June
14
Simulated Learning Technologies in
Undergraduate Curricula:
An Evidence Check review for HETI
D Nestel, J Harlim, C Smith, K Krogh, M Bearman
HealthPEER, Faculty of Medicine, Nursing & Health Sciences
Monash University
1
Table of Contents
The project team ............................................................................................................... 4
Executive summary .......................................................................................................... 5
Introduction.......................................................................................................................... 9
Operational definitions ............................................................................................................. 9
Simulation .................................................................................................................................................. 9
Simulators or simulation modalities ........................................................................................... 9
Simulation educators ......................................................................................................................... 9
Graduate outcomes ....................................................................................................................... 10
Methods .............................................................................................................................. 11
Results .................................................................................................................................. 12
Search results ..............................................................................................................................12
Summary of selected reviews .............................................................................................12
Review question 1 .....................................................................................................................16
Strong evidence................................................................................................................................. 16
Moderate evidence ........................................................................................................................ 16
Enablers for successful outcomes........................................................................................... 18
Barriers to successful outcomes ............................................................................................... 19
Review question 2 .....................................................................................................................20
Research papers........................................................................................................................21
Common themes and summary of selected papers................................................ 22
Gaps in the evidence ..............................................................................................................22
The NSW context ........................................................................................................................23
Strengths and limitations of the review ............................................................................24
Conclusions ...................................................................................................................... 26
Recommendations ........................................................................................................ 27
References ........................................................................................................................ 29
Box 1: Search terms used in databases ..........................................................................33
Box 2: Search strategy for review.......................................................................................34
Box 3: Reasons for excluding reviews and papers ....................................................35
Box 4: Themes from the national research agenda from the 2013 Research
Summit of the Australian Society for Simulation in Healthcare ............................36
Appendix I: List of simulators or simulation modalities and their descriptions
...........................................................................................................................................................37
Appendix II: Data display table of graduate outcomes for eleven eligible
health professions .....................................................................................................................39
Table 1: Summary of data extracted from eligible reviews ...................................66
Table 2: Summary of data extracted from eligible papers ....................................76
Table 3: Number of papers by respondent group ................................................... 232
Table 4: Number of papers by simulation modality ............................................... 233
Table 5: Number of papers by study design .............................................................. 234
2
Table 6: Number of papers by quality rating ............................................................. 235
3
The project team
The project team was comprised of:

Professor Debra Nestel (DN)

Dr Kristian Krogh (KK)

Dr Jennifer Harlim (JH)

Dr Cathy Smith (CS)

Associate Professor Margaret Bearman (MB)
DN undertook the database search.
DN and KK offered additional contributions of reviews and papers.
JH and DN sourced the graduate outcomes documents.
JH prepared the thematic analysis of graduate outcomes.
DN and JH created the tables summarising the review papers.
MB and DN analysed the review papers to answer the questions posed by HETI.
KK, CS, JH and DN created the table that summarise the research papers.
DN and JH analysed the research papers to identify examples relevant to NSW.
DN took overall responsibility for writing the Report.
All authors reviewed the final version of the Report.
The authors all have experience in undertaking reviews, work in the field of healthcare
simulation and have extensive experience in supporting health professional students and
clinicians with simulation-based education. Four authors have been involved in the NHET-Sim
Program1 as faculty (DN, KK, CS, MB) and two in the Victorian Simulated Patient Network 2. MB is
Director of the Graduate Certificate in Clinical Simulation, Monash University. Three authors are
based in Victoria (DN, MB, JH), one in Denmark (KK) and one in Canada (CS) although all are
familiar with the landscape of simulation education in Australia.
4
Executive summary
This Report on the use of simulated learning technologies in undergraduate health
professions education was prepared for NSW Health Education and Training Institute
(HETI) as an Evidence Check Review. Simulation is widely used in training individuals to
work in high reliability industries such as aviation. Here, our focus is healthcare and
undergraduate education for 24 eligible professions.
Two questions were addressed: What is the evidence for the effectiveness of
simulated learning technologies for core graduate outcomes in the accredited
undergraduate curricula for eligible professions? In which settings are simulated
learning technologies most effective?
We defined simulated learning technologies as activities that provide students with
an opportunity to rehearse skills or elements of practice that they will be required to
perform as part of their future professional roles. This includes activities that use simple
to complex technologies and low to high fidelity and that may take place in learning,
simulated or real clinical settings. That is, we adopted a definition that included a
breadth of simulated learning technologies.
Method
In May 2014, statements of graduate outcomes were sourced from eligible health
professions associations (as defined by HETI) and thematically analysed. The search
terms related graduate outcomes with simulation. Searches were undertaken of the
OvidMedline, Cochrane, PsychInfo, and Informit databases. We also searched the
collections and libraries of Best Evidence Medical Education and the Joanna Briggs
Institute respectively and sought recommendations from simulation education
experts. Inclusion criteria focused on undergraduate health professions education,
simulation, published in 2005 to present and in English language.
Results
The Report is based on 27 reviews. We also extracted data from 439 research papers
relevant to the NSW context. In undergraduate health professions education,
simulation is most often used to support learning of commonly performed skills and
procedures and for management of acutely ill (and deteriorating) patients. However,
learning is often out of context because of limited access to simulated learning
environments. Simulation is also used for transitions including those for entering new
clinical environments. This includes orientating students to practices on clinical
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placements and for entry to registered practice. Simulation is widely used for
assessments of skills, especially in the Objective Structured Clinical Examination.
Question 1: What is the evidence for the effectiveness of simulated learning
technologies for core graduate outcomes in the accredited undergraduate curricula
for eligible professions?
From the reviews, there is strong evidence for simulated learning technologies leading
to increased knowledge and improved skills under specific conditions for several core
graduate outcomes in undergraduate curricula, when compared with no
intervention. This includes the development and application of clinical knowledge
and, of clinical skills such as assessing and examining patients, communicating with
patients, performing procedural skills and clinical reasoning. There is also moderate
evidence of increased knowledge and practice of these clinical skills and patient
safety, teamwork and professionalism. The specific conditions include the choice of
simulator, which must be appropriate for the graduate outcomes, the educational
design, the learner characteristics and the simulation educator. From the research
papers, there is strong evidence that simulation can in part (25%) replace clinical
placements without compromising graduate outcomes.
Question 2: In which settings are simulated learning technologies most effective?
Simulated learning technologies have relevance in all undergraduate health
professions education. Although high technology learning environments are not
essential for effective simulation practice, efforts must be made for learning of
procedures and skills to be contextualised. That is, students have the opportunity to
integrate whole procedures and skills with the people and settings that resemble
those in which they will be expected to practice. Simulation facilities need to be
accessible for students across their undergraduate education and reflect the varied
environments in which they will eventually work. Learning technologies such as audiovisual capture are now relatively inexpensive and easily integrated into nonspecialised environments. There is moderate evidence for the value of video-assisted
debriefing.
Simulation modalities have different degrees of relevance across health professions.
Simulated patients have value in all health professions. Task trainers are highly
relevant in procedure-oriented health professions. Manikins are essential for
recognising and managing deteriorating patients and can be enhanced by adding
simulated patients to scenarios. Virtual patients assist the development of clinical
reasoning but can be unhelpful for empathic communication.
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Not using simulation (or using it ineffectively) in undergraduate education may result
in greater costs in the longer term to the health and social care services.
Summary
There are ethical imperatives for the use of simulation in health professions education.
The first imperative is to minimise risks to patients by ensuring health professional
students are prepared for integrated work learning (clinical placements) and for
transition to professional practice. The second imperative is to students where strong
evidence exists for the benefits of learning in simulation, they should be afforded this
opportunity.
Recommendations
Based on the evidence, the resources and expert opinion, recommendations for
implementing effective simulated learning technologies in undergraduate health
professions education include:
1. Ensuring sound design of simulation-based education programs that are
integrated with broader curriculum activities.
a. Theoretical underpinning of simulation-based education programs.
b. Explicit learning objectives.
c. Feedback and debriefing processes to optimise student learning.
d. Provision of multiple opportunities to practise and rehearse using
simulation.
e. Access to a wide range of simulators (including simulated patients,
manikins, task trainers etc.). For example, establish a simulated patient
database, training program and network (as part of a simulation
educator network). Increase access to a wide range of simulators
through distributed models supported by appropriate technology such
as EdWISE. Commission the development of new simulator task trainers
appropriate to specific professions whose needs are currently not met.
f.
Access to scenarios including a database that include profession
specific and interprofessional resources that are graded by task
difficulty and map to graduate outcomes
g. Access to simulated learning environments where undergraduate
programs are offered.
h. Assessment methods in simulation that reflects curriculum goals and
real clinical practice.
2. Using simulation to prepare students for clinical placements.
3. Using simulation to transition from student to professional.
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4. Providing professional development opportunities for faculty involved in
simulation education.
5. Supporting professional networks for simulation educators to share
experiences and resources by establishing/maintaining state-wide/regional or
local simulation educator networks to facilitate exchange of experience,
ideas and resources.
6. Implementing quality improvement processes.
a. Develop research skills of simulation educators or fund educational
researchers to work with simulation educators to conduct multi-site
studies on healthcare simulations.
b. Develop a state-based research strategy in healthcare simulation.
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Introduction
Simulated learning technologies in undergraduate curricula are the focus of this
Evidence Check. The Report provides a summary of reviews and highlights key
research papers, offers expert opinion on the quality and strength of the findings,
describes effective practices and identifies gaps in the evidence. Simulated learning
technologies are here to stay3 and we have an obligation to use them optimally in
supporting health professional students in meeting the needs of the health care
workforce.
Operational definitions
Simulation
We drew on two commonly used definitions of healthcare simulation. That is,
simulation is defined as:

“an educational technique that allows interactive, and at times immersive
activity by recreating all or part of a clinical experience without exposing
patients to the associated risks”4

“a technique - not a technology - to replace or amplify real experiences with
guided experiences that evoke or replicate substantial aspects of the real
world in a fully interactive manner”.5
We defined simulated learning technologies as activities that provide students with
an opportunity to rehearse skills or elements of practice that they will be required to
perform as part of their future professional roles. This includes activities that use simple
to complex technologies and of low to high fidelity and that may take place in
learning, simulated or real clinical settings. That is, we adopted a definition that
included a breadth of simulated learning technologies.
Simulators or simulation modalities
We limited the study to those simulators or simulation modalities listed in Appendix I.
That is, anatomical models, cadaveric models, computer based simulations (e.g.
virtual patients, virtual worlds – Second Life, virtual reality – haptic with 2D and 3D
visualisation), task trainers, simulated (standardised) patients (SPs), hybrid simulations
(two or more simulation modalities blended), manikins (low, medium and high
fidelity), Objective Structured Clinical Examinations (OSCEs) and role-play.
Simulation educators
We refer to anyone offering simulation as an educational method as a simulation
educator. They may be clinicians or subject specialists and may function as a
teacher, instructor or facilitator. For ease of reading, we have not distinguished
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simulation technicians from educators although practically there is often a difference
in their roles.
Graduate outcomes
Graduate outcomes refer to competencies or standards expected of new
graduates. We thematically analysed the published outcomes of ten from the 24
eligible health professions defined by HETI 6. These include: i) Medicine; ii) Nursing; iii)
Midwifery; iv) Dentistry; v) Physiotherapy; vi) Aboriginal Health; vii) Occupational
Therapy; viii) Dietetics; ix) Paramedicine; and x) Psychology. Common themes were
theoretical knowledge (including biomedical science, therapeutics, other theories
underpinning practice etc.), clinical skills including communication, patient
assessment skills, physical examination skills, clinical reasoning/decision-making,
patient safety, teamwork, professionalism (including law and ethics), reflection, selfawareness, self-care, organisational skills, cultural understanding and research skills
(Appendix II).
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Methods
We adopted the search strategy detailed in Boxes 1 and 2. In summary, we searched
four databases Cochrane, Medline, PsychInfo and Informit. The first three as set out in
the Contract and the fourth to capture studies originating from Australia. We
conducted a limited search of the grey literature including government reports (e.g.
Health Workforce Australia), the Joanna Briggs Institute and the Best Evidence
Medical Education collaborative and sought recommendations from simulation
education experts. Only publications since 2005 and in English were included. Review
papers were considered in full while data was extracted from abstracts of research
papers. Reasons for exclusion of reviews and papers are listed in Box 3.
Quality assessments ranged from the highest - large systematic meta-analyses,
followed by moderate - narrative, integrative, critical and best practice reviews none
of which had pooled data. Research papers using randomised control trials (RCT’s)
were rated as very strong through single post-test only studies as very weak.
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Results
Search results
3277 papers were retrieved from the initial search. On reading review abstracts, 37
remained in the pool while data was extracted from abstracts of 425 papers.
Additionally, 13 reviews and 14 papers were included after grey literature search and
consultation with experts. After further consideration the Report is based on 27
reviews and 439 papers.
Summary of selected reviews
Reviews included in the study are summarised in Table 1. Before answering the two
questions posed, we highlight selected reviews most relevant to the NSW context. We
also draw attention to the reports commissioned by Health Workforce Australia (HWA)
in 2010 as a scoping exercise on Simulated Learning Environments (SLE) in
undergraduate health professions education. Although we have included just three
of these reports7-9 (physiotherapy, dentistry, social work) in our review, most offered
valuable contextual and profession specific insights. The summaries are in
alphabetical order.
Carey JA, Madill A, Manogue M. Communication skills in dental education: a
systematic research review. Eur J Dent Educ. 2010;14(2):69-7
Carey et al10 reviewed communication skills training in dental education. The level of
evidence was very weak although all interventions were in a positive direction with
respect to improved communication skills. Training addressed pre- and postoperative rather than intra-operative communication. SPs and role-play were the
commonly reported simulation modality and video replay was reported to be
valuable by faculty and students. Peer observation and feedback was widely used.
Interventions appeared to be integrated with other curriculum activities. Some
interventions were distributed across the curriculum while others were confined to the
early years of dental education. Outcome measures were based on observations in
practice or in simulations (e.g. OSCEs). One study developed a rating tool to address
communication skills in the context of dental education. The authors noted the
minimal contribution of real patients in the development, implementation and
evaluation of communication skills training. Programs were feasible and students
reported value and satisfaction with them. The settings and cost effectiveness were
largely unreported.
Cook, D.A., et al., Technology-enhanced simulation for health professions
education: a systematic review and meta-analysis. JAMA. 2011. 306(9): p. 978-88.
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This is an important study since it is the only meta-analysis in the reviews. The authors
sought to summarise the outcomes of technology-based simulation training for
health professionals (and students) compared with no intervention. The study did
not include simulated patients. Pooled effect sizes were large for knowledge, skills,
and behaviours. The authors conclude that, “technology-enhanced simulation
training is associated with improved outcomes in comparison with no intervention
for health care professionals across a range of clinical topics and outcomes,
including large effects on clinician behaviours and moderate effects on patient
care.” The authors propose that future research should focus on when and how to
use technology-based simulation most effectively and cost-efficiently.
Flanagan B, Clavisi O, Nestel D. Efficacy and effectiveness of simulation-based
training for learning and assessment in healthcare, 2007, Department of Human
Services (Victoria): Melbourne.
In 2007, the Department of Human Services (Victoria) commissioned a report on
the current state of simulation in health care in relation to specific topics:
transferability of skills learned via simulation to real patient care; clinical skills;
decision-making; communication with patients; teamwork, leadership and cost
effectiveness of simulation compared with earning in real clinical settings. The
search differed to this review in that it also included studies of clinicians and did
not restrict time frame. The authors included 458 papers. Most papers were
related to the medical profession. There were gaps in the literature for every topic
by profession. The authors concluded that overall, simulation makes a valuable
contribution to learning for students, trainees and clinicians. It enables learning of
routine and non-routine procedures and management of patients. However, the
level of evidence is low using conventional approaches 11 to measuring
quality. There is substantial evidence for simulation-based activities at Levels 1 and
2 of the modified Kirkpatrick’s framework12,13, some evidence at Level 3 and a
small number of studies at Level 4 where there was clear evidence of direct
benefit to patients. Most studies report high levels of participant satisfaction. There
were almost no studies on cost effectiveness.
Leigh, G.T., High-fidelity patient simulation and nursing students' self-efficacy: a
review of the literature. International Journal of Nursing Education Scholarship, 2008. 5:
p. Article 37.
Leigh et al (2008) conducted a literature review examining the effects of high fidelity
human patient simulation (manikins) on undergraduate nursing student's self-efficacy
and confidence14. They conclude that high fidelity manikins are effective when used
13
with sound educational practices. The quality of evidence ranged from very weak to
very strong with respect to improved confidence, clinical knowledge and skills (e.g.
critical thinking, leadership, decision-making, problem-solving, prioritisation). Studies
with very strong evidence used randomisation of participants and observed
measures of skills (in simulations). Most studies used perceived rather than actual skills.
The review did not find conclusive evidence for the impact of high fidelity manikins on
nurses’ self-efficacy when compared with other methods. From students’
perspectives, high fidelity manikins were valuable to learn to apply knowledge to
clinical practice, to learn from their mistakes, to learn from peers and to identify gaps
in their knowledge. The use of manikins appeared most beneficial when the students
believed the scenarios to be legitimate, authentic and realistic. Faculty believed that
manikins prepared students to perform in real clinical settings and that the
experiences in the simulation environment transfer to clinical practice. Multiple studies
revealed students and educators perceptions that simulation improves clinical
performance. Nursing students believed manikins improved both critical thinking skills
and confidence. Students rate debriefing and direct feedback as a major
advantage of high fidelity manikins. Challenges associated with this type of
simulation included a “sense of foreboding” that something was going to go happen.
Studies consistently reported that students’ anxiety levels initially rose but this tended
to decrease with repeated exposure to simulation. Although team communication
improved, communication with a manikin was not valued and may lead to
inappropriate communication styles. Studies reported logistical issues with large
cohorts of students and significant investment of faculty time and costs associated
with facilities and their maintenance.
Murdoch, N., J. Bottorff, and D. McCullogh, Simulation education approaches to
enhance collaborative healthcare: A best practices review. International Journal of
Nursing Education Scholarship. 2013. 2013(10): p. 307-321.
This review was interesting in its focus on identifying best practices for interprofessional
education for undergraduate students15. Seventeen studies met the inclusion criteria.
Key findings include that learning objectives are not always made explicit, nursing
students were involved in all studies, most studies included convenience samples of
less than 100 learners, group teaching sizes from three to ten. Study outcomes did not
seem related to teaching group size. Simulation centres were the most common
venue for activities. Although educational activities appeared to be underpinned by
learning theories, these were rarely described in papers. The most common modality
was manikins (n=13), especially high fidelity, SPs (n=8) and role-play (n=6). Learner
satisfaction (n=17) and awareness of others’ roles (n=11), knowledge (n=12),
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confidence and comfort in collaboration (n=10) were reported. Study quality was
diverse as judged by Beach et al (2004) rating scale (median 19, range 10 to 31.5/32)
on a scale of 32. On the modified Kirkpatrick framework two studies were at Level 3.
The authors cautiously conclude that learners were satisfied with interprofessional
simulation education in supporting the development of knowledge, skills and
attitudes needed for collaborative practice. There was less certainty about timing in
the curriculum. Most of the studies occurred in the later years of the undergraduate
programs and this was considered effective.
McGaghie W, Issenberg B, Petrusa E, Scalese R. (2010). A critical review of
simulation-based medical education research: 2003-2009. Medical Education. 44(1),
50-63.
This paper by McGaghie et al (2010) is commonly cited in the literature and included
studies of undergraduate and qualified health professionals. The review extends
earlier work16 identified twelve features and best practices of simulation to maximise
educational benefit. These include feedback, deliberate practice, curriculum
integration, outcome measurement, simulation fidelity, skill acquisition and
maintenance, mastery learning, transfer to practice, team training, high-stakes
testing, instructor training, and educational and professional context. For each of
these features, the authors also identified gaps in understanding. Additionally, they
refer to a review by Salas et al 17on debriefing practices conducted in the context of
continuing professional development for medical teams (and so excluded from this
review). However, the practices may have relevance to undergraduate students. The
authors also draw on the work of Ericsson18 who has described the theoretical
concept of deliberate practice. This theory is especially relevant for the development
of skills. Mastery learning is also promoted as a rigorous approach to competencybased education and has some overlap with deliberate practice. Although not
declared, the lead author has a strong personal stance for this approach. An
important advance from the earlier review is training for simulation educators. The
authors argue that there is a great need for a mechanism to educate, evaluate and
certify simulation educators, teaching with simulation is not intuitive, clinical
experience is not a proxy for simulation instructor effectiveness and simulation
educators need not be from the same profession as the learners.
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Review question 1
What is the evidence for the effectiveness of simulated learning technologies for core
graduate outcomes in the accredited undergraduate curricula for eligible
professions?
The direction of evidence is clear that simulation leads to improved knowledge and
skills under specific conditions for several core graduate outcomes in undergraduate
curricula – in particular, for application of theoretical knowledge, clinical skills
including communication with patients, patient assessment skills, physical
examination skills, procedural skills and clinical reasoning, patient safety, teamwork
and professionalism. The following bullet points convey key areas for which there is
evidence. There are nuanced differences between the statements even though they
appear similar. The evidence is divided between strong and moderate. There was
only one meta analysis19, a consequence of the limited number of suitable studies
meeting eligibility criteria. A challenge in synthesising the outcomes relates to the
broad range of simulation modalities, graduate outcomes and the varied contexts in
which the studies are set.
Strong evidence

