Simulation In Healthcare Education Research Articles

Challenges and opportunities in the uptake of simulation in healthcare education in the developing world: a scoping review

Background Simulation is increasingly being adopted by healthcare educators throughout the developed world as it offers a safe environment to practice skills. While there is literature on learning via simulation in healthcare in the developed world, more studies are required to investigate the factors influencing this approach in the developing world. Objective This scoping review highlights the key factors that act as deterrents as well as encouragement to the uptake of simulation as a teaching methodology in healthcare education in developing countries. Design The MEDLINE (via OVID, using keywords and MeSH in OVID), and PubMed (via NCBI using MeSH), and CINAHL databases were searched between January 2000 and January 2024 for research articles published in peer reviewed English language journals using a combination of keywords. Results A total of 48 articles were included in the final analysis. Challenges and opportunities were divided into professional, academic, and resource-based factors, and their individual sub-themes. The main challenges reported were the lack of a contextual curriculum, content heavy curricula, dearth of trained simulationists and cost of simulators. Performance anxiety was an important challenge reported by both trainers and trainees. Main opportunities were an interest in adopting simulation-based education from both trainers and trainees, and the opportunity to improve patient safety and quality of education. Other findings were that academic leadership and faculty show interest and urgency to adopt simulation in curricula and allocate funds for this. Facilitators need to be provided with protected time to become simulationists. Local manufacturers need to be sourced for simulators, and transfer of technology and expertise needs to be negotiated. Conclusion Simulation needs to be looked at from the lens of not only education, but more importantly of patient safety in developing countries to allow simulation-based education to be mainstreamed in health professions education in low- and middle-income contexts.

Exploring accessible, inclusive and sustainable simulation-based education in remote and rural communities: a realist review

Access to and inclusion in simulation-based education (SBE) for remote and rural (RR) healthcare practitioners, irrespective of geographic setting, professional background and workplace context, is challenging. This challenge is compounded because simulation in healthcare education is acknowledged as a complex intervention, and healthcare systems are in and of themselves complex. A realist review of published and grey literature was conducted, seeking to identify programme theories and to explore what works, how and why, in respect of mobile and distance SBE for healthcare practitioners in RR and harder-to-reach communities. There is limited rigorous research in this field. Mobile and distance simulation programmes exist in physical, digital and hybrid forms. This makes simulation more accessible and inclusive for RR healthcare professionals in respect of facilitating simulation. It allows for clinical and simulation centres of expertise to collaborate with harder-to-reach communities enabling the contextualizing of learning with, from and about the needs of a target population. However, the challenges of implementing and sustaining mobile and distance simulation interventions are underexplored. Mobile and distance programmes of SBE are introduced into and are subject to dynamic and heterogeneous social contexts. The intended outcomes of such programmes are dependent on building relationships, trust and networks between geographically distanced communities of practice. These social connections are the key mechanisms which support accessibility, inclusivity and sustainability. Further explorations of mobile and distance simulation innovations are critical to building capacity, sustainable solutions and enhancing future use.

Standardized Patient Simulation in Healthcare Education

Standardized Patient Simulation in Healthcare Education

The effect of deception in simulation-based education in healthcare: a systematic review and meta-analysis

Simulation in healthcare education enables learners to practice in a realistic and controlled environment without putting real patients at risk. Deception can be incorporated to generate a realistic learning experience. We aim to perform a systematic review of the literature to study the effect of deception in SBE in healthcare. Online database search was performed from conception up to the date of search (December 2023). Qualitative descriptive analysis included all published and unpublished works as for the quantitative analysis, only randomized clinical trials with an objective measurement tool relating to learner’s performance were included. Forward citation tracking using SCOPUS to identify further eligible studies or reports was also applied. Twelve out of 9840 articles met the predefined inclusion criteria. Two randomized controlled trials were identified using deception for the intervention group and ten articles provided current knowledge about the use of deception in simulation-based education in healthcare. The aspects discussed in the latter articles related to the possible forms of deception, its benefits and risks, why and how to use deception appropriately, and the ethics related to deception. Although this meta-analysis shows that using deception in SBE in healthcare by challenging authority negatively affects the trainees’ performance on the mAIS scale, this approach and other forms of deception in SBE, when used appropriately and with good intent, are generally accepted as a valuable approach to challenge learners and increase the level realism of SBE situations. Further randomized trials are needed to examine and confirm the effect of other deceptive methods and the true psychological effect of those interventions on validated scales.

