Simulation based learning places students in situations where they can put their classroom knowledge into practice. In healthcare, simulation training has been part of curricula since the 18th century; it has been continually evolving as technology advances.
This post explores the history of simulation in healthcare, highlights its advantages over other methods of learning, details the types of simulation environments, and shows how simulation-based learning benefits healthcare providers, students, and patients.
What is Simulation-Based Education?
Simulation-based education is the pedagogical approach of providing students with the opportunity to practice learned skills in real-life situations. (BMC Medical Education 16, 152 (2016)
Educational simulation is a teaching method that tests participants’ knowledge and skill levels by placing them in scenarios where they must actively solve problems. The instructor defines the parameters to create a safe environment for hands-on learning experiences.
When participating in a scenario, students must quickly evaluate the situation, decide on the best course of action, and perform the correct procedural steps. Educators can then assess whether the students understand the material and are translating their learned knowledge into skills.
Simulation is useful not only for students—it can also be a way for patients to practice new skills while healthcare providers measure their progress.
Simulation Based Learning Framework
Types of Simulation
Nursing students may be familiar with types of simulation in nursing education, such as standardized patients, role playing, and low-fidelity mannequins. Nursing education uses so many more types of simulation.
- Screen Based / PC Based Simulation
- Virtual Patients
- Partial task trainers
- Human patient Simulator
- Standardized Patients
- Integrated Models
History of Educational Simulation in Healthcare
The systematic use of simulation in healthcare education advanced in the 18th century in Europe. At that time, medical educators were improving the use of forceps in obstetrics. Obstetric simulators were created that could leak amniotic fluid and blood; midwives and obstetricians trained with these devices so they could better manage complications of childbirth and use forceps in optimal ways.
Simulation in medicine continued to advance during the 19th and 20th centuries. It was not until after the Industrial Revolution that technology developed to such a degree that simulation became a popular and standard feature of healthcare education.
Advantages of Simulation-Based Learning
Turn Knowledge into Practice
Simulation-based learning allows students to apply abstract concepts to active hands-on practice. For instance, nursing students can read about how to perform a procedure, but hands-on practice will help them feel much more comfortable. Practicing with mock or real patients in a dedicated clinical environment such as a clinical skills lab helps students learn to make appropriate decisions at various points within the scenario, especially when patient complications occur.
For patients, simulation-based learning provides a way for them to practice daily tasks without putting themselves and others at risk. For example, someone learning to drive again after a serious injury can benefit greatly from driving in a simulator under the supervision of an occupational therapist before driving an actual vehicle. The simulator provides safety for the patient and others.
Gather Measurable Data on Students and Patients
Another benefit of simulation in healthcare education is the ability to gather measurable data on students and patients. In simulation-based learning, the instructor defines the parameters of the scenario, and based on these parameters, can gather data on the progress of students and patients.
The instructor can monitor how participants make decisions and how long specific actions take, thus gleaning information about which skills need further practice and how far participants are from mastering them. Having this information establishes a future safety net for those involved by not putting unprepared students and patients in risky situations outside of simulations.
Safety for Practitioners and Patients
Simulation learning allows students and patients to experience an analog of a real-life situation while keeping themselves and others safe. Students typically practice with a mock patient, such as a manikin or a scripted actor, so if they make mistakes in their treatment protocol, this won’t adversely affect a real person. And the instructor can step in if something goes awry.
For patients, simulations can help them build confidence in performing challenging movements before they need to do so independently in real life.
Examples of Simulation Scenarios for Different Classes
The American Nurses Association recommends that the most effective simulations require faculty to coordinate what classes are going to use simulation scenarios. This way, students only repeat key skills in multiple classes. Otherwise, they learn different skills and experience new simulations in each of their classes. Below are examples of common scenarios.
1.Maternal Health
Students can perform newborn assessments using a newborn simulator or an appropriately sized doll. Students learn how to care for a laboring pregnant individual, especially in high-risk situations such as the pregnant patient hemorrhaging.