Technology-enhanced simulations in comparison with no intervention or when
added to traditional interventions were associated with better learning
outcomes19.

Simulation supports learners in the recognition and management of specific
clinical conditions compared with non-experiential forms of learning in
randomised control trials (RCTs). For example, in dyspnoea20, cardiac
arrhythmias20 and pre- and post-operative care in the ICU21.

Most RCTs (70%) showed simulation training significantly improved procedural skills
performance in comparison with standard or no training 22.


Examples of clinical skill, modality and respondent group are:
o
Dental procedures with haptic virtual reality for dental students7
o
Cardiopulmonary resuscitation skills with manikins for nursing students 23
o
Intravenous cannulation with task trainers for medical students 20
Simulation leads to improved examination skills:
o
Interpreting cardiac sounds for medical students20
o
Intimate examinations for medical students24
Moderate evidence
By far the most evidence sits at a quality assessment of moderate.
16

Almost all simulation-based education leads to increased knowledge of clinical
conditions20,24,25 although one review identified a very small number of neutral or
negative results23.

Simulation can lead to increased efficiency (learning faster) when compared with
other methods7 and are effective when used in conjunction with other methods.

Patient safety knowledge, attitudes and skills are improved or enhanced by a
range of simulation modalities when integrated in curricula for medicine, nursing,
pharmacy and dentistry students26 and specifically in using protocols in clinical
settings20.

Simulated learning technologies can lead to increased confidence in
interprofessional collaborative practice and team training in medicine, nursing
and pharmacy students21,25,27.

Simulation leads to clinical skill acquisition and retention when ongoing practice is
offered10,23,28 and, to transfer to clinical settings20.

Although not evidence of actual transfer, nursing students believe that the skills
learned through simulation are transferable to clinical settings in relation to the
deteriorating patient29.

Simulated learning technologies are shown to be valuable for nursing students in
orientation to clinical settings30.

Simulation provides the only opportunity for students to learn some skills/manage
some events/situations in relation to the deteriorating patient in a patient safe
environment29,30.

Specific simulation modalities lead to defined outcomes:
o
Confidence, knowledge and skills are shown to improve with simulated
patient based simulations for communication10, patient counselling24,
error disclosure skills24,25,31, professionalism20 and other clinical skills24.
o
Simulated health professionals and simulated students support the
development of a diverse range of professional skills24.
o
Virtual patients compared with no intervention, are consistently
associated with higher learning outcomes – knowledge, clinical
reasoning7,32 and other clinical skills7,33.
o
For nursing students, although knowledge acquisition was unrelated to
manikin fidelity, clinical reasoning skills were better supported by high
rather than medium fidelity manikins34.

Feedback plays a critical role in effective outcomes. Simulation alone is rarely
sufficient. It must be accompanied by strong educational design and feedback
or debriefing is essential. The source, amount, nature and timing of feedback
influences satisfaction, immediate and longer term outcomes. The use of video
17
assisted debriefing is thought to be valuable10.

Real patients are noticeably absent from the design of simulations 10.

Most papers do not reference learning theory in the design or assessment of
student learning35.

Student satisfaction with simulated learning technologies is moderate to very
high.
Enablers for successful outcomes
Educational design is paramount with key stages including preparation, briefing,
simulation, debriefing, feedback, reflection and evaluation 1.

Feedback is considered a feature of simulation-based education14,28.

Theoretical underpinning is important in educational design:
o
Deliberate practice is an approach to developing expert status in skills
that is derived from psychological studies of experts18. Deliberate
practice is characterised by a highly motivated individual (learner),
the opportunity for repeated practice with feedback, the opportunity
to increase the level of challenge and a coach or mentor
o
28.
Mastery learning28 can lead to successful outcomes in the
development of psychomotor skills and includes establishing clear
learning objectives, explicit expectations of performance and
repetitive practice with feedback.

Curriculum integration of simulation activities is essential 7,28,34,36,37. Simulation
usually forms part of a broader program or as an adjunct to other learning
experiences. Integration and coordination is more likely to lead to successful
outcomes than isolated programs. Simulation activities need to reflect the
educational, clinical and professional contexts of the learners14,28.

