Simulated Learning Environment Research Articles

What do we understand about maternal–fetal drug disposition? Critical issues and knowledge for midwives practicing across the childbearing continuum

In midwifery we espouse a woman centred care approach to practice, yet in midwifery education no valid instrument exists with which to measure the performance of these behaviours in midwifery students.To develop and validate an instrument to measure woman centred care behaviours in midwifery students.We identified four core concepts; woman’s sphere, holism, self-determination and the shared power relationship. We mapped 18 individual descriptive care behaviours (from the Australian National Competency Standards for the Midwife) to these concepts to create an instrument to articulate and measure care behaviours that are specifically woman centred.Review by expert midwifery clinicians ensured face, content and construct validity of the scale and predictive validity and reliability were tested in a simulated learning environment. Midwifery students were video recorded performing a clinical skill and the videos were reviewed and rated by two expert clinicians who assessed the woman centred care behaviours demonstrated by the students (n = 69).Test and re-test reliability of the instrument was high for each of the individual raters (Kappa 0.946 and 0.849 respectively p < 0.001). However, when raters were compared there were differences between their scores suggesting variation in their expectations of woman centred care behaviours (Kappa 0.470, p < 0.001). Midwifery students who had repeated exposures to higher levels of simulation fidelity demonstrated higher levels of woman centred care behaviours.The WCCS has implications for education and the wider midwifery profession in recognising and maintaining practice consistent with the underlying philosophy of woman centred care.

Advance Care Planning Communication for Young Adults

The process of advance care planning (ACP) is shown to improve quality of life at the end of life by increasing communication, social support, autonomy, and emotional well-being and by decreasing stress, anxiety, and depression. However, approaching the topic of ACP is challenging, and there is often discomfort on the part of the clinician, as well as the patient and family. Issues such as fear of removing hope, lack of training, and timing are described in the literature as barriers to discussions about end of life. Conversations about future health are not easy and are often avoided by both health care providers and families. They are even less likely to occur if the patient is not an adult. The literature on ACP in young adults has increased in recent years and shows that this communication does not result in distress or negative effects on psychological well-being and is helpful for patients and caregivers. The purpose of this evidence-based project was to use an advance directive document as a guide to initiate communication about ACP for young adults with high-risk cancer in a simulated clinical setting. A pretest/posttest nonexperimental design was used to describe nurse provider confidence and attitudes toward ACP in young adults, as well as satisfaction with the use of Voicing My Choices to introduce ACP within the simulated experience. Eighteen nurse providers were recruited from a convenience sample of practicing pediatric nurses and nurse practitioners from a large metropolitan teaching hospital. Each measure of self-confidence in ACP significantly increased after the simulation, including comfort in ability to initiate ACP in the practice setting (t = −4.01, P &lt; .0009), confidence in ability to discuss ACP (t = −2.49, P &lt; .02), confidence in ability to discuss ACP with patients younger than 18 years (t = −3.42, P &lt; .003), and an acknowledgement that they possess the skills needed to have an ACP discussion with their patients (t = 0.002, P &lt; .002). There was an overwhelmingly positive response to this simulation activity. The participants felt that the simulation should be held routinely and that ACP should be a regular part of conversations with patients. Advance care planning is important and, too frequently, a missing step in the care of young adults with life-limiting conditions. There is evidence to support the recommendation that clinicians routinely provide ACP to young adults. However, few nurse providers have training or experience in having these difficult conversations. Offering a simulated learning environment enables the learner to develop competence and confidence in communication skills required for difficult conversations such as ACP in a safe environment. In this project, most nurses had no previous training in ACP. After a 45-minute simulation exercise, these nurses expressed significant increases in self-confidence and skills not only to discuss ACP but also to initiate the conversation. In addition, nurse providers felt that it was beneficial to use an ACP tool such as Voicing My Choices as a guide to structure the conversation.

