help, (2) initiate bag-mask ventilation, and (3) initiate chest compressions. A prospective study involving 31 first-year pediatrics residents at a children's hospital assigned to an early or late (control) intervention group. Residents underwent baseline assessment followed by repeat evaluations at 3 and 6months. Time to critical actions was scored by video review. A 90-minute educational intervention focused on skill practice was conducted following baseline evaluation for the early-intervention group and following 3-month evaluation for the late-intervention group. Primary outcome was change in time to initiating the 3 critical actions. Change in time was analyzed by comparison of Kaplan-Meier curves, using the log-rank test. A 10% sample was timed by a second rater. Agreement was assessed using intraclass correlation (ICC). There was a statistically significant reduction in time for all 3 critical actions between baseline and 3-month evaluation in the early intervention group; this was not observed in the late (control) group. Rater agreement was excellent (ICC ≥ 0.99). A simulation-based educational intervention significantly reduced time to initiation of CPR for first-year pediatrics residents. Simulation training facilitated acquisition of critical CPR skills that have the potential to impact patient outcome.

Simulation-based training to teach open abdominal aortic aneurysm repair to surgical residents requires dedicated faculty instruction

We assessed the impact of abdominal aortic aneurysm (AAA)-specific simulation training on resident performance in simulated open AAA repair (SOAAAR) and determined whether simulation training required dedicated faculty instruction. We randomized 18 residents (postgraduate years 3-5) to an AAA simulation course consisting of two mandatory practice sessions proctored either by a surgical skills lab coordinator (Group A, n = 8) or by a vascular surgery faculty instructor (Group B, n = 10). All residents received a detailed manual and video demonstrating the technique of open AAA repair. Using a validated tool, vascular faculty who were blinded to resident identity, level of training, and randomization status graded SOAAAR performance via videos that were recorded before and after the course. Characteristics and baseline scores between Groups A and B were not different. Postcourse, there was a no significant improvement in performance in Group A. Group B performance was improved significantly from baseline with regard to task-specific checklist scores (44.1 ± 6.3 vs 34.9 ± .5; P = .02), global rating scores (28.4 ± .6 vs 25.3 ± 5.0; P = .049), and overall assessment of operative competence (P = .02). Time to complete SOAAAR improved in both groups (P = .02). Baseline performance varied significantly with year of training as measured by task-specific checklist scores, global rating scores, final product analysis, time to complete repair, and overall operative competence. Improvement varied inversely with year of training (P < .05) and postcourse scores were equivalent for postgraduate year 3-5 residents. An AAA-specific simulation training course improved resident performance in simulated open AAA repair. Dedicated faculty instruction during the simulation training was required for significant improvement in resident performance. The impact of simulation training was greatest in more junior residents. Procedure-specific simulation training with dedicated faculty can be used to effectively teach simulated open AAA repair.

Impact of simulator training on resident cataract surgery

Virtual reality surgery simulation training improves resident performance as measured by the simulator itself and wet-lab performance. This study aims to determine whether virtual surgery simulator training improves actual resident cataract surgery performance. The first 50 phacoemulsification cases of 20 residents, at a single residency program (Henry Ford Hospital), were retrospectively compared as two groups: before (2007-8) and after (2009-10) introduction of the Eyesi virtual surgery simulator to the surgical training program. Primary outcomes were the incidence of posterior capsule tears and operation duration. All residents received traditional didactic and wet-lab training. Instructor surgeons were surveyed for their impression of the simulator's contribution to resident surgical training. The nonsimulator and simulator groups each comprised 500 cases with 40 and 35 posterior capsule tears respectively. Capsular tear rates for the nonsimulator and simulator groups were 8.8 % and 10 % respectively for the first 25 cases, and 7.2 % and 3.6 % (P = 0.11) respectively for cases 26 through 50 . The percentage of long cases (defined as >40 min) for cases 10 through 50 was 42.3 % and 32.4 % (P = 0.005) for the nonsimulator and simulator groups respectively. Virtual reality surgical simulator training mildly shortens the learning curve for the first 50 phacoemulsification cases. The less adept residents appear to benefit most.

