Simulation-based Learning Experiences Research Articles

Call to Action: Ethical Awareness in Healthcare Simulation

The purpose of this paper is to raise awareness of the implications of intentional inclusion of ethics in simulation design [1]. This call-to-action provides a roadmap for nursing students and faculty engaging in simulation. While simulation-based learning experiences have been used in the education of health professions such as medicine, it is now recognized as an essential component of nursing education [2]. Simulation as pedagogy, is an effective strategy for teaching and learning in nursing education provided students and faculty exhibit professional integrity during the learning opportunity [3].

A Hybrid Simulation-Based Pre-Professional Physical Therapist Intensive Care Unit Course

Background and Purpose: There is demand for physical therapists to practice in intensive care units (ICUs); however, many physical therapists lack the specialized knowledge and skills to provide these services. Immersive simulation is an ideal instructional design strategy for learning ICU rehabilitation skills because simulation provides safe, low-risk environments to master high-risk interventions. This case report describes an elective hybrid pre-professional physical therapist course that incorporates simulation-based learning experiences (SBLEs) with clinical mentoring to prepare students for formal ICU internships. Case Description: Eight final-year physical therapist students participated in this course. The goal of this course was to facilitate the development of students interested in specializing in ICU practice. Course objectives included acquiring the knowledge, communication skills, and clinical skills essential for participating in mentored clinical ICU internships. Educational strategies included lectures, SBLEs, and clinical ICU experiences. Outcomes: All students successfully completed the course, earned the American Heart Association Advance Cardiac Life Support certification, and were identified by ICU physical therapist clinical instructors as ready for formal ICU internships. Stakeholders positively reviewed the course. One year following the course, 4 of 8 students were employed in acute care and/or ICU settings. Discussion: This elective course used a combination of lectures, SBLEs, and clinical experiences to successfully prepare physical therapist students for mentored ICU internships and employment in acute and critical care practice settings. More research is required to evaluate the simulation pedagogy (structure, types of cases, and time in simulation) and criteria for determining student competence level for ICU practice.

The Lived Experience of Nursing Students Participating in High-Fidelity Simulation at a School Grounded in Caring

Abstract The lived experiences of senior students in a bachelor-of-science program in nursing participating in high-fidelity simulation at a school grounded in caring was investigated by conducting focus-group interviews at one university in the southeastern United States. Evidence from research studies supports students' ability to learn critical thinking, clinical decision making, and psychomotor skills, and to acquire the affective behavior of caring, during high-fidelity simulation-based learning experiences. A qualitative descriptive design, using a phenomenological methodology, was used to guide this research study. Findings from this study revealed that participants experienced caring during high-fidelity simulation-based learning experiences.

Student-Perceived Influences on Performance During Simulation.

Understanding the effect of the context of simulation to learning and performance is critical to ensure not only optimal learning but to provide a valid and reliable means to evaluate performance. The purpose of this study is to identify influences on performance from the student perspective and understand the contextual barriers inherent in simulation before using simulation for high-stakes testing. This study used a qualitative descriptive design. Senior nursing students (N = 29) provided nursing care during simulation. Vocalized thoughts during simulation and reflective debriefing were digitally recorded and transcribed verbatim. Thematic analysis was conducted on transcribed data. Student performance during simulation was influenced by anxiety, uncertainty, technological limitations, and experience with the patient condition. Students had few previous simulation-based learning experiences that may have influenced performance. More needs to be understood regarding factors affecting simulation performance before pass-or-fail decisions are made using this technology. [J Nurs Educ. 2016;55(7):396-398.].

Validation evidence of the paediatric Objective Structured Assessment of Debriefing (OSAD) tool

IntroductionDebriefing is essential to maximise the simulation-based learning experience, but until recently, there was little guidance on an effective paediatric debriefing. A debriefing assessment tool, Objective Structured Assessment of Debriefing...