The use of virtual reality simulation to improve technical skill in the undergraduate medical imaging student

ABSTRACTIn recent years, simulation has increasingly underpinned the acquisition of pre-clinical skills by undergraduate medical imaging (diagnostic radiography) students. This project aimed to evaluate the impact of an innovative virtual reality (VR) learning environment on the development of technical proficiency by students. The study assessed the technical skills of first year medical imaging students. The learning experience by each student was either via traditional laboratory-based simulation or VR simulation, for two specified anatomical protocols. Following the learning experience, the students performed role-plays and were assessed on their technical proficiency. The type of learning environment, laboratory-based or VR simulation, was recorded for each radiographic procedure, as well as demographic data. Data demonstrated an improved total role-play skill score for those students trained using VR software simulation compared with the total role-play skills score traditional laboratory simulation. Demographic multivariable analysis demonstrated no statistically significant association of age, gender, gaming skills/activity with the outcome. The novel medical imaging VR simulation learning tool facilitated technical skill acquisition, equal to, or slightly better than traditional laboratory training. Ongoing data collection will evaluate the impact this VR software has on the undergraduate medical imaging student.Abbreviations: QUT: queensland university of technology; VR: virtual reality; SLE: simulated learning environment; PA: posterio-anterior; DP: dorsi-plantar; CP: central point; CR: central ray; SID: source image distance; HWA: health workforce Australia

Nursing and medical staff’s experiences of simulation education

Objective: The purpose of the research was to describe nursing and medical staff’s knowledge of simulated learning and their experiences of the usefulness of simulation education in one hospital district in Finland. The research aimed at producing user-oriented knowledge to be used in the development of multiprofessional simulation pedagogical continuing education. The study is part of a larger research project, whose purpose is to build up a multiprofessional simulated learning environment for a network of partners. They involve a university of applied sciences, a vocational education center, a health technology development center and a hospital district.Methods: Data were collected using aWeb-based survey tool between December 1, 2016 and January 13, 2017. The questionnaire contained both quantitative (n = 24) and qualitative (n = 3) items. This article deals with quantitative data only. Data was analyzed using SPSS Statistics for Windows 23. The response rate was 28% (n = 125).Results: Both nursing and medical staff found that simulation education had been useful for the development of their theoretical and practical competence. Some statistically significant differences were discovered between various age and professional groups.Conclusions: As a conclusion, nursing and medical staff in this hospital district need more information about simulation education and simulated learning environments. The knowledge produced in this study can be used in planning multiprofessional simulation pedagogical continuing education. Simulation pedagogy can be especially useful when practicing teamwork and interaction in acute, recurring and infrequent care situations.

Learning in Simulated Environments: A Comparison to Learning in a Physical Environments Using Video Data Analysis

Few studies that have evaluated the efficacy of learning in simulated environments have also examined differences in the processes that learners in the simulated environments employed to arrive at the outcomes being measured. In this video analysis study, the researchers sought to understand whether there were differences in the construction process used by participants who learned to construct circuits using a 2D simulation, a 3D simulation, or a physical breadboard and whether these differences subsequently impacted several learning outcomes. The researchers systematically reviewed 30 videos (10 videos per condition) of participants’ circuit construction to identify variations in their comprehension level and their construction procedures. The study found differences in the construction process, odds of successful construction, and construction time for participants in the three conditions that could be attributed to differences in fidelity. These findings provide valuable insights about how learning in simulated environments impact proficiency and learning and can help improve the design of simulated learning environments.

Developing physiotherapy student safety skills in readiness for clinical placement using standardised patients compared with peer-role play: a pilot non-randomised controlled trial

BackgroundUsing simulated learning environments with standardised patients (SPs) provides a way to scaffold the development of skills for patient safety in a low risk environment. There are no data regarding whether adding SP interactions in early years of physiotherapy training improves safe performance on clinical placement. We assessed the feasibility of recruiting and collecting data from junior physiotherapy students during an SP workshop with a pilot non-randomised trial, also assessing time, cost and scheduling information.MethodsSecond year physiotherapy students were invited to participate and allocated to either the SP workshop in a simulated hospital environment (with and without video feedback) or usual teaching comprising peer role play. The main outcome measures were participant recruitment, retention and survey response rates, whether the training and workshops were delivered as scheduled and costs for SPs and staff training and workshop attendance. Students self-reported confidence, communication, preparedness for clinic and satisfaction was measured using pre-post surveys.ResultsThe pilot trial proved feasible, with 108 students recruited (100%) and high retention (95%) and survey response rates (85%). The training sessions and SP workshops were delivered as scheduled, costing $4700AUD. Students rated their confidence and preparedness for clinical placement higher post intervention (p < 0.001) with high levels of satisfaction with the SP interactions (mean score 9.3/10).ConclusionsIn this setting the SP workshop was feasible. Further research incorporating a randomised trial investigating the integration of SPs for the development and assessment of patient safety skills in physiotherapy education is recommended.Trial registrationANZCTR no: 12,615,000,686,505.

