Simulation-based Learning Research Articles

The relation between learners’ experience in simulations and diagnostic accuracy: Generalizability across medical and teacher education

Simulation-based learning is being increasingly implemented across different domains of higher education to facilitate essential skills and competences (e.g. diagnostic skills, problem-solving, etc.). However, the lack of research that assesses and compares simulations used in different contexts (e.g., from design perspective) makes it challenging to effectively transfer good practices or establish guidelines for effective simulations across different domains. This study suggests some initial steps to address this issue by investigating the relations between learners' experience in simulation-based learning environments and learners' diagnostic accuracy across several different domains and types of simulations, with the goal of facilitating cross-domain research and generalizability. The findings demonstrate that used learners' experience ratings are correlated with objective performance measures, and can be used for meaningful comparisons across different domains. Measures of perceived extraneous cognitive load were found to be specific to the simulation and situation, while perceived involvement and authenticity were not. Further, the negative correlation between perceived extraneous cognitive load and perceived authenticity was more pronounced in interaction-based simulations. These results provide supporting evidence for theoretical models that highlight the connection between learners' experience in simulated learning environments and their performance. Overall, this research contributes to the understanding of the relationship between learners’ experience in simulation-based learning environments and their diagnostic accuracy, paving the way for the dissemination of best practices across different domains within higher education.

Impact of the modified curricula on periodontal instrumentation skills development during the COVID-19 pandemic from 2020 to 2023.

This study aimed to evaluate the impact of curriculum modifications on periodontal instrumentation skills development among classes of 2021, 2022, and 2023 during the COVID-19 pandemic. The pandemic began and affected the three classes at different stages of their studies. Onsite simulation-based learning (SBL) was employed for the classes of 2021 and 2022; remote SBL was adopted for the class of 2023. Modified clinical education, due to social distancing guidelines, impacted the class of 2021 significantly and the class of 2022 to a lesser extent. A multiple linear regression model was built to examine the association between the fourth-year patient-based scaling competency examination scores and selected predictors. The classes of 2021 and 2023 showed consistent performances over time, while the class of 2022 exhibited significant variation exhibiting the lowest performance at the second-year practical examination. While the clinical experience of the class of 2021 was significantly less than that of the classes of 2022 and 2023, the fourth-year competency examination scores did not differ across the three classes. The clinic points (p=0.014) significantly affected the fourth-year competency examination score while student gender (p=0.18), the first-year (p=0.736), and second-year (p=0.198) practical examination scores showed no correlations. Based on student performance in the fourth-year scaling competency examination, the curriculum modifications due to the COVID pandemic did not affect student learning outcomes. Clinical experience was the most influential determinant of skill development in periodontal instrumentation.

Assessing REflective simulation-based e-Training on motivational interviewing among multidisciplinary healthcare practitioners [RESeT-MI]: a mixed methods pilot study

BackgroundMany health science curricula have integrated behavioral modification techniques in their plans. Motivational Interviewing is one such technique. Educational interventions to promote Motivational Interviewing have had limited success. Integrating simulation-based learning in health science curricula might offer a platform whereby students can train in well controlled environments with increased authenticity, provision of standardized experiences and the capacity for immediate feedback to participants. Using motivational interviewing as an exemplar, the purpose of this study was to assess the impact of a simulation-based reflective e-training program on knowledge, attitudes, and confidence in Motivational Interviewing among healthcare practitioners from diverse healthcare disciplines. A secondary aim was to explore whether self-reflection can promote reflective learning.MethodsThis was a mixed-method study design. Fifteen participants from different health disciplines were included in the quantitative phase of the study, the simulated interview, and the reflective assignments while five participated in the focus group. Pre and post tests were used to examine the effect of training on knowledge, attitudes, and confidence in Motivational Interviewing. Assessment of Motivational Interviewing Treatment Integrity [MITI] scores in a simulation-based scenario was used. A qualitative content analysis of a focus group provided a more in-depth understanding of the participants experiences. Excerpts from reflective assignments were analyzed using Transformative Learning Theory concepts.ResultsA Wilcoxon test showed that the training elicited a change in confidence in performing Motivational Interviewing [Z= -2.766, p = 0.006], median scores increased from 29 to 34. A quarter of technical scores and half of the relational scores indicated good competence. Participants reflected content transformation through feelings of empowerment and satisfaction when they were successful in engaging and motivating clients. Process transformation was evident in reflections on how to improve core skills specifically reflective listening. Reflections on Motivational Interviewing spirit related values showed premise transformation, which may indicate attitude changes.ConclusionA simulation-based e-training program on Motivational Interviewing represents an important educational modality for training in the health disciplines. Results of this study provide evidence supporting the integration of reflective simulation-based e-training into the education curricula of health disciplines in MI and beyond.