The integration of simulation into a post registration neurological course: a phenomenological research study

Background: Simulation in healthcare education is becoming increasingly popular. However, there is limited evidence of simulation in post registration education or in neurological practice. This article reports on the introduction of simulation into a neurological course for registered nurses and the value of this from the learner perspective. Aim: To explore the experiences of nurses who participated in a neurological simulation activity. Methods: A phenomenological research design was used to explore the experiences of 10 registered nurses using semi-structured interviews. Findings: A total of four key themes were generated from the analysis: being in the spotlight, reality of simulation, theory to practice interface, and learning and working with others. Conclusion: The lived experience of the participants of this study has shown that neuro-simulation is valued as a teaching strategy to consolidate learning, with low-fidelity simulation receiving the most positive feedback owing to its authentic nature. A review of the high-fidelity session, where the simulation should become more realistic and use smaller, interprofessional groups, needs to be considered.

SIM-STEPS: a structured trainee educator programme in simulation – an innovative, blended learning approach for simulation faculty development

At present there are limited resources for simulation faculty development and educators are unable to access face-to-face courses uniformly across the region. Currently available online resources lack interactive reflective activity and recorded faculty videos which leads to a less engaging and effective learner experience. We aimed to create a structured and accredited simulation faculty development course on the Bridge online platform for educators who are novice in simulation-based education using a blended learning approach by incorporating recorded faculty videos and current available resources on eLearning For Healthcare (eLFH), Scottish Simulation framework and provide a platform with links to online resources. A scoping review was conducted to review current available online resources and face to face courses across the East of England region. Faculty across the region were contacted to understand the learning objectives, outcomes, and content of their courses. A survey was sent out to Bridge users across the region to determine how best to deliver the simulation faculty development course and whether they would find a Bridge course useful. We received 158 responses of which 94% respondents were keen to develop their simulation education skills, 74% had not received any formal training, and nearly 90% wanted a blended learning course. SIMSTEPS has been developed following a detailed gap analysis and scoping review. The course has been designed incorporating the eLFH learning modules, the Scottish framework for Simulation Faculty development. It does not replace face to face teaching but gives a starting point to develop the learners’ knowledge and skills about simulation-based education which can be enhanced further in face-to-face courses or workshops. Modules have been developed on key topics relevant to simulation-based education [1] with links to videos, recorded Faculty sessions, and online educational resources. Learners are encouraged for continuing reflective practice [2] and prompted to reflect after modules. The course would be accessible to all Bridge users (Interprofessional educators) in the East of England at no cost and can be completed by them at their own pace and time. We planned meticulously to ensure the course content meets learning objectives and ensured quality assurance by independent review of the course by established and experienced faculty. Post-course evaluation by learners will be done on course completion. A blended learning course like SIM-STEPS can potentially provide an effective resource on Simulation faculty development and improve learner experience and engagement. 1. Motola I, Devine LA, Chung HS, Sullivan JE, Issenberg SB. Simulation in healthcare education: a best evidence practical guide. AMEE Guide No. 82. Medical teacher. 2013;35(10):e1511–1530. 2. Brydges R, Manzone J, Shanks D, Hatala R, Hamstra SJ, Zendejas B, Cook DA. Self‐regulated learning in simulation‐based training: a systematic review and meta‐analysis. Medical education. 2015;49(4):368–378.