Integrating Biomedical Sensor Data into a Simulation Learning Environment for Children Newly Diagnosed with Diabetes

Integrating Biomedical Sensor Data into a Simulation Learning Environment for Children Newly Diagnosed with Diabetes

Narrative, machinima and cognitive realism: Constructing an authentic real-world learning experience for law students

In Australian law schools didactic pedagogies such as lectures devoted to the transmission of theory and knowledge to a largely passive audience still predominate. However, curriculum design embedding authentic learning pedagogies has been shown to be supportive of student learning. The challenge in adopting such curriculum design is how to offer situated cognitive learning opportunities on a large scale to increasingly diverse cohorts. This paper is a case study of a blended learning approach introduced into a second year undergraduate law unit to teach negotiation theory and practice to a large cohort of students studying in full-time, part-time, and distance external modes. This innovation was situated in an authentic simulated learning environment created through careful design of a high-fidelity scenario, utilising a narrative depicted by Second Life machinima video and simulated documentation. This approach resulted in greater student engagement and improved learning outcomes.

Communication in the Operating Room Setting.

Ideal and effective communication consists of a clear, audible, and focused message from a transmitter that is delivered to an attentive, undistracted receiver, and consists of both verbal and nonverbal types. Communication in the health care setting is highly complex and dynamic, involving multiple settings, participants, and unique challenges. Effective communication in the perioperative environment is a requirement for safe patient care delivery and an important element of teamwork. A message must be accurately delivered in a uniquely high-risk and time-sensitive location, beset with numerous distractions, barriers, and challenges. Surgical checklists and time-out procedures have promoted a standardized, "all-hands" approach to addressing some of the challenges to effective communication in the perioperative environment. Postoperative debriefing sessions have demonstrated effectiveness in improving team functioning in the simulated learning environment and hold promise as another strategy to address these challenges, but require further research and development. Other promising strategies to improve effective perioperative communication are focused on team building activities and minimizing distractions at critical time points within patient care delivery, but to date are not substantiated by evidence. Future research is necessary to examine these novel approaches to improving communication in the perioperative environment to influence the safety of patient care delivery in this highly challenging health care setting. Wise men speak because they have something to say; Fools because they have to say something. Plato.

Development and piloting the Woman Centred Care Scale (WCCS).

In midwifery we espouse a woman centred care approach to practice, yet in midwifery education no valid instrument exists with which to measure the performance of these behaviours in midwifery students. To develop and validate an instrument to measure woman centred care behaviours in midwifery students. We identified four core concepts; woman's sphere, holism, self-determination and the shared power relationship. We mapped 18 individual descriptive care behaviours (from the Australian National Competency Standards for the Midwife) to these concepts to create an instrument to articulate and measure care behaviours that are specifically woman centred. Review by expert midwifery clinicians ensured face, content and construct validity of the scale and predictive validity and reliability were tested in a simulated learning environment. Midwifery students were video recorded performing a clinical skill and the videos were reviewed and rated by two expert clinicians who assessed the woman centred care behaviours demonstrated by the students (n=69). Test and re-test reliability of the instrument was high for each of the individual raters (Kappa 0.946 and 0.849 respectively p<0.001). However, when raters were compared there were differences between their scores suggesting variation in their expectations of woman centred care behaviours (Kappa 0.470, p<0.001). Midwifery students who had repeated exposures to higher levels of simulation fidelity demonstrated higher levels of woman centred care behaviours. The WCCS has implications for education and the wider midwifery profession in recognising and maintaining practice consistent with the underlying philosophy of woman centred care.

Attention Recognition in EEG-Based Affective Learning Research Using CFS+KNN Algorithm.

The research detailed in this paper focuses on the processing of Electroencephalography (EEG) data to identify attention during the learning process. The identification of affect using our procedures is integrated into a simulated distance learning system that provides feedback to the user with respect to attention and concentration. The authors propose a classification procedure that combines correlation-based feature selection (CFS) and a k-nearest-neighbor (KNN) data mining algorithm. To evaluate the CFS+KNN algorithm, it was test against CFS+C4.5 algorithm and other classification algorithms. The classification performance was measured 10 times with different 3-fold cross validation data. The data was derived from 10 subjects while they were attempting to learn material in a simulated distance learning environment. A self-assessment model of self-report was used with a single valence to evaluate attention on 3 levels (high, neutral, low). It was found that CFS+KNN had a much better performance, giving the highest correct classification rate (CCR) of % for the valence dimension divided into three classes.