Conceptualizing Student Experiences of Psychological Safety in Simulation: A Grounded Theory Study.

Simulation-based learning activities have become more prevalent in prelicensure nursing curricula. When following the Simulation Standards of Best Practice, optimal learning conditions can be achieved, including the creation of a psychologically safe learning environment. Yet, the process of how students come to feel psychologically safe during a simulation experience remains unknown. A grounded theory approach was used to conceptualize the basic social process by which nursing students feel psychologically safe during a simulation learning experience. Six categories emerged from the data: (1) being nervous; (2) having a good instructor; (3) learning; (4) coming together; (5) being in debriefing; and (6) leaving on a positive note. The core category of putting myself out there emerged as the basic social process. The social process of psychological safety in simulation develops within nursing students as the result of interplay among several dimensions of the learning experience. [J Nurs Educ. 2024;63(7):427-433.].

Investigating the Impacts of A Simulation-Based Learning Model Using Simulation Virtual Laboratory on Engineering Students

Considering electrical engineering students at Universitas Negeri Medan as a case study, this research looks at how an SVL affected their grades. Integrating the TAM with the ABET Laboratory Learning Objectives, it provides a comprehensive framework for quality engineering and technology education. This research is the first of its kind to theoretically compare the two concepts in a VL context. This research examines the relationship between student performance in the classroom and the TAM's usability components as well as the ABET's learning objectives. The results from the surveys given to first-year Electrical Engineering students are analyzed using Structural Equation Modeling (SEM) and Partial Least Squares (PLS). Because it enhances student performance and satisfies their learning goals, the results demonstrate that utilizing simulation-based virtual laboratories (SVL) in engineering education offers substantial educational benefits.

Addressing the Decline in Clinical Skills: A Call for Comprehensive Educational Reform

Despite technological advances, clinical skills are the foundation of medical practice. Taking a comprehensive clinical history, performing physical examinations, and communicating effectively are crucial for high-quality patient care. Medical students need to focus on developing strong clinical skills to ensure they are well-prepared for their careers and adapt to the evolving field of medicine through continual practice and refinement.1 The medical community is worried about declining essential clinical skills among undergraduate medical students.2,3 This editorial aims to analyze the reasons for the decline and suggest evidence-based methods to address the situation. 05885.0258063. The declining standards of clinical skills among medical students can be attributed to the widespread adoption of technology-based learning, which has the potential to diminish the importance of traditional hands-on bedside teaching.4 Technology should enhance, not replace, practical clinical experiences. Practical training improves the clinical abilities, expertise, and self-assurance of medical students.5 Moreover, the growing magnitude and expansion of medical curricula provide difficulties in the development of educational programs without ample time for bedside practical teaching.6,7 There is frequently an excessive focus on remembering facts rather than on cultivating clinical reasoning abilities.8 The reduced patient interaction during medical school, due to increased reliance on simulations and less time in clinical rotations and bedside teaching, hampers the development of clinical skills.9 External factors such as limited time and extensive paperwork may affect the quality of patient encounters. Efficient communication is crucial for building good relationships with patients, obtaining accurate medical histories, and ensuring patient understanding and adherence to treatment.9 Insufficient training in communication skills can result in less-than-ideal interactions between patients and healthcare providers and can also contribute to errors in diagnosis and medical treatment.10 The provision of trained faculty for teaching medical students is an issue worldwide. Insufficient supervision and feedback during clinical rotations hinder the development of essential clinical skills.11 Larger student cohorts reduce the opportunities for individual students to practice and receive personalized instruction in clinical skills.12 Medical education often prioritizes theoretical testing over practical examinations and undervalues communication skills training. Variability in clinical experiences at different medical schools can lead to inconsistencies in skill acquisition. The scarcity of skilled clinicians as role models impacts students’ learning. Economic constraints and modern healthcare pressures limit opportunities for thorough patient interactions and clinical training.13 THE WAY FORWARD Educational institutions should prioritize hands-on clinical experiences throughout the curriculum to improve students’ diagnostic and communication abilities. These experiences should include simulation-based learning, standardized patients, and longitudinal clerkships. Faculty members need support and resources for effective clinical mentorship and development. Reflective practice should be integrated into the curriculum to enhance self-awareness and critical thinking. Open communication and mentorship programs between students and faculty can strengthen medical training and promote continual learning. To address declining clinical proficiency among medical students, institutions can adopt evidence-based approaches including curriculum changes, faculty training, promoting reflective thinking, collaboration among healthcare professionals, and fostering a culture of ongoing learning. Regulatory bodies should ensure adequate time for bedside teaching and appropriate assessment weightage.