The Prebriefing Concept: A Delphi Study of CHSE Experts

BackgroundOver the past 10 years, simulation-based learning (SBL) has developed as a viable strategy to prepare students for clinical reasoning; however, very little is known about the specific components of the SBL experience and how they affect student learning. Currently, there is a gap in the simulation literature regarding prebriefing and the best strategies for preparing students for SBL. MethodA three round modified electronic Delphi design was used to seek consensus from simulation experts about the prebriefing component of SBL. Initial qualitative responses of round one led to the creation of quantitative prebriefing item statements for consideration in rounds two and three. Expert panel members used a Likert scale to indicate agreement with each prebriefing statement. A 70% level of consensus was set as the benchmark. ResultsAn expert panel of Certified Healthcare Simulation Educators reached consensus (>70%) on 83 statements about prebriefing. Findings suggest that prebriefing is an important three-phase process of SBL composed of planning, briefing, and facilitating. ConclusionsThe panel participants agreed that the simulation educator plays a vital role in preparing simulation participants for a successful SBL experience; however, further clarification of the prebriefing terminology is necessary. Findings of this study may be used to develop guidelines for simulation educators, administrators, and SBL learners to prepare for a successful SBL experience.

Supporting Students' Learning Experiences through a Pocket Size Cue Card Designed around a Reflective Simulation Framework

BackgroundAccording to the growing literature on simulation in nursing, reflective practice (RP) is a key tenet and an integral component of simulation-based learning outcomes in many higher education curricula, albeit mainly through the blanket terms of “feedback” or “debriefing” processes. Given its importance and the available literature on both RP and clinical simulation (including numerous models/frameworks), there is currently a lack of empirical testing or concrete evidence to inform how formal RP methods are utilized to ensure that appropriate student-centered learning outcomes are achieved. This article aims to discuss the usefulness of a portable structured framework that was designed to test the integration of RP during simulation-based learning experiences with undergraduate nursing and paramedic students. As part of ongoing simulation developments and refinement of reflective learning methods with these students, a small-scale pilot project was undertaken to evaluate the use of a portable reflective simulation framework (RSF) as a structured tool and technique to support and maximize learning aligned to curricula outcomes. MethodsA survey using a 10-item questionnaire explored the actual and potential use of a pocket-sized RSF “cue” card that was randomly assigned to groups of undergraduate nursing and paramedic students (N = 72). Students received the RSF cue cards before the start of scenario-based simulation activities and were asked to complete the survey afterward. ResultsMost students considered the RSF to be a useful tool for postsimulation learning. Eighty-nine percent of students also indicated that it would further encourage them to reflect on their learning in clinical practice, particularly for practical/technical skills such as patient assessment and diagnosis. Notably, use of the RSF for the identification of theoretical learning needs was scored much lower (22.2%). ConclusionsThe students surveyed generally agreed that the use of a pocket-sized RSF cue card was a highly beneficial tool for enabling them to individually identify and prioritize their learning needs especially postsimulation. However, the emergent imbalance of the theory/practice usefulness of the RSF suggests that educators need to ensure that important aspects such as theoretical applications are addressed if clinical simulation and RP are to contribute to wider learning outcomes beyond practical competencies alone. Further studies to test and extrapolate more in-depth use and efficacy of the RSF with students and facilitators are also recommended.

Use of Simulation Learning Experiences in Physical Therapy Entry-to-Practice Curricula: A Systematic Review.

To review the literature on simulation-based learning experiences and to examine their potential to have a positive impact on physiotherapy (PT) learners' knowledge, skills, and attitudes in entry-to-practice curricula. A systematic literature search was conducted in the MEDLINE, CINAHL, Embase Classic+Embase, Scopus, and Web of Science databases, using keywords such as physical therapy, simulation, education, and students. A total of 820 abstracts were screened, and 23 articles were included in the systematic review. While there were few randomized controlled trials with validated outcome measures, some discoveries about simulation can positively affect the design of the PT entry-to-practice curricula. Using simulators to provide specific output feedback can help students learn specific skills. Computer simulations can also augment students' learning experience. Human simulation experiences in managing the acute patient in the ICU are well received by students, positively influence their confidence, and decrease their anxiety. There is evidence that simulated learning environments can replace a portion of a full-time 4-week clinical rotation without impairing learning. Simulation-based learning activities are being effectively incorporated into PT curricula. More rigorously designed experimental studies that include a cost-benefit analysis are necessary to help curriculum developers make informed choices in curriculum design.

Student and educator experiences of maternal-child simulation-based learning: a systematic review of qualitative evidence protocol.