Learning Patterns as Criterion for Forming Work Groups in 3D Simulation Learning Environments

This study analyzes the relationship between the use of learning patterns as a grouping criterion to develop learning activities in the 3D simulation environment at University. Participants included 72 Spanish students from the Education and Marketing disciplines. Descriptive statistics and non-parametric tests were conducted. The process was analyzed by means of teamwork measurements and the product was analyzed by assessing the final group performance. Results showed that learning patterns can be an effective criterion for forming work groups, especially when the students do not know each other.

The influence of a novel simulated learning environment upon student clinical subjective refraction performance: A pilot study

BackgroundOptometry students are taught the process of subjective refraction through lectures and laboratory‐based practicals before progressing to supervised clinical practice. Simulated leaning environments (SLEs) form part of an emerging technology used in a range of health disciplines; however, there is limited evidence regarding the effectiveness of clinical simulators as educational tools.MethodsForty optometry students (20 fourth year and 20 fifth year) were assessed twice by a qualified optometrist (two examinations separated by four to eight weeks), while completing a monocular non‐cycloplegic subjective refraction on the same patient with an unknown refractive error, simulated using contact lenses. Half of the students were granted access to an online simulated learning environment, The Brien Holden Vision Institute (BHVI) Virtual Refractor, and the remaining students formed a control group. The primary outcome measures at each visit were; accuracy of the clinical refraction compared to a qualified optometrist and relative to the Optometry Council of Australia and New Zealand (OCANZ) subjective refraction examination criteria. Secondary measures of interest included descriptors of student SLE engagement, student self‐reported confidence levels and correlations between performance in the simulated and real‐world clinical environment.ResultsEighty per cent of students in the intervention group interacted with the simulated learning environment (for an average of 100-minutes); however, there was no correlation between measures of student engagement with the BHVI Virtual Refractor and speed or accuracy of clinical subjective refractions. Fifth year students were typically more confident and refracted more accurately and more quickly than fourth year students. A year group by experimental group interaction (p = 0.03) was observed for accuracy of the spherical component of refraction and post hoc analysis revealed that less experienced students exhibited greater gains in clinical accuracy following exposure to the SLE intervention.ConclusionsShort‐term exposure to a SLE can positively influence clinical subjective refraction outcomes for less experienced optometry students and may be of benefit in increasing the skills of novice refractionists to levels appropriate for commencing supervised clinical interactions.

An Innovative Approach Using Clinical Simulation to Teach Quality and Safety Principles to Undergraduate Nursing Students.

The aim of this learning experience was to enhance students' knowledge of safety practices. A threefold approach was used, which involved viewing a prerecorded scenario in which safety practices were violated and another scenario that consistently depicted safe practice behaviors. Students then performed an environmental safety check of the physical simulated scene and then participated in a debriefing session. The conceptual basis for this project was the teaching-learning strategy "What's Wrong With This Patient," which requires the learner to evaluate a simulated learning environment to identify safety practices that were not followed and suggest strategies to correct these errors.

Behavioral Modeling Based on Probabilistic Finite Automata: An Empirical Study.

Imagine an agent that performs tasks according to different strategies. The goal of Behavioral Recognition (BR) is to identify which of the available strategies is the one being used by the agent, by simply observing the agent’s actions and the environmental conditions during a certain period of time. The goal of Behavioral Cloning (BC) is more ambitious. In this last case, the learner must be able to build a model of the behavior of the agent. In both settings, the only assumption is that the learner has access to a training set that contains instances of observed behavioral traces for each available strategy. This paper studies a machine learning approach based on Probabilistic Finite Automata (PFAs), capable of achieving both the recognition and cloning tasks. We evaluate the performance of PFAs in the context of a simulated learning environment (in this case, a virtual Roomba vacuum cleaner robot), and compare it with a collection of other machine learning approaches.

Using Multiple Representations to Simultaneously Learn Computational Thinking and Middle School Science

Computational Thinking (CT) is considered a core competency in problem formulation and problem solving. We have developed the Computational Thinking using Simulation and Modeling (CTSiM) learning environment to help middle school students learn science and CT concepts simultaneously. In this paper, we present an approach that leverages multiple linked representations to help students learn by constructing and analyzing computational models of science topics. Results from a recent study show that students successfully use the linked representations to become better modelers and learners.