Successfully delivering a new, trust-wide in-situ simulation training programme to multidisciplinary teams in the clinical environment

Simulation-based education is well established as a teaching strategy but is often taught in dedicated simulation centres. In-situ simulation had previously been less prominent as a teaching tool within the Trust due to lack of awareness of its benefits and versatility. The aim of this project was to utilise in-situ simulations to increase knowledge and implementation of Trust processes, encourage self-reflection, collaboration, and communication within the clinical teams [1]. As part of a year-long collaborative project between our nursing education and simulation teams, an in-situ simulation programme was designed for delivery to established teams. Simulation topics came from various sources including local patient safety agenda, patient safety incidents, curricular requirements, and educational priorities. The simulations were undertaken in their native clinical setting and sessions were supported by subject-matter experts to ensure accuracy and appropriate complexity. These sessions were aimed to reach all members of the multidisciplinary team with the focus on nursing workforce and allied healthcare professionals. Over a period of four months, thirty sessions were delivered, at approximately thirty minutes per session, in five clinical areas. These sessions encompassed key priorities including care of the deteriorating patient, falls, end of life care, and tissue viability. This included a pre-simulation discussion and a debriefing immediately after. Feedback was gathered from the 113 participants using a post-course survey, featuring both quantitative and qualitative questions to analyse pre- and post-simulation experience, confidence, and knowledge of how to care for patients with a focus on the identified key priorities. The results collected showed a 25% increase in confidence partaking in simulation again, 10% increase of confidence working and communicating within a multidisciplinary team, 14% increase in confidence assessing patients, and 6% increased awareness of personal/professional limitations. The main themes reported by participants were increased awareness of Trust protocols and incident reporting, improved value of self-reflection through the debriefings, and increased awareness of effective team communication to support patient safety. Additionally, the delivery of more regular sessions would aid with exploring different topics in greater detail and further solidify their knowledge. Participants valued the provision of live actors and authentic learning experiences in the workplace. In-situ simulation is an effective method of delivering multidimensional, realistic scenarios allowing participants the opportunity to continuously explore various clinical priorities and human factors. Regular, reoccurring simulation sessions in the clinical setting would prove more effective in improving patient safety along with staff’s confidence and competence. 1. Martin A, Cross S, Attoe C. The Use of in-situ Simulation in Healthcare Education: Current Perspectives. Adv Med Educ Pract. 2020;11:893–903.

Using Simulation to Teach Learners in Health Care Behavioral Skills Related to Diversity, Equity, and Inclusion: A Scoping Review.

Bias is commonplace in the health care environment and can negatively impact patients and their health outcomes. Simulation has long been shown to be an effective teaching tool for communication skills in health care, but it has rarely been used to deliver concrete behavioral skills that address issues of diversity, equity, and inclusion (DEI). This scoping review examines 23 published articles surrounding the use of simulation in health care education to impart behavioral skills that reduce bias and promote DEI. Included articles described various behavioral skills including communication, history-taking, and system/community-level advocacy. The most commonly used simulation modality to teach these skills included the use of simulated participants (16 articles, 70%). The main DEI topics addressed in the trainings included sexual orientation/gender identity, language, and culture/ethnicity. Based on findings from this review, the authors suggest recommendations for educators who are considering teaching DEI-related skills through simulation.

How to plan for simulation integration into undergraduate physiotherapy training

Background. The benefits of simulation in healthcare education are undeniable, and in the current healthcare climate, a drastic change in delivering healthcare training is critical. Therefore, integration of simulation is essential, and necessitates detailed planning and well-trained educators. Objectives. To develop a conceptual framework for the integration of simulation in South African (SA) undergraduate physiotherapy programmes. Methods. A non-experimental descriptive research design using a modified Delphi survey was conducted. Results from a systematic review identifying simulation integration framework elements informed the Delphi survey. A purposive sample of 15 healthcare educationalists from SA and abroad were approached to participate. Data were analysed as percentages, and feedback was provided to panel members following each round.
 Results. A response rate of 73.3% (n=11) was achieved. Planning was explored as one of the themes. Both institutional- and discipline-specific needs analyses were identified as essential (93%), and societal needs were useful to consider (64%). Resource identification and sharing (84%) were regarded as vital, and expert collaboration in curriculum development (79%) with scaffolded skills integration (75%) was advised. The necessity for trained facilitators (93%) and educator role identification (71%) was evident. Statements related to mastery learning/deliberate practice and the use of simulation for assessment purposes yielded the least consensus.
 Conclusion. A constructively aligned curriculum based on both student and institutional needs and resource availability in guiding simulation integration was regarded as essential. Educator competency in both the development and delivery of the programme, especially debriefing methods, is vital for optimising student learning.