Review question/objective The overall aim of this systematic review is to identify the appropriateness and meaningfulness of maternal-child simulation-based learning for undergraduate or pre-registration nursing students in educational settings to inform curriculum decision-making. 1. What are the experiences of nursing or health professional students participating in undergraduate or pre-licensure maternal-child simulation-based learning in educational settings? 2. What are the experiences of educators participating in undergraduate or pre-licensure maternal-child simulation-based learning in educational settings? 3. What teaching and learning practices in maternal-child simulation-based learning are considered appropriate and meaningful by students and educators? Inclusion criteria Types of participants Participants will include undergraduate or pre-registration or pre-licensure nursing or midwifery or health professional students and educators participating in maternal-child simulation-based learning. Midwifery or undergraduate medical students are included as participants as their clinical learning experiences are similar to undergraduate nursing students. However students in graduate, postgraduate, or specialty education programs and practising nurses or other health care professionals (continuing education) will be excluded from this review because the purpose is to identify the implications for undergraduate or pre-registration nursing programs. Undergraduate or pre-registration education differs from continuing professional education as students are more likely to be learning this way of thinking or clinical reasoning for the first time. The pedagogical approaches used also differ from continuing professional development. Phenomena of interest This review will consider studies that investigate simulation-based learning experiences that are relevant to maternal-child nursing. Our primary interest in this review is in preparing nursing students for senior level maternal-child practice placements and transition to working as an Registered Nurse. However, we will include all qualitative studies and case reports of simulation-based learning that involve pre-registration nursing or health professional students. Context The purpose of this review is to identify the implications of this body of knowledge for undergraduate or pre-registration nursing programs in Canada This review will include qualitative research that may be applicable to the Canadian context for nursing education, such as reports from North America, Europe, Australia and New Zealand.

Improving Nurses' Vasopressor Titration Skills and Self-Efficacy via Simulation-Based Learning

BackgroundAdministration of vasopressors in patients with septic shock can be a difficult skill for nurses to learn. Simulation-based learning (SBL) may be a useful tool for improving nurses' self-efficacy and skill performance in this context. MethodsThe purpose was to determine if an SBL experience increases nurses' self-efficacy and performance across three time points, using a quasi-experimental pre–post test design. ResultsWe identified statistical trends in 16 RNs for improvement in self-efficacy (general and situational) and performance over time. ConclusionsSBL training demonstrated an effect on self-efficacy and performance. Additional research is needed to confirm these findings.

Situational Interest and Instructional Design

The education reformer, Horace Mann once suggested that trying to teach a learner without creating interest is like hammering cold iron. All too often, health care educators begin an instructional session while the mind of the learner is focused on places other than on the subject to be learned. Regardless of specialization, understanding situational interest and ways to nurture it in the facilitation process is important for educators. However, it is especially important for the health care community as it helps us to develop best practices in instructional design and facilitation that can improve simulation-based instruction. This article defines situational interest and explains how instructional design can generate such interest with the use of advance organizers, active learning strategies, and the practices of effective reflection-in-action and reflection-on-action. Developing situational interest may lead to an individual interest or passion for the subject, foster lifelong learning, and encourage learners to return for additional simulation-based learning experiences.

Supporting accomplished facilitation: examining the use of appreciative inquiry to inform the development of learning resources for medical educators

This paper examines the use of appreciative inquiry (AI) to guide development of web-based learning resources for medical educators who facilitate simulation-based learning experiences for doctors-in-training. AI can be viewed as a positive form of action research, which seeks to avoid deficit-based analyses and solutions, and commonly associated defensiveness. The use of AI to guide research and curriculum development has hitherto received scant attention.Simulated medical practice allows learners’ needs to take top priority because simulated patients replace real patients (whose care would otherwise be top priority). Each episode of simulated clinical practice is followed by facilitated debriefing. Facilitators complete an initial ‘train the trainers’ course (typically one or three days). Our learning resources aimed to complement and extend initial courses.AI informed data collection and analysis. It focused attention on identifying and understanding what was good about contemporary debriefing practices. We identified examples of practical wisdom and designed resources to help make these more transparent and accessible to all facilitators. Selected video records and interview excerpts demonstrated key points. We found opportunities to introduce ideas that would extend facilitators’ expertise.We critique AI as an approach to action research and curriculum development, and recommend further use of AI in other contexts.