Simulation fidelity and modality needs to be fit for purpose7,28,34,36. For example,
VPs are not well suited to supporting the development of empathic skills which
are better suited to SPs. Medium fidelity manikins are at least of equal benefit as
high fidelity manikins in supporting the development of clinical skills for managing
deteriorating patients38.

Undergraduate students usually value the experiential nature of simulation28,30.

Successful outcomes depend on access to simulation programs, simulators and
simulation educators. Kneebone et al (2010) argue for distributed simulation
enabling anytime anywhere39 simulations with local educators (or at least coeducators). Flinders University operates a small van to take simulators and
faculty/technicians to sites where they are needed across the state. The
Queensland Skills Development Service operates a central sharing and
18
maintenance service of simulators to health services and higher education
facilities40.

Faculty who are informed about simulation education 28 combined with a
network of simulation educators is needed to ensure successful outcomes. The
national simulation educator programs - AusSETT and NHET-Sim - were developed
with three pillars of a theoretical community of practice in mind 41. That is, joint
enterprise (members of the community have a common goal), mutual
engagement (many opportunities for participation) and a shared repertoire
(common language and resources)42. This approach has been successful and has
led to the establishment of local communities of practice. The overarching
national perspective has enabled sharing of resources and practices across the
country with a positive impact on quality. Leveraging existing networks is
important to further advance healthcare simulation practice.
Barriers to successful outcomes
Unsurprisingly, the barriers directly contrast with the enablers. These include macro
level barriers. Not using simulation in undergraduate health professions education
may result in greater costs in the longer term22. Different funding streams for those
responsible for undergraduate education and those who provide health services may
discourage education providers from investing in simulated learning technologies.
However, few papers considered the cost of simulation. Cook et al (2009)36 report
development cost of a virtual patient at US$10-50K, time for development
(approximately 16 months), and then there are maintenance costs. This is a
substantial investment for the development of a single virtual patient case. In
contrast, Lapkin and Levett-Jones (2011) conducted a cost analysis of manikins and
found the same learning outcomes could be achieved for $AU1.21 for medium
compared with $AU6.28 for high fidelity38 per student. Kneebone et al (2010) provide
evidence for learning outcomes in low cost, mobile simulated learning environments
compared with static, resource intensive simulation centres39. That is, not all simulated
learning technologies are expensive but they do need to be carefully selected for
their intended purpose. Some technologies need significant maintenance, some
have other recurring costs8 and some require highly specialised skills to operate8.
Barriers may exist at the level of the professional association where there may be a
reluctance to embrace simulation-based training methods, especially those that
challenge traditional work integrated learning through clinical placements.
At the faculty level, there are several barriers to effective outcomes and include a
lack of training in simulation methods9,28,34,37, of educational theories that inform
19
simulation practice, such as instructional design 7,9 and even in fundamentals such as
not making learning objectives explicit. There may be insufficient time to develop
simulation resources9. Faculty may not have scope to integrate their simulation
program into broader curricula28. There may be logistical issues of timetabling into
already crowded curricula and in providing learners with opportunities for repeated
practice and feedback23,28.
Barriers also include access to appropriate simulators7,8,34. For example, a lack of
clinical realism has been reported with simulated patients8 who may have had
limited or no training. Inadequacy34 of simulation equipment (e.g. fidelity of
simulator to replicate tissue swelling, stiffness)8 or not fit for purpose (e.g.
inappropriate communication skills with manikin and virtual patients) constrains
effective outcomes.
Review question 2
In which settings are simulated learning technologies most effective?
This question was largely answered in the section above. In summary, simulation
design needs to ensure that learning is contextualised. That is, by locating the clinical
skills or knowledge in the wider arc of care required for safe practice. That is, physical
examination skills learned in simulation without reference to communicating with
patients may lead to unprofessional practice. Learning intravenous cannulation
without attention to proper hand washing and safe disposal of sharps may lead to
poor performance in clinical settings. Therefore, students need access to facilities in
which they can place their learning in context. The physical settings varied widely
with simulation centres, skills labs and training provider tutorial/class rooms. Like
selecting simulators, environments also need to be fit for purpose. Undergraduate
health professional education often takes place on campuses that may not be colocated with clinical and social care settings in which students undertake
placements. In order for students to have ready access to simulation facilities
throughout their education, simulated learning technologies need to be available
where and when they are needed on campus. Additionally, unless the scale of
healthcare service simulation facilities is substantive, they may be unable to provide
access for large student cohorts.
High technology does not necessarily lead to better outcomes. Other “settings” for
effective simulation include those:

Associated with transitions, usually into clinical settings20,30 and from medical
student to junior doctor.
20

Coupled with appropriate pedagogy (e.g. acquisition and performance of the
skill were improved when manikin-based simulations were coupled with the
principles of cognitive task analysis and mental imagery)21.

Learning technologies such as audio-visual capture are now relatively
inexpensive and easily integrated into non-specialised environments. There is
moderate evidence for the value of video-assisted debriefing.

There is some limited evidence of using video technologies for remote simulationbased instruction21. That is, high definition teleconferencing can support the
learning of clinical skills through simulation where faculty from a central location
can brief, observe and debrief simulation activities in a remote location.
Research papers

We extracted 439 research papers that have relevance to the NSW context.

Table 3 summarises the respondent groups with medical students the most
commonly reported group (n=218) followed by nursing (n=119), pharmacy
(n=36), dentistry (n=15) and other professions students with less than 5 papers.
Combinations of students were identified in 15 papers, which usually but not
always implied interprofessional education.

With respect to simulation modality, manikins (n=92) and SPs (n=92) were most
commonly reported (Table 4). Seventy-two of the papers extracted reported
the use of multiple modalities in their studies. For example, both manikins and
SPs.

The majority of papers used a quantitative research design (n=277) followed
by mixed methods (n=66) and qualitative design (n=45) (Table 5).

Based on the abstract, the study design was given a quality assessment as
very weak, weak, strong or very strong. More papers were assessed as weak
(weak n=167 and very weak n=72) than strong (strong n=167 and very strong
n=30).

Thirty-six studies were drawn from Australia.
RCTs are difficult to establish in educational interventions. Reasons include the
underfunding of new educational interventions, educational interventions not
conceived as research and that educational developers may not be working with
researchers who have these skills. So although RCTs are used in education, other
approaches for assessing quality are more accessible and also valued. RCTs may not
give insight to why or how simulation is working (or not). Additionally, we do not know
if negative findings are occurring but are simply not published. Although the overall
weak quality assessment of these papers carries some weight, it does not minimise
21
their value to simulation educators, clinicians and policy makers.
Common themes and summary of selected papers
There are several commonly referenced studies that improve patient outcomes for
healthcare professionals following simulation43-46. Although there is limited evidence
of patient outcomes as a result of simulation-based programs in undergraduate
education, this is likely to relate to the relatively limited role that health professional
students have in direct patient care. However, there are some notable exceptions.
Nestel and Campbell (In press) reported better performance in workplace
assessments of medical students who learned intravenous cannulation in a
progressive stepwise simulation model when compared with students who learned
in a traditional way47.
Watson et al (2012) report an important Australian study on the substitution in
simulation of selected clinical placements (15%) for physiotherapy students and
found no difference in performance of students between experimental and control
groups48. In late 2014, the results will be released of a national US study on the
replacement of traditional clinical hours in nursing curricula with 10%, 25% and 50% of
simulation49. This is an important large-scale longitudinal study that is likely to have
implications for nursing education internationally. Ten schools of nursing have
participated, with the students randomly allocated to the different percentages of
simulation and students evaluated after their first year of clinical practice.
Gaps in the evidence
We note gaps in the evidence in the following areas for undergraduate health
professions education:

Comparisons of theory-based simulation designs.

Feedback (and debriefing) models to establish timing, nature, source etc.

Timing, frequency and repetitions of simulation in curricula (e.g. how much, how
often etc.) including the timing of interprofessional simulation education.

The role of real time in simulations. That is, for which skills is it important that
students practise skills in the time frames in which they would be needed in real
clinical settings?

The role of student observers in simulations with respect to optimising learning.

Retention of learning.

Impact of simulation education for undergraduate students on patient outcomes.

Impact of simulation on the emerging professional identities of students.
22

Fit for purpose simulators relative to the targeted competencies including the
necessity for the development of new simulators to meet the needs of
undergraduate students (e.g. physiotherapy, dentistry etc).

Simulation and the healthcare of Aboriginal and Torres Strait Islanders.

Cost effectiveness of simulation compared with other educational methods.

Distributed models of simulation to increase access for all health professional
students.