Simulation in plastic surgery: Features and uses that lead to effective learning

Background. Increased competition for surgical exposure and practice, smaller teaching platforms and shorter training times have an impact on the quality of training and competence of plastic surgery registrars. Demands for accountability and minimising patient risks are the driving forces for incorporating simulation in healthcare education. We addressed the problem of whether the features and uses of simulation would enhance postgraduate plastic surgery education and training and ensure more effective learning. Objective. To identify and describe: ( i ) how simulation impacts on student learning; therefore, how the effectiveness of learning may be enhanced in postgraduate and/or plastic surgery education and training; and ( ii ) which features and uses of simulation have the potential to enhance learning in plastic surgery. Methods. A descriptive design was used for the study. Data were collected by means of semi-structured interviews with 8 national and international role players in simulation. Results. The results indicated a positive outcome of simulation, as it provides, e.g. a non-threatening environment for learning and improves clinical competency, ensuring an increase in patient safety. The features and uses of simulation render it an excellent method to enhance learning effectiveness at different cognitive levels and to fulfil a specific role in integrated and holistic training, while providing opportunities to practise specific skills. The lack of clinical opportunities can be addressed, and more clinical exposure and practice will result in fewer medical errors. Conclusion. Simulation-based education in postgraduate plastic surgery education and training proved to be an effective teaching-learning method, which provides solutions to current deficiencies, hindrances and gaps in health professions education. The research question was answered and the use of simulation is recommended to enhance plastic surgery education and training and promote safe patient care.

The Use of in situ Simulation in Healthcare Education: Current Perspectives.

In situ simulation is the practice of using simulated scenarios in a clinical environment itself rather than in training facilities to promote learning and improved clinical care. The use of in situ simulation has been increasingly used to train healthcare staff in dealing with emergencies, resuscitation and clinical skills. The aim of this study is to provide an overview of the themes, perspectives and approaches to in situ simulation for educational purposes with healthcare staff. The literature search included studies describing and evaluating in situ simulations with an educational component. We carried out a narrative synthesis and extracted data on the clinical setting, the simulation purpose, design, evaluation method and impact. In situ simulation has proved useful in a range of different specialties for skills improvement and team development. Simulation design ranges in terms of fidelity, duration and topic. No specific design has shown to be the most efficient. However, adopting a design that fits into the specific centers resources, educational needs and clinical demands is the most important consideration.

Application of Mezirow’s Transformative Learning Theory to Simulation in Healthcare Education

Theory is a vital component of teaching, providing both systematic ways in which to view the learning process and frameworks for designing educational experiences. There is growing interest in identifying theory specific to simulation-based learning (SBL). We assert that the ten phases of Mezirow’s Transformative Learning Theory (TLT) closely mirror the simulation process of prebriefing, scenario, and debriefing in preparation for future experiences. The assumptions of TLT may help SBL facilitators understand how simulation fosters transformative adult learning. However, limitations to the theory must also be considered when applying TLT to the SBL arena.