Standards of Best Practice: Simulation Standard III: Participant Objectives

All simulation-based learning experiences begin with development of clearly written participant objectives, which are available prior to the experience. Participant objectives are the guiding tools for simulation. Objectives are essential to determine if the outcomes for simulation-based learning experience have been achieved. To meet participant objectives, identification of appropriate scenario, fidelity, and facilitation methods is crucial.

Standards of Best Practice: Simulation Standard VI: The Debriefing Process

All simulation-based learning experiences should include a planned debriefing session aimed toward promoting reflective thinking. Learning is dependent on the integration of experience and reflection. Reflection is the conscious consideration of the meaning and implication of an action, which includes the assimilation of knowledge, skills, and attitudes with pre-existing knowledge. Reflection can lead to new interpretations by the learner. Reflective thinking does not happen automatically, but it can be taught; it requires time, active involvement in a realistic experience, and guidance by an effective facilitator. The skills of the debriefer are important to ensure the best possible learning; learning without guidance could lead the learner to negatively transfer a mistake into their practice without realizing it had been poor practice, repeat mistakes, focus only on the negative, or develop fixations. Research provides evidence that the debriefing process is the most important component of a simulation-based learning experience.

Standards of Best Practice: Simulation Standard IV: Facilitation

Multiple methods of facilitation are available, and use of a specific method is dependent on the learning needs of the participant(s) and the expected outcomes. Facilitation methods should vary, keeping in mind that participants bring cultural and individual differences that affect their knowledge, skills, attitudes, and behaviors. Facilitation assists participants to meet the objectives by incorporating their needs and experience level into the planning and implementation of a simulation-based learning experience. Facilitators use feedback or debriefing to help participants meet the objectives and expected outcomes. Facilitation should be appropriate to the participants' level of learning and experience and be theoretically based using best practices.

The effectiveness of debriefing in simulation-based learning for health professionals: A systematic review.

Simulation is defined as a technique used to replace or amplify real experiences with guided experiences that evoke or replace substantial aspects of the real world in a fully interactive manner. The use of simulation for educational purposes began decades ago with the use of low-fidelity simulations and has evolved at an unprecedented pace. Debriefing is considered by many to be an integral and critical part of the simulation process. However, different debriefing approaches have developed with little objective evidence of their effectiveness. The aim of this review was to identify, appraise and synthesise the best available evidence for the effectiveness of debriefing as it relates to simulation-based learning for health professionals. This review included any health professional participants regardless of gender, age or profession.Studies that evaluated the use of debriefing for the purpose of simulation-based learning were included.The review included randomised controlled trials.Outcome measures included objectively measured outcomes such as situational awareness, communication skills, teamwork, knowledge acquisition, and performance of psychomotor skills as assessed by validated instruments such the Anaesthesia Non-Technical Skills Scale, the Emergency Response Performance Tool, and the Clinical Simulation Tool. A three-stage comprehensive search strategy was utilised to search across ten electronic databases. English language studies published between January 2000 and September 2011 were considered for inclusion. Two independent reviewers assessed the methodological quality of each study selected for retrieval using standardised Joanna Briggs Institute critical appraisal tools. Data were extracted from studies using the standardised data extraction tool from the Joanna Briggs Institute DATA SYNTHESIS: Meta-analysis was not possible because of the different outcomes, control groups and interventions in the selected studies. Findings are therefore presented in narrative form. Ten randomised controlled trials involving various debriefing methods were eligible for inclusion in this review. The methods of debriefing included: post simulation debriefing, in-simulation debriefing, instructor facilitated debriefing and video-assisted instructor debriefing. In the included studies there was a statistically significant improvement pre-test to post-test in the performance of technical and nontechnical skills such as: vital signs assessment; psychomotor skills; cardiopulmonary resuscitation; task management; team working; and situational awareness, regardless of the type of debriefing conducted. Additionally, four of the studies reported improvement in these outcomes without the use of video playback during debriefing. In one study the effect of the educational intervention was evident 6-9 months after the initial simulation experience. The results of this systematic review support the widely held assumption that debriefing is an important component of simulation. It is recommended therefore that debriefing remain an integral component of all simulation-based learning experiences. However, the fact that there were no clinical or practical differences in outcomes when instructor facilitated debriefing was enhanced by video playback is an important finding since this approach is currently considered to be the 'gold standard' for debriefing.