Process for development and impact of shared simulation resources (including
governance models).
Most of these topics are suited to multi-site studies and relevant across professions but
require infrastructure to support the planning of research, implementation, analysis
and dissemination of results.
In 2013, the Australian Society for Simulation in Healthcare held a research summit in
which a national research agenda was created. The research questions generated
by the participants is in draft form and the eleven themes listed in Box 4. Three of the
authors of this Draft Report (DN, MB, KK) participated in the Summit. Each of the
themes has several associated research questions and these are likely to inform HETI
strategic planning. The questions are currently being refined and will be made
available on the Simulation Australia website. The US based Society for Simulation in
Healthcare has also just completed a White Paper on healthcare simulation research.
The White Paper will be published shortly and is likely to be valuable in informing HETI
of gaps in research and strategic direction.
The NSW context
We noted that some of the reviews involved NSW based academics. Of course the
HWA SLE reports also have NSW relevance. Although none of the 439 research papers
were obviously based in NSW, we wanted to consider examples of simulation
education in undergraduate health professional curricula.
In response to a call for illustrations of contemporary practice, there appear to be
excellent initiatives across NSW. Kelly (2014) has explored the impact of manikinbased simulations on the clinical judgement of final year nurses and followed their
transition to registered nurse practice50. Marley and Pedersen (2013) evaluated the
contribution of SPs to the management of critically unwell patients by final year
medical students51 in direct response to participating in the NHET-Sim program.
EdWise is increasing access to simulation through web-based and mobile
23
technologies from an established Sydney group52, while U-ITCT (Undergraduate
Interprofessional Teamwork and Communication Training) is a large collaboration
that seeks to offer interprofessional simulation education addressing core graduate
competencies of medical, nursing and allied health professional students53. The
Hunter New England Simulation Centre offers simulation training to over 4,000 students
and clinicians annually with a focus on interprofessional collaborative practice. These
examples document practices that reflect those reported in the reviews and wider
literature. Maintaining such activities is important in leveraging the momentum and
enabling maturity of programs.
With respect to simulation educators, as of the end of May 2014, 1,232 NSW-based
participants had registered for the NHET-Sim Program and 645 have completed. This is
a substantial investment in individuals able to use simulation as an educational
method. Additionally, there are 53 NHET-Sim faculty from NSW who have made a
significant contribution to professional development of simulation educators within
the state and nationally. Most of the faculty is directly involved in undergraduate
health professions education although they are mainly from medicine and nursing.
Strengths and limitations of the review
The strengths of this review are that it was tightly defined in order to answer specific
questions. Although the relatively recent 2005 time frame for inclusion may be
considered a limitation, we believed it to be a strength because it is more likely to
reflect contemporary practices in health care simulation and therefore to have
greater relevance than earlier studies. The complementarity of the project team’s
experience meant we were receptive to different simulation modalities and their
applications in undergraduate health professions education.
The limitations of the review are that data was sourced from just four databases.
However, these were carefully selected to reflect a wide coverage of professional
disciplines and to include Australasian data. We also sought expert advice on
essential reviews and papers of interest. We used abstracts to make decisions about
inclusion and may have overlooked important papers because of inadequate
abstracts. Some reviews were excluded when they focused more on qualified health
professionals rather than undergraduate students. Additionally, the scope of the
review did not cover identifying the most effective simulation methods associated
with specific clinical skills. However, we are confident the Report reflects
contemporary simulation practices in health professions education. A final limitation
was the relatively short time in which the review was to be conducted and the large
24
number of reviews that met inclusion criteria.
25
Conclusions
We conclude the Report by referring to the graduate outcomes identified in the
thematic analysis and for which simulated learning technologies were found to be
effective. The direction of evidence is clear that simulated learning technologies
generally leads to improved knowledge and skills under specific conditions for several
core graduate outcomes in undergraduate curricula. In particular, for application of
theoretical knowledge, clinical skills including communication with patients, patient
assessment skills, physical examination skills, procedural skills and clinical reasoning,
patient safety, teamwork and professionalism.
Under specific conditions, the value of simulated learning technologies is
overwhelmingly positive. There are ethical imperatives for the use of simulation in
health professions education. The first imperative is to minimise risks to patients by
ensuring health professional students are prepared for integrated work learning
(clinical placements) and for transition to professional practice. The second
imperative is to students where strong evidence exists for the benefits of learning in
simulation, they should be afforded this opportunity.
Simulated learning technologies have relevance in all undergraduate health
professions education. Although high technology learning environments are not
essential for effective simulation practice, efforts must be made for learning of
procedures and skills to be contextualised. That is, students have the opportunity to
integrate whole procedures and skills with the people and settings that resemble
those in which they will be expected to practice. Simulation facilities need to be
accessible for students across their undergraduate education and reflect the varied
environments in which they will eventually work. Learning technologies such as audiovisual capture are now relatively inexpensive and easily integrated into nonspecialised environments.
Simulation modalities have different degrees of relevance across health professions.
Simulated patients have value in all health professions. Task trainers are highly
relevant in procedure-oriented health professions. Manikins are essential for
recognising and managing deteriorating patients and can be enhanced by adding
simulated patients to scenarios. Virtual patients assist the development of clinical
reasoning but can be unhelpful for empathic communication.
26
Further, not using simulation (or using it ineffectively) in undergraduate education
may result in greater costs in the longer term to the health and social care services.
Finally, there is emerging evidence that simulation can replace some clinical
placement activities without impacting graduate outcomes. That is, simulation is at
least as effective as learning in clinical placements. However, the amount of
substitution is not yet determined.
Recommendations
Based on the evidence, the resources and expert opinion, recommendations for
implementing effective simulated learning technologies in undergraduate health
professions education include:
1. Ensuring sound design of simulation-based education programs that are
integrated with broader curriculum activities.
a. Theoretical underpinning of simulation-based education programs.
b. Explicit learning objectives.
c. Feedback and debriefing processes to optimise student learning.
d. Provision of multiple opportunities to practise and rehearse using
simulation.
e. Access to a wide range of simulators (including simulated patients,
manikins, task trainers etc.). For example, establish a simulated
patient database, training program and network (as part of a
simulation educator network). Increase access to a wide range of
simulators through distributed models supported by appropriate
technology such as EdWISE. Commission the development of new
simulator task trainers appropriate to specific professions whose
needs are currently not met.
f.
Access to scenarios including a database that include profession
specific and interprofessional resources that are graded by task
difficulty and map to graduate outcomes.
g. Access to simulated learning environments where undergraduate
programs are offered.
h. Assessment methods in simulation that reflects curriculum goals
and real clinical practice.
2. Using simulation to prepare students for clinical placements.
3. Using simulation to transition from student to professional.
4. Providing professional development opportunities for faculty involved in
27
simulation education.
5. Supporting professional networks for simulation educators to share
experiences and resources by establishing/maintaining statewide/regional or local simulation educator networks to facilitate
exchange of experience, ideas and resources.
6. Implementing quality improvement processes.
a. Develop research skills of simulation educators or fund educational
researchers to work with simulation educators to conduct multi-site
studies on healthcare simulations.
b. Develop a state-based research strategy in healthcare simulation.
28
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32
Box 1: Search terms used in databases
nurs*OR midw* OR medicine OR surgery OR physiotherap* OR pharmacy OR paramedic* OR
dentist* OR dietet* OR aboriginal torres strait islander health* OR indigen*
AND simulat* OR standardized patient OR standardised patient OR manikin OR mannequin OR
task trainer OR part task trainer OR parttask trainer OR part-task trainer OR virtual ADJ3 (object*
OR system* OR environ* OR world OR program* OR patient) OR OSCE OR Objective Structured*
OR role play OR role-play OR roleplay OR hybrid simulation OR patient focused simulat*
AND clinical skill OR procedural skill OR clinical examination OR teamwork OR professionalism
OR communication OR consultation skill OR history-taking OR ethics OR clinical judgement OR
decision-making OR patient safety OR physical examination OR patient care
AND undergraduate OR student OR intern OR junior doctor OR pre-registration OR pre-licensure
AND curriculum OR graduate outcomes OR learning outcomes
33
Box 2: Search strategy for review
Initial search in
Ovid Medline (2638)
Cochrane (167)
Informit (923)
PsychInfo (717)
Remove duplicates
Total 3277
Abstracts
included
37 + 425
Expert
identified
papers
14
Expert
identified
reviews
13
Reviews
Included
50
37 reviews
(Table 1)
Papers
Included
439
439 papers
(Table 2)
34
Box 3: Reasons for excluding reviews and papers
Reviews




Validation studies of simulators or assessment instruments
Only focused on healthcare professionals
Not a graduate outcome (e.g. laparoscopic skill proficiency)
Not a simulation modality
Papers