The Evolution of High‐fidelity Patient Simulation in Medical Education: A Literature Review

INTRODUCTIONThe use of patient simulation in healthcare education is extensive. This literature review identified and discussed the origins and current state of high‐fidelity patient simulation (HFPS) in medical education.AIMThe aim of this research was to piece together a comprehensive history of clinical simulation and to compile results from past and present HFPS investigations in order to develop evidence‐based recommendations for best practices when incorporating HFPS into medical curricula.METHODSData was obtained from an iterative review of historical literature, primary resources and references, as well as personal communication with authors of articles and texts related to the clinical application of simulation. Databases consulted included PubMed, Web of Science, ERIC, ProQuest Dissertations & Theses, EBSCOhost, Google Scholar, and the Indiana University library archive collections. As human subjects were not directly involved in this study, ethical approval was not applicable.RESULTSOver 110 different sources were reviewed and synthesized for data regarding the history, fidelity, advantages, challenges, and learning theories associated with HFPS in medical education. A review of current clinical HFPS research is organized by discipline and includes undergraduate medical education, continuing medical education, nursing education, and undergraduate pre‐professional education.DISCUSSION AND CONCLUSIONThis review spanned historical applications of clinical simulation dating back to Mesopotamia between the fourth and first millennia BCE and concludes with a review of computer‐controlled high‐fidelity simulators available today to train healthcare providers. Recommendations based on the literature include: formally integrating HFPS throughout the medical curriculum; providing authentic interprofessional education (IPE) opportunities for medical and other allied health professionals to develop essential team skills; and investing in the initial and continued training for those delivering the simulated experience and post‐simulation debrief.

Creating intelligent virtual patients for simulation-based pharmacy education through human-centred conversation modelling

Virtual Patients (VPs) with interactive conversational abilities are essential to create a fully immersive simulation in healthcare education. This paper presents a VP design case guided by educational design research that took the formative design approach towards their VR design and continuously refined them. The specific refinement processes used in the case include three phases of expert review, Human-centred distributed Conversation Modelling (HCM), and performance data analysis. HCM was employed as an integral approach to overcome limitations of the traditional Centralised Conversational Modelling (CCM). This paper describes each of the three phases and presents evaluation findings (continuity error rates, unanswered question error rates, and total error rates) using the three designed VPs for the Over-the-Counter (OTC) simulation for pharmacy students and further shares the useful knowledge constructed in creating VPs and lessons learned in the design process.

A conceptual framework for simulation in healthcare education — The need

This study used a social constructivist approach to explore the literature in relation to the acknowledgment and application of models and frameworks in simulation based learning and teaching activities in health care education. This paper addresses the data collection phases in the research design in developing a Conceptual Framework for Simulation in Healthcare Education. BackgroundTwo literature review activities occurred in the study. The first literature review explored the challenges in the literature for further research in relation to the educational factors that have an impact upon simulation as a learning and teaching modality. This part of the research process was to identify the publications that address simulation as a learning and teaching modality and uncover evidence to justify the study. The literature revealed that there were limited publications in relation to simulation as a learning and teaching modality that was underpinned by a conceptual framework. DesignThe study research design employed Evaluation Research to conduct a further intensive review of the literature as part of phase one of data collection. The second part of phase one of data collection was the surveying of randomly selected simulation education centres around the world to ascertain their employment of a conceptual framework in the application of simulation as a learning and teaching modality. Phase two was the genesis of the conceptual framework and Phase three was the evaluation of the draft framework using a modified Delphi Technique by randomly selected simulation experts. ResultsThe intensive literature review highlighted that authors acknowledged education-based theories but this did not extend to the application of a conceptual framework to simulation as a learning and teaching modality. The survey provided the evidence to support the development of a Conceptual Framework for Simulation in Healthcare Education for the conceptualisation, design, development and delivery of simulation teaching and learning activities in health care education. The simulation experts provided valuable data and commentary in the final formation of the conceptual framework. ConclusionBased on the outcomes of the literature review, questionnaire and modified Delphi Technique the need for the development, and subsequent structure and utility of the Conceptual Framework for Simulation in Healthcare Education was verified.

Using Scenario-Based Simulation to Address Affective Behaviors in Sonography Students

Simulation in health care education is considered an educational strategy in which a particular set of conditions is created or replicated to resemble authentic situations that are possible in real life. This research study records sonography student self-reflected confidence levels in three patient care scenarios using pre- and postsimulation surveys and debriefing strategies. Student confidence improved in (1) explaining the examination, (2) prepping the patient, and (3) performing the examination. In addition, students stated they had more confidence in what to do when a negative outcome is communicated to the patient. They also expressed greater appreciation for the importance of institutional policies that guide patient care. Research is ongoing to determine whether the simulation lab experience correlates to improved student performance in the actual clinical setting. This research occurred in a simulation lab but could be replicated by using high-fidelity sonography simulators and assigning an actor to interact with student learners.