Simulation and Debriefing: Helping the Pediatric Nurse Thrive

0882 doi:1 a car while riding his bike 5 hours ago. The child had a mild concussion and a fractured femur. You are to prepare for his admission. This brief introduction begins your simulated learning experience. Learning through simulation provides pediatric nurses with the opportunity to practice clinical skills in a safe environment. Simulated scenarios are useful as teaching methods within academic and clinical settings. Today's technology of highfidelity simulation offers alternatives to the traditional clinical teaching approach of “see one, do one.” Simulation offers a safe setting for health care professionals to practice clinical and team-building skills without endangering patients (Ruldolph, 2008). Simulated learning is “bridging the gap between experiencing an event and making sense of it” (Fanning & Gaba, 2007, p. 115). Some believe the most important feature of simulation is debriefing (Fanning & Gaba). Kolb's (1984) work on experiential learning is fundamental to understanding the role of debriefing. His theory supports the model that reflection coupled with experience can capture a learning opportunity. The primary focus of this article is how to effectively debrief after a simulation-based learning experience.

The effectiveness of high fidelity simulation on medical–surgical registered nurses' ability to recognise and respond to clinical emergencies

There is a paucity of evidence regarding the efficacy in preparing medical-surgical nurses to respond to patients with acutely deteriorating conditions. The aim of this study was to evaluate registered nurses' ability to respond to the deteriorating patient in clinical practise following training using immersive simulation and use of a high fidelity simulator. This study was a follow-up survey of medical-surgical graduate nurses following immersive high fidelity simulation training. Thirty eight registered nurses practising in medical-surgical areas completed the simulation as part of university graduate study. A follow-up survey of the graduate medical-surgical registered nurses conducted three months following completion of a high fidelity simulation-based learning experience. Outcomes consisted of the number of times skills were used in practise and the usefulness of simulation in preparing for actual emergency events. Participants reported a total of 164 clinical patient emergencies in the follow-up time period including: 46% cardiac, 32% respiratory, 10% neurological, 7% cardiac arrest and 5% related to electrolyte disturbances. The ability to respond in a systematic way, handover to the emergency team and airway management were identified as the skills most improved during patient emergencies following simulation. The most useful aspects of the simulation experience identified were scenario debriefing and assertiveness training. Participants with less years of clinical experience were more likely to report practising the team leader role and debriefing as the most useful aspects of simulation. The skills practised in simulation were highly relevant to participants practise in medical-surgical areas. Non-technical skills, including assertiveness skills should be considered in future emergency training courses for nurses.

Use of Multiple Patient Simulators to Enhance Prioritizing and Delegating Skills for Senior Nursing Students

The student clinical experience is rich, yet challenges arise in providing experiences where leadership skills can be developed and used in nursing practice. To increase student confidence and enhance student ability to safely and effectively prioritize, delegate, and implement care for numerous patients, a simulation-based learning (SBL) experience was developed. The SBL experience involves multiple patient simulators, case study analysis, and a debriefing session. Ninety-seven senior nursing students participated in this program. Students reported through Likert surveys to either "agree" or "strongly agree" that the SBL was well organized (87%, n = 84), prompted realistic expectations (59%, n = 57), the scenarios were believable (73%, n = 71), case studies increased understanding (66%, n = 64), and that the SBL experience increased understanding of prioritizing and delegating care (69%, n = 67). Seventy-eight percent (n = 76) reported "more confidence in ability to work as a team" and 55% (n = 52) reported "more confidence in prioritizing and delegating care."

“Fab 13:” The Learning Factory

This paper describes how situated learning theory was employed in the design of Fab 13, a four-day simulation-based learning experience for manufacturing professionals at Intel Corporation. The instructional challenge confronted by Intel is described, along with the rationale for adopting situated learning as the theoretical framework for the instructional intervention. A conceptual framework for understanding situated learning is also presented with detailed descriptions of how the elements were incorporated into the design of the Fab 13 simulation.