Validation studies of simulators or assessment instruments
Pilot studies
Not undergraduate/entry level except for intern/junior doctor/pre-registration medical
Not a graduate outcome (e.g. laparoscopic skill proficiency)
Descriptive and no data
Study aim not articulated
Letters
No abstract or insufficient information
Culturally disparate
Book chapter
35
Box 4: Themes from the national research agenda from the 2013
Research Summit of the Australian Society for Simulation in
Healthcare
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Using simulation to support learning in students and clinicians
Debriefing and simulation
Using simulation for performance assessment
Establishing standards for simulators and simulated environments
Modelling healthcare systems
Using simulation to address education and workforce issues
Considering simulation in the broader world
Theorising simulation
Conducting research on healthcare simulation
Considering funding, costs and efficiencies in education and research
Translating research outcomes to education and healthcare
36
Appendix I: List of simulators or simulation modalities and their
descriptions
Simulator
Description
Animal or cadaveric
simulators
Real animal or human tissue used which may be used in another
simulator to increase realism (e.g. issue in a box trainer for
learning minimally invasive skills). Human cadavers for learning
anatomy and clinical skills.
Computer b a s e d
simulation (e.g. virtual
patients, virtual worlds)
Learner interaction is with a computer-based activity such as
virtual patients, second life and avatars.
Task trainers
Bench top models or devices that replicate only a part of
the real thing, or part of the body, to teach specific tasks or
skills (e.g. male pelvis for urinary catheterisation)
Simulated patients (SP) (or
standardised patient)
A well person trained to portray a patient in a simulation of a
health care scenario. The SP may offer feedback to the
learners.
Hybrid simulations
A combination of two or more simulation modalities such as a
simulated patient and task trainer.
Manikin (or human patient
simulator or high fidelity
human patient simulators)
Full body patient manikins of various degrees of
capability/sophistication with which the learner’s must
interact. The models vary in level of technology and realism.
37
Objective Structured
Clinical Examinations
(OSCEs)
A series of scenarios or stations reflecting a range of skills-based
clinical activities. OSCEs are used to teach and assess clinical
skills and a dominant form of skills assessment in undergraduate
medical education.
Role-play
Learners take on their own role or that of another (e.g. patient,
relative, health professionals) in a health care scenario.
Virtual reality
Parts or all of the patient and environment are presented to
the user via 2D or 3D visual and audio representations, with or
without “touch” (haptics) to create a more “immersive”
experience.
38
Appendix II: Data display table of graduate outcomes for eleven
eligible health professions
Theme
Theoretical
knowledge
(including
biomedical
science,
therapeutics
and other
theories
underpinning
practice)
Profession
Medicine
Graduate outcome
Demonstrate an understanding of established and evolving
biological, clinical, epidemiological, social, and behavioural
sciences
Apply core medical and scientific knowledge to individual patients,
populations and health systems
Describe the aetiology, pathology, clinical features, natural history
and prognosis of common and important presentations at all stages
of life
Dentistry
Apply a thorough knowledge of the complex interactions between
oral health, nutrition, general health, drugs and systemic diseases
that can have an impact on oral health care and oral diseases
Understand and apply knowledge of the scientific basis of dentistry,
including the relevant biomedical and psychosocial sciences, the
mechanisms of knowledge acquisition, scientific method and
evaluation of evidence
Apply knowledge and understanding of the basic biological,
medical, technical and clinical sciences in order to recognise the
difference between normal and pathological conditions relevant to
clinical dental practice
Understand the causes and factors that lead to dental diseases or
disorders
Recognise the clinical features of oral mucosal diseases and
disorders
Examine the dentition for pathology and abnormalities including
dental caries, attrition, wear, abrasion and erosion, and other
damage to dental hard tissues
Identify the location, extent, contributing factors and degree of
activity of dental caries, tooth wear and other structural or traumatic
anomalies
Recognise the presence of systemic disease and know how the
disease and its treatment, including present medication, affect the
delivery of dental care and vice versa
Diagnose abnormalities in dental or periodontal anatomical form
that compromise periodontal health, function or aesthetics and
identify conditions which require management
Distinguish between periodontal health and periodontal disease and
identify conditions that require management
Diagnose, explain and manage the deterioration and breakdown of
existing restorations
Conduct, explain and discuss the planning of restorative, periodontic
and prosthetic dental treatment as part of comprehensive oral
rehabilitation
Understand the common impairments of function as a consequence
of tooth loss
Physiotherapy
Demonstrate a working knowledge and understanding of theoretical
concepts and principles relevant to physiotherapy practice
Relevant knowledge of theoretical concepts and principles of
biomedical and behavioural sciences is applied to physiotherapy
practice
Principles of the physiotherapy assessment process, its basis and use
of relevant outcome measures are applied to physiotherapy
practice
Knowledge of common clinical presentations, interventions and
management approaches is applied to physiotherapy practice
39
Dietetics
Applies current knowledge of the theory of human nutrition and
dietetics and related practice to a level which supports safe
practice
Describes personal, social, cultural, psychological, environmental,
economic and political factors influencing food and food use, food
habits, diet and lifestyle
Demonstrates knowledge of foods and food preparation methods
used in the practice community
Relates knowledge of food science to nutrition and dietetics
Describes and compares food service systems
Describes food systems, food use, and food and nutrition policy
Applies the basic principles of education theory as it applies to
nutrition and dietetic practice
Relates theories of organisation, management and marketing to
nutrition and dietetic practice
Describes and compares theories of health promotion, program
planning, and management and public health
Applies the National Physical Activity Guidelines in practice
Applies principles of learning theory
Applies clinical reasoning theory
Paramedicine
Understands the key concepts of the bodies of knowledge which are
specifically relevant to Paramedic practice:
•
understands the structure, function and pathophysiology of
the human body, relevant to their practice, together with
knowledge of health, human growth and development,
disease, disorder and dysfunction;
•
understands the principles and applications of scientific
enquiry, including the evaluation of treatment efficacy and
the research process;
•
understands the theoretical basis of and the variety of
approaches to assessment and intervention;
•
knows human anatomy and physiology sufficient to
understand the nature and effects of injury or illness and to
conduct assessment and observation in order to establish
patient management strategies;
•
understands psychological and social factors that influence
an individual in health and illness;
•
understands the clinical sciences underpinning paramedic
practice, including physiological, pharmacological,
behavioural and functional
Describe major areas of applied psychology (eg, clinical,
counselling, organisational, forensic, health)
Psychology
Display basic knowledge and understanding of the following core†
topics:

abnormal psychology

biological bases of behaviour

cognition, information processing and

language

individual differences in capacity and

behaviour, testing and assessment,

personality

learning

lifespan developmental psychology

motivation and emotion

perception

social psychology

history and philosophy of

psychology

intercultural diversity and

indigenous psychology
Demonstrate knowledge of the theoretical and empirical bases
underpinning the construction, implementation, and interpretation of
some of the most widely used cognitive and personality assessments
40
Demonstrate knowledge of the theoretical and empirical bases
underpinning evidence-based approaches to psychological
intervention
Delineate psychology as a scientific discipline and describe its major
objectives
Explain the major themes (eg, interaction of genetics and
environment) and perspectives (eg, behavioural, evolutionary,
sociocultural) of psychology
Explain psychological phenomena using the concepts, language,
and major theories of the discipline
Clinical skills
(including
communication,
procedural
physical
examination
and patient
assessment)
Medicine
Demonstrate by listening, sharing and responding, the ability to
communicate clearly, sensitively and effectively with patients, their
family/carers, doctors and other health professionals
Communicate effectively in wider roles including health advocacy,
teaching, assessing and appraising
Explain the main principles of ethical practice and apply these to
learning scenarios in clinical practice
Communicate effectively about ethical issues with patients, family
and other health care professionals
Perform a full and accurate physical examination, including a
mental state examination, or a problem-focused examination as
indicated
Select and perform safely a range of common procedural skills
Recognise and assess deteriorating and critically unwell patients who
require immediate care
Perform common emergency and life support procedures, including
caring for the unconscious patient and performing CPR
Nursing
Communicates skill mix requirements to meet care needs of
individuals/groups to management
Communicates effectively with individuals/groups to facilitate
provision of care:

Uses a range of effective communication techniques

Uses language appropriate to the context

Uses written and spoken communication skills
appropriate to the needs of individuals/groups

Uses an interpreter where appropriate

Provides adequate time for discussion

Establishes, where possible, alternative communication
methods for individuals/groups who are unable to
verbalise