2.Leadership Courses
Students benefit from role-playing scenarios of ethical dilemmas or nurse-to-nurse bullying to learn useful strategies on how to deal with it.
3.Pediatrics
Students can practice infant assessment in a clinical setting. Standardized patients can act as parents or guardians with cultural differences to help students practice with scenarios, such as with a parent or guardian who does not want their child vaccinated.
4.Mental Health Nursing
Standardized patients help reduce students’ anxiety and stress and build their communication skills by listening to the patients and answering their questions correctly.
5.Multiple Classes
Students may practice their skills in patient handoffs, handwashing, and medication safety in multiple classes because those skills need repeating.
What to Expect in Nursing Simulation
Well-planned, effective simulation consists of three phases: prebriefing, simulation, and debriefing. Faculty must plan for and students must participate in all three phases for the simulation to be successful.
Prebriefing: The prebriefing phase of simulation tells students what to expect. It sets up the case scenario and the expected outcomes and objectives. The instructor should set ground rules and remind students that it’s okay to make mistakes. They will discuss the mistakes in the debriefing.
Simulation: The simulation phase should have a clear starting point that sets up the context for the simulation. The activities are designed to help students learn skills and practice what they would do in a clinical situation. They should be centered around the participants and their level of knowledge, skills, and experience. The endpoint is usually when the learning objectives are met.
Debriefing/Evaluation: Debriefing immediately follows the simulation. During the debriefing, students receive feedback from their instructor. They discuss mistakes and ways to improve their skills next time. Students reflect on their own performance and incorporate what they learned into their previous knowledge.
The Future of Education Simulation
Technology
Technological advancements are the primary factor in the growth of simulation education. Such advancements are particularly strong in the healthcare field, thanks to the motivation of scientists and physicians to continuously seek out ways they can improve their patients’ lives.
Given the innovative nature of medicine, the healthcare market is a robust candidate for investors and startups looking to build technologies.
Assessment
By gathering data on performance, simulations help with the assessment of both student practitioners and patients.
Performance assessment using simulation will be subject to rigorous evaluation as to its validity, reproducibility, feasibility, acceptability to stakeholders and impact on learning and practice.” This leads us to the need for standardization, or uniformity, within the multitude of simulations put into practice.
Uniformity
Due to the continued need for assessment, it’s key to have uniformity across simulation-based learning. More studies are being conducted to test the validity of simulation-based learning in healthcare programs.
As results come in and the effectiveness of different simulations are measured, regularity and consistency across healthcare education will compel some simulations and simulators to be standardized across graduate healthcare programs, while others will become obsolete. However, as technology advances, there will be a back-and-forth between standardizing simulations and using the latest medical and technological advancements.
Simulations in healthcare education will continue to become more common and uniform across the nation. occupational therapy and physical therapy students participate in a variety of simulations that help them solve puzzles, better communicate with patients, and practice clinical skills. programs such as speech-language pathology, nursing, and others work with one another in simulations to practice how to work in interprofessional healthcare teams.
REFERENCES
- Kieran Walsh, “The Future of Simulation in Medical Education,” The Journal of Biomedical Research, May 2015: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4449494/
- Simulation in Preparation or Substitution for Clinical Placement: A Systematic Review of the Literature,” Journal of Nursing Education and Practice, July 2015: http://www.sciedupress.com/journal/index.php/jnep/article/view/7069/4432
- Government of Western Australia Dept. of Health, “What Is Simulation Learning?” Oct. 10, 2014: https://ww2.health.wa.gov.au/Articles/U_Z/What-is-simulation-learning
- SimStaff, “What Is the Difference between Low-Fidelity and High-Fidelity Simulations?”: https://simstaff.com/difference-between-low-fidelity-and-high-fidelity-simulations/
- Harry Owen, “Early Use of Simulation in Medical Education,” Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, April 2012: https://journals.lww.com/simulationinhealthcare/Fulltext/2012/04000/Early_Use_of_Simulation_in_Medical_Education.4.aspx
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