Virtual Simulation-Based Learning Competency Self-Evaluation Tool: A Methodological Study

Virtual Simulation-Based Learning Competency Self-Evaluation Tool: A Methodological Study

Investigating the Higher Education Students' Perception of an Interactive Virtual Processing Station Application

This study aims to evaluate the Virtual Processing Station as a simulation-based learning medium in the context of engineering education, based on student perceptions. Student perceptions of this medium were evaluated based on four main aspects: relevance, attention, interest, and usefulness. This study involved 30 students from the Department of Electrical Engineering Education at Yogyakarta State University who had used the Virtual Processing Station in laboratory practice sessions. Data were collected through a questionnaire with 17 statements using a Likert scale and supplemented with qualitative feedback from respondents. The results showed that this learning medium was very well received by students, with an average rating of 90.59%. The relevance aspect received the highest score (92.92%), followed by the interest aspect (90.83%) and usefulness (90.56%). Although the attention aspect received a slightly lower score (84.72%), the medium was still considered quite effective in capturing students' attention during the learning process. Positive comments from respondents emphasized the effectiveness of this medium in helping students understand both the practical and theoretical concepts of PLC-based industrial automation systems. The conclusion of this study indicates that the Virtual Processing Station has great potential in supporting more interactive and efficient engineering learning. However, there is still room for improvement in areas such as the user interface and visualization. Future research should focus on assessing the short-term and long-term impacts of this medium, particularly through larger sample sizes and objective assessments of student performance before and after using the Virtual Processing Station. This approach will provide deeper insights into how these medium influences learning outcomes and the development of practical skills in engineering education.

Using Simulation-Based Mastery Learning to Achieve Excellent Learning Outcomes in Physical Therapist Education.

The 2 aims of this observational study are (a) to describe the implementation and feasibility of a bed mobility skills simulation-based mastery learning (SBML) curricular module for physical therapist students and (b) to measure learning outcomes and student perceptions of this module. Simulation-based mastery learning is an outcome-based educational approach that has been successful in other health professions but has not been explored in physical therapy education. Eighty-seven students in a single cohort of a Doctor of Physical Therapy program. The SBML module in this pretest-posttest study included a pretest, instruction, initial posttest, and additional rounds of instruction and assessment as needed for all learners to achieve the minimum passing standard (MPS) set using the Mastery Angoff and Patient Safety methods. Outcome measures were bed mobility assessment pass rates and scores, additional student and faculty time compared with a traditional approach, and student perceptions of their self-confidence and the module. All students achieved the MPS after 3 rounds of training and assessment beyond the initial posttest. Mean Total Scores improved from 67.6% (12.9%) at pretest to 91.4% (4.8%) at mastery posttest (P < .001, Cohen's d = 1.8, 95% CI [1.4-2.1]); mean Safety Scores improved from 75.2% (16.0%) at pretest to 100.0% (0.0%) at mastery posttest (P < .001, Cohen's d = 1.5, 95% CI [1.2-1.9]). Students who did not achieve the MPS at the initial posttest (n = 30) required a mean of 1.2 hours for additional instruction and assessment. Survey results revealed an increase in student confidence (P < .001) and positive student perceptions of the module. Implementation of this SBML module was feasible and resulted in uniformly high levels of bed mobility skill acquisition. Based on rigorous learning outcomes, feasible requirements for implementation, and increased student confidence, SBML offers a promising approach for wider implementation in physical therapy education.