Uses open/closed questions appropriately
Demonstrates the necessary communication skills to manage
avoidance, confusion and confrontation
Demonstrates the necessary communication skills to enable
negotiation
Ensures that written communication is comprehensive, logical,
legible, clear and concise, spelling is accurate and only acceptable
abbreviations are used
Midwifery
Communicates information to facilitate decision making by the
woman
Communicates effectively with the woman, her family and friends
Demonstrates effective communication with midwives, health care
providers and other professionals
Dentistry
Communicate effectively, interactively and reflectively with patients,
their families, relatives and carers in a manner that takes into
account factors such as their age, intellectual development, social
and cultural background
Provide open, complete and timely communication throughout the
period of care
Provide information in a manner that ensures patients and families
can be fully informed when consenting to any procedure and
encourage them to make fully informed decisions by discussing
41
treatment options and expected outcomes
Communicate effectively with other health professionals involved in
patients’ care and convey written and spoken information clearly
Communicate effectively and responsibly in all communication
media
Recognise and communicate to patients the properties and risks
and benefits of dental materials and related tissue responses
Apply the scientific principles of sterilisation, disinfection and
antisepsis, and cross infection control
Work safely with ionising radiations with consideration for their effects
on biological tissues and understand and apply the regulations
relating to their use, including radiation protection and dose
reduction
Apply the principles of pharmacology in using therapeutics relevant
to clinical dental practice
Perform an extraoral and intraoral examination appropriate to the
patient, including assessment of vital signs and the recording of
those findings
Complete and record a comprehensive examination of oral hard
and soft tissues
Formulate and record a comprehensive diagnosis, management
and/or referral plan which meets the needs of patients
Take radiographs of relevance to the diagnostic process and dental
practice
Interpret radiographic and other diagnostic tests relevant to clinical
practice
Manage oro-facial pain, including TMJ disorders, discomfort and
psychological distress
Manage periodontal disease
Manage caries and other hard tissue tooth loss
Manage pulp and peri-radicular disease and disorders
Restore teeth and the dentition to acceptable form, function and
aesthetics
Manage patients with prosthodontic needs, including the provision
of fixed, patient-removable and implant prostheses
Treat and manage conditions requiring minor surgical procedures of
the hard and soft tissues, and apply and /or prescribe appropriate
pharmaceutical agents to support treatment
Manage common oral mucosal diseases and disorders
Manage minor developmental or acquired dentoalveolar, growth
related and functional abnormalities of the primary, mixed and
permanent dentition
Produce diagnostic casts, mounted with inter-occlusal records
Physiotherapy
Communicate effectively with the client
Rapport is established with the client
Verbal and non-verbal communication is adapted to the needs and
profile of the client
Communication with the client is conducted in a manner and
environment that ensures confidentiality, privacy and sensitivity
The goals, nature, purpose and expected outcomes of the
physiotherapy intervention are discussed and agreed
Appropriate techniques are used to communicate effectively with
the client about health promotion issues relevant to area of
physiotherapy practice
Where communication barriers exist, efforts are made to
communicate in the most effective way possible and assistance is
sought as required from sources including technology and other
persons
Communication is adapted to accommodate client needs
Appropriate strategies are employed to address communication
42
difficulties
Prepare and deliver presentations to groups
•
Presentations are planned and prepared to match
audience needs
•
Information is conveyed in a format and style to match
audience needs
•
A range of relevant delivery strategies are applied to
presentations
A systematic format is applied to measuring and recording client
data to ensure the effectiveness of the intervention is evaluated
Aboriginal
Health
Occupational
Therapy
Collaborating and communicating with other health professionals
Dietetics
Demonstrates or employs effective communication and counselling
strategies as they apply to nutrition and dietetic practice
Uses appropriate verbal and non-verbal communication
Listens and provides feedback that encourages participation and
engagement
Communicates in a way which respects customs of other cultures,
using socially and culturally appropriate strategies
Uses an interpreter appropriately to communicate nutrition and
health information
Presents an accurate, clear and logical message that is targeted to
the audience when speaking publicly
Develops and delivers education sessions for small groups
•
Develops, implements and evaluates nutrition education
plans for a variety of target groups
•
Provides appropriate rationale for educational approach
based on evidence
•
Uses a variety of presentation techniques
•
Displays innovation implementing nutrition education plans
•
Displays group facilitation skills
Communicates food service and supply needs of individual clients to
appropriate persons
Formulates unambiguous instructions for other personnel involved in
the delivery of nutrition care
Communicates the nutrition care plan to other members of the
healthcare team as appropriate, including referring practitioners
Communicates outcomes of nutrition programs to relevant internal
and external stakeholders
Clearly articulates and justifies conclusions and recommendations for
action
Provides accurate and clear information to food service personnel
and other health carers to allow implementation of plans
Communicates to effect practice change if required
Uses negotiation and conflict resolution skills to promote best
practice
Translates technical nutrition information into practical advice on
food and eating
Uses food composition data, food regulations and codes of
practice, nutrient reference tools and food guides to identify food
options, which meet nutrition needs
Develops and uses specific tools to assist food choices and
Develops, communicates and implements an effective, efficient
plan for occupational therapy intervention
Facilitates active participation of the client in service provision
Adopts a communication approach appropriate to the working
environment
Documents and reports relevant aspects of service provision
Shares professional information responsibly
Performs a relevant, comprehensive assessment of occupational
performance
43
preparation
Collects health and medical, social, cultural, psychological,
economic, personal and environmental data
Identifies and records health and medical, social, cultural,
psychological, physical activity, economic, personal and
environmental data, which are necessary to plan nutritional
management
Uses a variety of sources to obtain health and medical, social,
cultural, psychological, economic, personal and environmental
data, taking into account ethical issues
Provides assessment of food intake data
Selects a suitable method and level of detail for assessing intake of
foods and nutrients identified by referral, the client, previous history or
epidemiological data
Is able to estimate nutrient intake for individuals using food
composition tables and/or databases and compare with Nutrient
Reference Values (NRVs) or estimated requirements
Is able to interpret nutrient intake for groups and populations using
food composition tables and/or databases and compare with
Nutrient Reference Values (NRVs) or estimated requirements
Uses food guidance systems to contribute to the assessment of the
client’s dietary intake
Provides assessment of nutritional status
Selects suitable methods for assessment of anthropometry and body
composition
Is able to interpret anthropometric and body composition and
nutritional assessment data using appropriate reference ranges
Recognises clinical signs of malnutrition
Assesses and assigns priorities to all data
Undertakes screening and assessment to identify and prioritise those
at nutritional risk
Demonstrates awareness of the range of validated nutrition
screening and assessment tools available, including strengths and
limitations
Identifies and uses appropriate validated tools in nutrition screening
and assessment
Includes appropriate follow-up timeline
Determines nutritional status using assessment data
Interprets available documentation to identify problems
Assesses anthropometric and other body composition data
Assesses clinical, biochemical and other biomedical parameters
Assesses dietary intake, food habits, mental health and well-being
issues, physical activity and lifestyle habits
Makes appropriate nutrition diagnoses
Develops dietary prescriptions and formulates meal plans and
feeding regimens consistent with nutrition goals
Implements nutrition care plan in collaboration with client or carer
and other members of health care team
Selects the most suitable strategy in terms of feasibility and client
outcome
Implements nutrition plan and a system for monitoring and review
with client and other health care team members
Promotes physical activity guidelines in care plan with client and
other health care team members
Conducts a needs assessment
Plans nutrition programs with the population group
Develops program plans, that are relevant to the target group,
which consider the social determinants of health
Develops program plans that incorporate goals, objectives and
strategies relevant to identified determinants and needs assessment
findings
44
Develops program plans that incorporate process, impact, outcome
evaluation
Develops program plans that incorporate a communication strategy
Applies existing standards to evaluate available nutrients and
nutritional adequacy and recommends strategies to improve
nutrition in general and in therapeutic menus
Assesses the nutrition implications of food service systems on
individuals and groups
Develops plans to provide safe and nutritious foods in a food service
institution
Prepares meal plans for individuals and groups, which meet
nutritional, personal, cultural, sociological, psychological,
socioeconomic needs and specific health needs, taking into
account the ordering, preparation, service, availability and
distribution of food
Applies these meal plans for groups in an institutional, commercial or
community foodservice setting
Provides advice on appropriate ingredients and alternatives to
achieve nutritional goals for general, diverse or therapeutic diets
Formulates, modifies or standardises recipes for general, diverse or
therapeutic diets that are relevant to the production and distribution
system within a food service
Paramedicine
Demonstrates effective and appropriate skills in communicating
information, advice, instruction and professional opinion to
colleagues, service users, their relatives and carers;
Communicates effectively in English;
Identifies that communication skills affect the assessment of patients
and how the means of communication should be modified to
address and take account of factors such as age, physical ability
and learning ability;