Use of simulation‐based mastery learning to improve the quality of central venous catheter placement in a medical intensive care unit

Central venous catheter (CVC) insertions are performed frequently by internal medicine residents. Complications, including arterial puncture and pneumothorax, decrease when operators use fewer needle passes to insert the CVC. In this study, we evaluated the effect of simulation-based mastery learning on CVC insertion skill. This was a cohort study of internal jugular (IJ) and subclavian (SC) CVC insertions by 41 internal medicine residents rotating through the medical intensive care unit (MICU) over a five-month period. Thirteen traditionally-trained residents were surveyed about the number of needle passes, complications, and procedural self-confidence on CVCs inserted in the MICU. Concurrently, 28 residents completed simulation-based training in IJ and SC CVC insertions. Simulator-trained residents were expected to perform CVC insertions to mastery standards on a central line simulator. Simulator-trained residents then rotated through the MICU and were surveyed regarding CVC placement. The impact of simulation training was assessed by comparing group survey results. No resident met the minimum passing score (MPS) (79.1%) for CVC insertion at baseline: mean (M) (IJ) = 48.4%, standard deviation (SD) = 23.1, M(SC) = 45.2%, SD = 26.3. All residents met or exceeded the MPS at testing after simulation training: M(IJ) = 94.8%, SD = 10.0, M(SC) = 91.1%, SD = 17.8 (p < 0.001). In the MICU, simulator-trained residents required fewer needle passes to insert a CVC than traditionally-trained residents: M = 1.79, SD = 1.0 versus M = 2.78, SD = 1.77 (p = 0.04). Simulator-trained residents displayed more self-confidence about their procedural skills: (M = 81, SD = 11 versus M = 68, SD = 20, p = 0.02). Simulation-based mastery learning increased residents' skills in simulated CVC insertion, decreased the number of needle passes when performing actual procedures, and increased resident self-confidence.

Intuitive Expertise and Empowerment: The Long-Term Impact of Simulation Training on Changing Accountabilities in a Biotech Firm

This paper describes a two-year study in which high levels of performance were achieved and sustained among so-called low-level workers in a biotech company. The purpose of the study—funded by National Science Foundation and lnvitrogen Corporation—were to explore the effectiveness of an accelerated learning Operational Simulation (OpSim) training on workers in biological manufacturing. While greater responsibility is demanded of “front-line” workers in biotech, efforts at “empowerment” have not worked well in this context. In this particular OpSim, workers were facing a large and expensive backorder problem. The OpSim did not target or specify the skills or means for greater responsiveness; rather we emphasized only goals and challenged the groups to develop a solution. All groups failed on the first try, but exceeded desired outcomes on the second try and subsequently sustained these performance objectives. Implications for Naturalistic Decision Making, training, and empowerment are discussed.

Effectiveness of simulation on health profession students' knowledge, skills, confidence and satisfaction

Background Despite the recent wave of interest being shown in high-fidelity simulators, they do not represent a new concept in healthcare education. Simulators have been a part of clinical education since the 1950s. The growth of patient simulation as a core educational tool has been driven by a number of factors. Declining inpatient populations, concerns for patient safety and advances in learning theory are forcing healthcare educators to look for alternatives to the traditional clinical encounter for skill acquisition for students. Objective The aim of this review was to identify the best available evidence on the effectiveness of using simulated learning experiences in pre-licensure health profession education. Inclusion criteria Types of studies: This review considered any experimental or quasi-experimental studies that addressed the effectiveness of using simulated learning experiences in pre-licensure health profession practice. In the absence of randomised controlled trials, other research designs were considered for inclusion, such as, but not limited to: non-randomised controlled trials and before-and-after studies. This review included participants who were pre-licensure practitioners in nursing, medicine, and rehabilitation therapy. Types of intervention(s)/phenomena of interest: Studies that evaluated the use of human physical anatomical models with or without computer support, including whole-body or part-body simulators were included. Types of outcome measures Student outcomes included knowledge acquisition, skill performance, learner satisfaction, critical thinking, self-confidence and role identity. Search strategy Using a defined search and retrieval method, the following databases were accessed for the period 1995-2006: Medline, CINAHL, Embase, PsycINFO, HealthSTAR, Cochrane Database of Systematic Reviews and ERIC. Methodological quality Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the standardised critical appraisal instruments for evidence of effectiveness, developed by the Joanna Briggs Institute. Disagreements were dealt with by consultations with a third reviewer. Data collection Information was extracted from each paper independently by two reviewers using the standardised data extraction tool from the Joanna Briggs Institute. Disagreements were dealt with by consultation with a third reviewer. Data synthesis Due to the type of designs and quality of available studies, it was not possible to pool quantitative research study results in statistical meta-analysis. As statistical pooling was not possible, the findings are presented in descriptive narrative form. Results Twenty-three studies were selected for inclusion in this review including partial task trainers and high-fidelity human patient simulators. The results indicate that there is high learner satisfaction with using simulators to learn clinical skills. The studies demonstrated that human patient simulators which are used for teaching higher level skills, such as airway management, and physiological concepts are useful. While there are short-term gains in knowledge and skill performance, it is evident that performance of skills over time after initial training decline. Conclusion At best, simulation can be used as an adjunct for clinical practice, not a replacement for everyday practice. Students enjoyed the sessions and using the models purportedly makes learning easier. However, it remains unclear whether the skills learned through a simulation experience transfer into real-world settings. More research is needed to evaluate whether the skills acquired with this teaching methodology transfer to the practice setting such as the impact of simulation training on team function.