Simulation-based echocardiography learning contribution on training of medical residents.

Echocardiography is a pivotal exam in critically ill patients, a specific training is crucial. Medical residents often lack echocardiography practice. This study aims to evaluate the impact of simulation-based training on medical residents' echocardiography mastery. This interventional study was conducted among medical residents at the Simulation Center of the Faculty of Medicine in Monastir (CeSim) in January 2022. The intervention consisted of a theoretical training and a simulator-based practical training concerning echocardiography. Residents underwent evaluation before and after training through a "Pre-Test" and a "Post-Test," respectively, using a French-language questionnaire. Participation was entirely voluntary. A total of 28 medical residents participated in our study, with the majority being female (57.1%). The median age was 29 years (interquartile range: 28-31.75). Following training, the proportion of participants who reported having the necessary skills for echocardiography interpretation significantly increased (p<0.05). Respondents demonstrated significant improvements in their scores on theoretical tests and practical skills assessments. Concerning echocardiographic views, the percentage of participants who correctly identified the title of the parasternal small axis section increased from 53.6% before training to 100% after training (p <10-3). Significant enhancements were observed in all parameters evaluating the practice of echocardiographic sections by respondents on a mannequin after training, encompassing time to obtain the view, view quality, image quality, visualization of structures, interpretability, and image stability (p<10-3). There was a significant improvement in average response rates for echocardiographic clinical syndroms among medical residents before and after training. All participants emphasized the indispensability of ultrasound education in the training of physicians specializing in managing cardiopulmonary emergencies. This study reports the beneficial role of simulation-based training in enhancing the mastery of medical residents in echocardiography. Incorporating such training methods into their learning curricula is advisable.

Training in cardiothoracic surgery: The role for simulation.

Adequate cardiothoracic surgical training is essential for provision of quality care to patients. In recent years, simulation-based training has been advocated as an adjunct to traditional surgical training. Advances in simulation technology has resulted in many low- and highfidelity simulators being employed in cardiothoracic surgical training. Such models allow trainees to practice an array of realistic full-length procedures in a safe and controlled environment, with the window to make mistakes and consider them learning points. There is significant evidence to demonstrate the effectiveness of cardiothoracic surgery simulation in improving surgical skills and operating room performances in addition to building confidence among trainees. However, owing to the high financial cost of arranging it, simulation-based training is not widespread in low- and middle-income countries, including Pakistan. More work is warranted on the cost effectiveness of implementing simulation-based learning, which, in turn, would increase the uptake of simulation to enhance cardiothoracic surgical training in Pakistan.

Developing palliative care skills in undergraduate allied health students using an interprofessional simulation-based learning experience

Introduction: There is a growing need to prepare the health workforce to work collaboratively to meet the needs of people affected by life-limiting illness. Despite the call from industry for the inclusion of palliative care in undergraduate curriculum, there are few established methods to deliver this education for interprofessional student cohorts. Where clinical experience options are limited, the simulation-based learning experience (SBLE) offers a valuable experiential learning opportunity in the preparation of students to care for dying patients and their families. This research aims to examine the impact of SBLE on the level of allied health students' confidence in delivering palliative care. Methods: A quasi-experimental, pre-test/post-test design was used with 11-point rating scales to measure the change in levels of self-reported confidence in knowledge, providing care, preparedness, management and assessment of need, and professional and ethical practice among allied health students who participated in either a face-to-face or an online palliative care SBLE. Results: A total of 130 students participated in the SBLE in 2019 and 2020. A paired-sample t-test showed improvement post simulation, with mean differences ranging from 2.87 [95% CI 2.45–3.29] for knowledge to 3.2 [95% CI 2.79–3.60] for confidence. All categories were statistically significant (p &lt; .05). Analysis of opened-ended questions indicated that after the simulation, students recognised the importance of a holistic focus and patient-centred care model. Conclusions: The SBLE improved levels of student perceived confidence for the delivery of palliative care. Educators are encouraged to use SBLE to support the development of graduate capabilities in palliative care in allied health students.