Using Scenario-Based Simulation to Address Affective Behaviors in Sonography Students:

Simulation in health care education is considered an educational strategy in which a particular set of conditions is created or replicated to resemble authentic situations that are possible in real...

Training students to detect delirium: An interprofessional pilot study

AimThe purpose of this paper is to report nursing student knowledge acquisition and attitude after completing and interprofessional simulation with medical students. IntroductionThe IOM has challenged healthcare educators to teach teamwork and communication skills in interprofessional settings. Interprofessional simulation provides a higher fidelity experience than simulation in silos. Simulation may be particularly useful in helping healthcare workers gain the necessary skills to care for psychiatric clients. Specifically, healthcare providers have difficulty differentiating between dementia and delirium. Recognizing this deficit, an interprofessional simulation was created using medical students in their neurology rotation and senior nursing students. MethodTwenty-four volunteer nursing students completed a pre-survey to assess delirium knowledge and then completed an education module about delirium. Twelve of these students participated in a simulation with medicine students. Pre and Post Kid SIM Attitude questionnaires were completed by all students participating in the simulation. After the simulations were complete, all twenty-four students were asked to complete the post-survey regarding delirium knowledge. ResultsWhile delirium knowledge scores improved in both groups, the simulation group scored higher, but the difference did not reach significance. The simulation group demonstrated a statistically significant improvement in attitudes toward simulation, interprofessional education, and teamwork post simulation compared to their pre-simulation scores. ConclusionNursing students who participated in an interprofessional simulation developed a heightened appreciation for learning communication, teamwork, situational awareness, and interprofessional roles and responsibilities. These results support the use of interprofessional simulation in healthcare education.

State of Simulation in Healthcare Education: An Initial Survey in Beijing.

Background and Objectives:In 2013, medical error was the third leading cause of death in the United States.1 In China, as in the case with the United States, training and assessment are developing as a strategy to reduce the occurrence of such errors. The objective of this study was to assess the current state of the use of simulation-based training in Beijing and to explore the barriers to further development.Methods:This study included hospitals in Beijing accredited by the Standardized Residency Training (SRT) program. The questionnaire was designed online and distributed to the SRT management departments by e-mail or instant message.Results:Thirty hospitals were invited to participate in this survey, and 15 responses were completed and met the inclusion criteria. Task trainers (15/15), full-scale mannequins (14/15), standardized patients (12/15), and virtual reality workstations (11/15) were the most common types of simulation modalities available for use. Among the given specialties for SRT, the availability of simulation courses was 2/2 for pediatric internal medicine, 1/1 for pediatric surgery, 10/11 for surgery, 11/14 for internal medicine, 7/9 for anesthesiology, 6/8 for emergency medicine, and 3/9 for obstetrics/gynecology. Of the 13 institutions with available simulation curricula, 12/13 had simulation focused on proficiency-based skill training, 11/13 had medical knowledge learning, 10/13 had skill competency assessment. The main targeted trainees in these hospitals were residents (or postgraduate residents) and medical students (or interns). The top 2 barriers were the shortage of sustainable financial resources (12/15) and advocacy from their institutional authorities (7/15).Conclusion:It is evident that there is a need for more development of training facilities, and for training the “trainers” and administrators. Financial funding, curricular design, and research seem to be crucial for building a long-term, sustainable, effective program.

Simulation in Healthcare Education. An Extensive History

The Obstetrician & GynaecologistVolume 18, Issue 4 p. 330-330 Book Review Simulation in Healthcare Education. An Extensive History First published: 23 October 2016 https://doi.org/10.1111/tog.12329Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume18, Issue4October 2016Pages 330-330 RelatedInformation