Assessing the Impact of Simulation Training On Endoscopic Hemostasis Skills

Assessing the Impact of Simulation Training On Endoscopic Hemostasis Skills

The Impact of Simulation Training on Call Center Agent Performance: A Field-Based Investigation

The most prevalent form of training call center agents is via classroom instruction coupled with role-plays. Role-play training has a theoretical base in behavior modeling that entails observation, practice, and feedback. Emerging simulation-based technologies offer enhancements to behavior modeling that are absent in role-play training. This study evaluates the effectiveness of simulation-based training (henceforth, simulation training) as a behavior modeling technique vis-à-vis role-play training in a real-world call center environment across tasks of different levels of complexity. We collaborate with call centers at two Fortune 50 firms and examine on-job performance metrics to evaluate the effectiveness of simulation training. The performance measures of interest are call accuracy and call duration because these are two important factors that influence customer satisfaction and productivity in call center operations. After controlling for factors such as trainee's learning and technology orientation, age, education, and call center experience, results show that simulation training outperforms role-playing-based training in terms of both accuracy and speed of processing customer calls. Further, the relative superiority of simulation training improves at higher levels of task complexity.

Effectiveness of simulation on health profession students' knowledge, skills, confidence and satisfaction.

Despite the recent wave of interest being shown in high-fidelity simulators, they do not represent a new concept in healthcare education. Simulators have been a part of clinical education since the 1950s. The growth of patient simulation as a core educational tool has been driven by a number of factors. Declining inpatient populations, concerns for patient safety and advances in learning theory are forcing healthcare educators to look for alternatives to the traditional clinical encounter for skill acquisition for students. The aim of this review was to identify the best available evidence on the effectiveness of using simulated learning experiences in pre-licensure health profession education. Types of studies: This review considered any experimental or quasi-experimental studies that addressed the effectiveness of using simulated learning experiences in pre-licensure health profession practice. In the absence of randomised controlled trials, other research designs were considered for inclusion, such as, but not limited to: non-randomised controlled trials and before-and-after studies. This review included participants who were pre-licensure practitioners in nursing, medicine, and rehabilitation therapy. Types of intervention(s)/phenomena of interest: Studies that evaluated the use of human physical anatomical models with or without computer support, including whole-body or part-body simulators were included. Student outcomes included knowledge acquisition, skill performance, learner satisfaction, critical thinking, self-confidence and role identity. Using a defined search and retrieval method, the following databases were accessed for the period 1995-2006: Medline, CINAHL, Embase, PsycINFO, HealthSTAR, Cochrane Database of Systematic Reviews and ERIC. Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the standardised critical appraisal instruments for evidence of effectiveness, developed by the Joanna Briggs Institute. Disagreements were dealt with by consultations with a third reviewer. Information was extracted from each paper independently by two reviewers using the standardised data extraction tool from the Joanna Briggs Institute. Disagreements were dealt with by consultation with a third reviewer. Due to the type of designs and quality of available studies, it was not possible to pool quantitative research study results in statistical meta-analysis. As statistical pooling was not possible, the findings are presented in descriptive narrative form. Twenty-three studies were selected for inclusion in this review including partial task trainers and high-fidelity human patient simulators. The results indicate that there is high learner satisfaction with using simulators to learn clinical skills. The studies demonstrated that human patient simulators which are used for teaching higher level skills, such as airway management, and physiological concepts are useful. While there are short-term gains in knowledge and skill performance, it is evident that performance of skills over time after initial training decline. At best, simulation can be used as an adjunct for clinical practice, not a replacement for everyday practice. Students enjoyed t he sessions and using the models purportedly makes learning easier. However, it remains unclear whether the skills learned through a simulation experience transfer into real-world settings. More research is needed to evaluate whether the skills acquired with this teaching methodology transfer to the practice setting such as the impact of simulation training on team function.