Reconceptualizing Simulations: Epistemic Objects and Epistemic Practices in Professional Education

This study explores how and why simulation training facilitates professional learning by investigating how simulators and simulations are used and conceptualized in two professional domains, nursing and maritime navigation, and offer a reconceptualization. Our aim is to move beyond past theorizing of simulators and simulations that has mainly centered on representational issues like validity, fidelity, and authenticity. Instead, we approach simulators as epistemic objects and simulations as epistemic practices. These concepts offer a lens to examine the situated and sociomaterial practices that make simulators into simulations and simulations into entry points to the epistemic culture of a profession. As a result, we pinpoint three central mechanisms for transforming the simulation experience into an event that facilitates the enrollment of students into their future profession. The first mechanism involves the instructional practice of “filling in” aspects of the work context that might be missing in the simulator. The second mechanism, sometimes labeled the “as-if” mode of simulations, manifests through the participants’ ongoing commitment to treat the simulation as-if it was a real professional encounter. The third relates to how simulation-based learning activities afford a crucial pedagogical orientation towards defining what constitutes exemplary professional practice in specific training situations.

Comparing the impact of PASS-BAR handoff education for new nurses between simulation-based and case-based approaches: A quasi-experimental design

AimTo develop a patient, assessment, situation, safety concerns, background, action, recommendation (PASS-BAR) handoff training program and compare the educational effects of the program between simulation-based (experimental group) and case-based (control group) groups using repeated measures among new nurses. BackgroundNew nurses are not well prepared to provide clear handoff reports because nursing schools and healthcare institutions rarely offer structured programs or training for handoff communication practices. DesignThis study used a pretest–posttest quasi-experimental design with repeated measures with two non-randomized groups. MethodsThis study targeted new nurses with less than 12 months of experience and was conducted at a university hospital’s clinical nursing education center in Seoul, South Korea, between September 2022 and April 2023. Seventeen participants were allocated to the experimental group and 17 participants to the control group. Both groups were given lectures and exercises for both scenarios. Participants were asked to complete a questionnaire on nursing handoff competency, handover performance competency and perceived self-efficacy of handoff at pre- and posttest and two weeks after training. Satisfaction with learning was measured after the intervention. ResultsWe developed a simulation-based learning handoff program that includes a simulated handoff performance and debriefing and a case-based learning handoff program that includes discussion, handoff performance and feedback. This study found no immediate difference in the educational effect of PASS-BAR handoff training between simulation-based learning and case-based learning; however, over time, simulation-based learning was more effective than case-based learning in improving nursing handoff competency and handover performance competency. ConclusionsBased on the results of this study, a simulation-based handoff training program using PASS-BAR can enhance handoff competencies and help new nurses strengthen their communication skills to understand patients and convey important information. Tweetable AbstractDeveloping a simulation-based handoff training program using PASS-BAR helps nurses strengthen their communication skills with colleagues.

Development of peer assessment rubrics in simulation-based learning for advanced cardiac life support skills among medical students