A Simulated Learning Environment for Teaching Medicine Dispensing Skills

To develop an authentic simulation of the professional practice dispensary context for students to develop their dispensing skills in a risk-free environment. A development team used an Agile software development method to create MyDispense, a web-based simulation. Modeled on virtual learning environments elements, the software employed widely available standards-based technologies to create a virtual community pharmacy environment. Assessment. First-year pharmacy students who used the software in their tutorials, were, at the end of the second semester, surveyed on their prior dispensing experience and their perceptions of MyDispense as a tool to learn dispensing skills. The dispensary simulation is an effective tool for helping students develop dispensing competency and knowledge in a safe environment.

Designing the simulation learning environment: An active engagement model

Simulation is rapidly becoming a significantly learning methodology in healthcare education. The unique characteristics of simulation learning create a bridging experience between the classroom and actual patient care and, more importantly, helps learners develop advanced clinical reasoning skills. Learner active engagement is a critical requirement for effective learning during simulation and debriefing, which tasks educators to design simulation learning environments that foster learner active engagement. To foster learner active engagement, the educator and the learner must develop a dyadic relationship of trust, openness, sharing, and safety. The formation of this dyadic relationship implies that the learner has engaged in the learning environment. The simulation literature lacks significant discussion of how the elements of the simulation learning environment can be used to create a learning environment that encourages active engagement in the learning process. From the information gathered through a literature search in CINHAHL, PubMed, and Psychology and Behavioral Sciences databases, this article describes the critical elements of effective simulation learning. The purposes of this article are to elucidate how the interaction of important elements of the simulation experience can foster active engagement and to introduce an Active Engagement Model as a framework for designing the simulation learning environment that encourages and supports learner engagement. The components of the model are the educator, the learner, the environment, which must interact effectively to form the functional entity of the model–-the educator/learner dyad. Once the educator/learner dyad is formed, all the elements of the model function in concert to form an effective simulation learning environment.

CaseWorld™: Interactive, media rich, multidisciplinary case based learning

Nurse educators are challenged to keep up with highly specialised clinical practice, emerging research evidence, regulation requirements and rapidly changing information technology while teaching very large numbers of diverse students in a resource constrained environment. This complex setting provides the context for the CaseWorld project, which aims to simulate those aspects of clinical practice that can be represented by e-learning. This paper describes the development, implementation and evaluation of CaseWorld, a simulated learning environment that supports case based learning. CaseWorld provides nursing students with the opportunity to view unfolding authentic cases presented in a rich multimedia context. The first round of comprehensive summative evaluation of CaseWorld is discussed in the context of earlier formative evaluation, reference group input and strategies for integration of CaseWorld with subject content. This discussion highlights the unique approach taken in this project that involved simultaneous prototype development and large scale implementation, thereby necessitating strong emphasis on staff development, uptake and engagement. The lessons learned provide an interesting basis for further discussion of broad content sharing across disciplines and universities, and the contribution that local innovations can make to global education advancement.

Clinical Placement Before or After Simulated Learning Environments?: A Naturalistic Study of Clinical Skills Acquisition Among Early-Stage Paramedicine Students.

There is conflicting evidence surrounding the merit of clinical placements (CPs) for early-stage health-profession students. Some contend that early-stage CPs facilitate contextualization of a subsequently learned theory. Others argue that training in simulated-learning experiences (SLEs) should occur before CP to ensure that students possess at least basic competency. We sought to investigate both claims. First-year paramedicine students (n = 85) undertook 3 days of CP and SLEs as part of course requirements. Students undertook CP either before or after participation in SLEs creating 2 groups (Clin → Sim/Sim → Clin). Clinical skills acquisition was measured via direct scenario-based clinical assessments with expert observers conducted at 4 intervals during the semester. Perceptions of difficulty of CP and SLE were measured via the National Aeronautics and Space Administration Task Load Index. Students' clinical assessment scores in both groups improved significantly from beginning to end of semester (P < 0.001). However, at semester's end, clinical assessment scores for the Sim → Clin group were statistically significantly greater than those of the Clin → Sim group (P = 0.021). Both groups found SLEs more demanding than CP (P < 0.001). However, compared with the Sim → Clin group, the Clin → Sim group rated SLE as substantially more time-demanding than CP (P = 0.003). Differences in temporal demand suggest that the Clin → Sim students had fewer opportunities to practice clinical skills during CP than the Sim → Clin students due to a more limited scope of practice. The Sim → Clin students contextualized SLE within subsequent CP resulting in greater improvement in clinical competency by semester's end in comparison with the Clin → Sim students who were forced to contextualize skills retrospectively.