IntroductionPeer assessment can enhance understanding of the simulation-based learning (SBL) process and promote feedback, though research on its rubrics remains limited. This study assesses the validity and reliability of a peer assessment rubric and determines the appropriate number of items and raters needed for a reliable assessment in the advanced cardiac life support (ACLS) context.MethodsNinety-five third-year medical students participated in the ACLS course and were assessed by two teachers (190 ratings) and three peers (285 ratings). Students rotated roles and were assessed once as a team leader on a ten-item rubric in three domains: electrocardiogram and ACLS skills, management and mechanisms, and affective domains. Messick’s validity framework guided the collection of validity evidence.ResultsFive sources of validity evidence were collected: (1) content: expert reviews and alpha, beta, and pilot tests for iterative content validation; (2) response process: achieved acceptable peer interrater reliability (intraclass correlation = 0.78, p = 0.001) and a Cronbach’s alpha of 0.83; (3) internal structure: demonstrated reliability through generalizability theory, where one peer rater with ten items achieved sufficient reliability (Phi-coefficient = 0.76), and two raters enhanced reliability (Phi-coefficient = 0.85); construct validity was supported by confirmatory factor analysis. (4) Relations to other variables: Peer and teacher ratings were similar. However, peers rated higher in scenario management; further generalizability theory analysis indicated comparable reliability with the same number of teachers. (5) Consequences: Over 80% of students positively perceived peer assessment on a 5-point Likert scale survey.ConclusionThis study confirms the validity and reliability of ACLS SBL rubrics while utilizing peers as raters. Rubrics can exhibit clear performance criteria, ensure uniform grading, provide targeted feedback, and promote peer assessment skills.

Nurse Practitioner Education: Recommending Theories and Frameworks for Simulation-Based Experiences and Research

Simulation-based education is an evidence-based strategy to address learning and evaluation of outcomes in the updated American Association of Colleges of Nursing Essentials. Currently, there is a dearth of rigorous research on nurse practitioner education simulation. Studies on the topic often neglect a sound theoretical or conceptual framework beyond the National League of Nursing Jeffries Simulation Theory. This article aims to explore and distinguish the implementation of various theories and frameworks to determine how these elements can be stand-alone or used in combination to explore simulation-based experience competency outcomes. Specific recommendations for simulation research are (a) to include learning theories, (b) level learning and track competency progression using a framework, and (c) use a framework for measuring outcomes. Simulation science for nurse practitioner education can be advanced through united and consistent use of established theories and frameworks. These efforts will inform emerging best practices of simulation-based learning to address competition-based learning initiatives, validity of high-stakes simulation evaluation, and how to credit learners for simulation activities.

Healthcare Students' Experiences of Learner-Educator Cocreation of Virtual Simulations: A Phenomenographic Study.

Cocreating virtual simulations with learners during a course is an innovative approach to improving student preparation for real-world practice while helping simulationists meet learner needs, support authentic assessment, and maximize the impact of simulation-based learning. This study explores differences in healthcare students' experiences of learner-educator cocreation of virtual simulations (LECoVSs) using phenomenographic methods. Identifying differences in perceptions of LECoVSs enables educators to make evidence-informed decisions about engaging in simulation cocreation as a tool to maximize learning. Phenomenography focuses on identifying different ways that participants can experience the same phenomenon, in this case, LECoVSs. The setting was a collaborative interprofessional simulation assignment between navigation and nursing students. Participants completed a demographic survey then submitted reflective journals completed during the course and/or an open-ended survey. Data analysis occurred in iterative stages, from familiarization with the data to grouping and interpreting themes. Nineteen open-ended surveys and 13 reflective journals from navigation and nursing students who completed the simulation assignment between 2021 and 2023 were analyzed. Students experienced LECoVSs in 4 increasingly complex ways: (1) supporting consistent student progress, (2) amending course expectations, (3) sharing decision-making, and (4) fostering mutual growth. Simulationists may leverage cocreation to improve student learning, access, empowerment, and professional growth. However, for students to achieve higher learning outcomes, educators need to clearly communicate the full potential of cocreation, how it can occur, and why it can support learning. This study's findings may be used as a framework for explaining simulation cocreation to students to maximize their learning.

A Survey of Learning Technology Integration in Information Warfare Education

Information and communication technologies (ICTs) are enduringly important in today’s world. From paying for morning coffee at the local cafe to receiving a text message from a loved one, ICTs are a part of everyday life. On a larger scale, entire nations are dependent on ICTs. From power grids to the storage of classified documents, nations have come to rely on ICTs. This dependence on ICTs has increased information warfare’s importance as a warfighting domain. In order to effectively conduct information warfare operations, operators must first be properly trained on how to be successful in this domain. The use of learning technologies could be useful to train information warfare forces. This paper surveys the current state of learning technology integration into information warfare education. Learning technologies have become commonplace in today’s professional world. Many topics in organizations are taught through learning technologies such as interactive computer-based trainings, educational videos, and more complex serious games. This is no different for information warfare professionals. Learning technologies can provide alternative ways to teach important information warfare concepts such as the roles, assets, and capabilities that are necessary to succeed in this domain. The use of artificial intelligence, game-based learning, gamification, and simulation-based learning to enhance the training of information warfare forces is discussed in this survey. Additionally, the effect of adding learning technology into information warfare education curriculum as well as the key elements for each type of learning technology integrated are analysed. This paper also identifies areas of future research to further develop this topic. These findings are useful to information warfare educators who are developing curriculum or looking for ways to introduce new technologies into existing curriculum. Artificial intelligence, game-based learning, gamification, and simulation-based learning are all great options to support information warfare education, and there are even more options that have yet to be researched that present further opportunities to study in this area.

Effectiveness of Simulation-Based, Peer Learning Intervention in Continuing Nursing Education: An Explorative Study.

Despite the vast research by nursing professionals on various methods of nursing education, little research has been conducted exploring the efficacy of peer learning as a teaching-learning tool amongst registered nurses. Hence, this study was conducted among in-service nursing officers to evaluate the usefulness of simulation-based peer learning sessions as an educational tool for capacity building. Using a pre-test and post-test design, the study was conducted among 150 in-service nurses at a tertiary care hospital. Five structured simulation-based, peer learning modules were designed. The nurses were divided into five groups using random and purposive sampling. Each group attended one session of the peer learning module on advanced nursing care by simulated clinical and nursing care 'demonstrate, observe, assist, and perform' (DOAP) activity. Pre-test, post-test, and retention tests (after two months) were conducted, and the results were compared. There was a significant increase in mean knowledge (p-value < 0.05) in the post-test after all five sessions, which shows the effectiveness of such peer learning sessions in improving the baseline. There was a decline in mean scores in the retention test compared to that of the post-test, which was statistically significant in only the group of learners participating in the first session. The study provides substantial evidence that simulation-based peer learning is an effective tool for continuing nursing education, and it can be used as a valuable tool to reduce the documented theory-practice gap.

Safely gaining experience in death and dying: Simulation in palliative care and end-of-life education

BackgroundTraining in palliative and end-of-life (EOL) care provision represents a critical topic in health professional curricula for ensuring a workforce prepared to provide safe and person-center care at the end of one's life. This manuscript describes the incorporation of a simulation-based learning experience (SBLE) and the evolution of a professional elective course for student pharmacists related to palliative and EOL care. Educational activityA SBLE was incorporated into a long-standing professional pharmacy elective course in palliative and EOL care. The decision to incorporate and utilize SBLE to introduce topics of deprescribing, communication, prioritization of quality of life, and establishing goals of care was utilized in recognition of a need to establish a psychologically safer environment to allow students to explore these topics prior to the advanced pharmacy practice experiences. DiscussionIncorporation of SBLE in this professional elective course resulted in a favorable effect on course enrollment. Observations from structured debriefing and anecdotal student feedback suggest that students had trouble tailoring care plans to the circumstances, particularly in focusing on de-escalating medication treatments, emphasizing the need for training in the care for this patient population which incorporate considerations for goals of care. Lessons related to the influence of environmental distractions, expressions of discomfort conveyed by body language, and challenges in prioritizing and focusing on tailoring care plans given evolving information at hand were identified. ImplicationsWe describe the effective implementation and utilization of SBLE in a professional elective focused on palliative and EOL care for student pharmacists. Future directions include research initiatives designed to evaluate the impact of simulation on key competencies and areas developed through participation in such exercises. Systematic evaluation of outcomes and competencies related to team dynamics, sympathetic communication, professional identity formation and resiliency and preparation for dealing with death and dying in experiential learning are planned.