Selects, moves between and uses appropriate forms of verbal and
nonverbal communication with patients and others;
Identifies the characteristics and consequences of non-verbal
communication and how this can be affected by culture, age,
ethnicity, gender, religious beliefs and socio-economic status;
Provides patients (or people acting on their behalf) with the
information necessary to enable them to make informed decisions;
Uses an appropriate interpreter to assist patients whose first language
is not English, wherever possible;
Recognises that relationships with patients should be based on
mutual respect and trust, and is able to maintain high standards of
care even in situations of personal incompatibility; and
Identifies anxiety and stress in patients, carers and others and
recognises the potential impact upon communication
Effectively communicates throughout the care of the patient:
•
uses interpersonal skills to encourage the active
participation of patients;
•
utilises appropriate communication skills to effectively
manage avoidance, confusion and confrontation
•
utilises appropriate communication skills when dealing with
the patient’s relatives and carers
Knowledge, understanding and skills required for Practice
Conducts a thorough and detailed physical examination of the
patient using observations, measurement and other assessment skills
to inform clinical reasoning;
Conducts a detailed physical examination of the patient to inform
clinical reasoning
Demonstrates an understanding of the public health model for
response to major incidents;
Demonstrates a working knowledge of the application of
emergency medicine in a mass casualty/major incident event;
45
Maintains currency with organisational policy, directions, procedures
and guidelines relating to the ambulance major incidents
Patient history
taking and
record keeping
Psychology
Communicate effectively in a variety of formats and in a variety of
contexts
Suggested learning outcomes:
Write a standard research report using American Psychological
Association (APA) structure and formatting conventions
Write effectively in a variety of other formats (eg, essays, research
proposals, reports) and for a variety of purposes (eg, informing,
arguing)
Demonstrate effective oral communication skills in various formats
(eg, debate, group discussion, presentation) and for various
purposes
Describe the basic characteristics of the science of psychology
Describe, apply and evaluate the different research methods used
by psychologists
Demonstrate practical skills in laboratory-based and other
psychological research
Describe and evaluate questionnaire and test construction,
implementation and interpretation
Describe the key principles for designing, implementing and
evaluating programs of behaviour change
Locate, evaluate and use information appropriately in the research
process
Undertake statistical analysis appropriately
Use basic web-search, word-processing, database, email,
spreadsheet, and data analysis programs
Design and conduct basic studies to address psychological
questions: frame research questions; undertake literature searches;
critically analyse theoretical and empirical studies; formulate
testable hypotheses; operationalise variables; choose an
appropriate methodology; make valid and reliable measurements;
analyse data and interpret results; and write research reports
Evaluate psychologists’ behaviour in psychological research and
other professional contexts in relation to the Australian Psychological
Society Code of Ethics and the complementary Ethical Guidelines,
as well as the Australian National Practice Standards for the Mental
Health Workforce
Promote evidence-based approaches to understanding and
changing human behaviour
Medicine
Elicit an accurate, organised and problem-focused medical history,
including family and social occupational and lifestyle features, from
the patient, and other sources
Elicit patients’ questions and their views, concerns and preferences,
promote rapport, and ensure patients’ full understanding of their
problem(s)
Involve patients in decision-making and planning their treatment,
including communicating risk and benefits of management options
Dentistry
Identify patients’ expectations, desires and attitudes when planning
and delivering treatment
Obtain and record a complete history of the patient’s psychosocial,
medical, oral and dental status
Maintain an accurate, consistent and legible record of patient
management including referral, delegation or handover
Physiotherapy
Relevant information and communication technology is used
efficiently to record, store, convey and retrieve client information
Client information and history are obtained
Presenting signs and symptoms are explored
46
Relevant measurable data are obtained and accessed where
possible
Goals, values and expectations of the client are identified
All information is recorded to enable the development of a detailed
management plan based on accurate and current information
Patient safety
Paramedicine
Identifies and assesses health and social care needs in the context of
the environment
Analyses the situation, gathers appropriate information and selects
and uses appropriate assessment techniques:
Undertakes and records a thorough assessment
Frames questions that indicate the use of a structured approach
Psychology
Demonstrate basic interviewing skills
Demonstrate effective interpersonal communication skills including
the abilities to: listen accurately and actively; use psychological
concepts and theories to understand interactions with others;
identify the impact or potential impact of one’s behaviour on others;
Provide constructive feedback to others; adopt flexible techniques
to communicate sensitively and effectively with diverse ethnic and
cultural partners, including in the context of team-work
Nursing
Provide information to patients, and family/carers where relevant, to
enable them to make a fully informed choice among various
diagnostic, therapeutic and management options
Prescribe medications safely, effectively and economically using
objective evidence Safely administer other therapeutic agents
including fluid, electrolytes, blood products and selected
inhalational agents
Describe the principles of care for patients at the end of their lives,
avoiding unnecessary investigations or treatment, and ensuring
physical comfort including pain relief, psychosocial support and
other components of palliative care
Place the needs and safety of patients at the centre of the care
process Demonstrate safety skills including infection control, graded
assertiveness, adverse event reporting and effective clinical
handover
Describe a systems approach to improving the quality and safety of
health care
Provide care to all patients according to “Good Medical Practice: A
Code of Conduct for Doctors in Australia” and “Good Medical
Practice: A Guide for Doctors” in New Zealand
Demonstrate professional values including commitment to high
quality clinical standards, compassion, empathy and respect for all
patients Demonstrate the qualities of integrity, honesty, leadership
and partnership to patients, the profession and society
Demonstrate awareness of and explain the options available when
personal values or beliefs may influence patient care, including the
obligation to refer to another practitioner
Recognises and responds appropriately to unsafe or unprofessional
practice:
•
identifies interventions which prevent care being
compromised and/or law contravened
•
identifies appropriate action to be taken in specified
circumstances
•
identifies and explains alternative strategies for intervention
and their likely outcomes
•
identifies behaviour that is detrimental to achieving optimal
care, and
•
follows up incidents of unsafe practice to prevent
recurrence
Questions and/or clarifies interventions that appear inappropriate
with relevant members of the health care team
Integrates nursing and health care knowledge, skills and attitudes to
provide safe and effective nursing care:
•
maintains a current knowledge base
47
•
•
considers ethical responsibilities in all aspects of practice
ensures privacy and confidentiality when providing care,
and
•
questions and/or clarifies interventions which appear
inappropriate with relevant members of the health care
team
Provides comprehensive, safe and effective evidence-based nursing
care to achieve identified individual/group health outcomes
Effectively manages the nursing care of individuals/groups:
•
uses resources effectively and efficiently in providing care
•
performs actions in a manner consistent with relevant
nursing principles
•
performs procedures confidently and safely
•
monitors responses of individuals/groups throughout each
intervention and adjusts care accordingly
Provides effective and timely direction and supervision to ensure that
delegated care is provided safely and accurately:
•
supervises and evaluates nursing care provided by others
•
uses a range of direct and indirect techniques such as
instructing, coaching, mentoring, and collaborating in the
supervision and support of others
•
provides support with documentation to nurses being
supervised or to whom care has been delegated
Midwifery
Accepts accountability and responsibility for own actions within
midwifery practice
•
Recognises and acts within own knowledge base and
scope of practice
•
Identifies unsafe practice and takes appropriate action
•
Consults with, and refers to, another midwife or appropriate
health care provider when the needs of the woman and
her baby fall outside own scope of practice or
competence
Promotes safe and effective midwifery care
•
Applies knowledge, skills and attitudes to enable woman
centred care
•
Provides or supports midwifery continuity of care
•
Manages the midwifery care of women and their babies
Assesses, plans, provides and evaluates safe and effective midwifery
care
•
Uses midwifery knowledge and skills to facilitate an optimal
experience for the woman
•
Assesses the health and well being of the woman and her
baby
•
Plans, provides, and is responsible for, safe and effective
midwifery care
•
Protects, promotes and supports breastfeeding
•
Demonstrates the ability to initiate, supply and administer
relevant pharmacological substances in a safe and
effective manner within relevant state or territory legislation
•
Evaluates the midwifery care provided to the woman and
her baby
Ensures midwifery practice is culturally safe
Plans, implements and evaluates strategies for providing culturally
safe practice for women, their families and colleagues
Dentistry
Provide patient-centred care, respect patients’ dignity and choices;
acknowledge that all interactions, including history taking, diagnosis,
treatment planning and treatment, must focus on the patient’s best
interests
Manage and maintain a safe working environment; have an
appreciation of the systems approach to quality health care and
safety, and the need to adopt and practise health care that
maximises patient safety
Select treatment options based on the best available information
and the least invasive therapy necessary to achieve the appropriate
and favourable outcome for the patient
48
Appreciate the importance of identifying both the patient and the
intended site for a procedure before undertaking irreversible
treatment
Propose, discuss and agree treatment options that are sensitive to
each patient’s individual needs, goals and values, compatible with
contemporary methods of treatment, and congruent with an
appropriate oral health care philosophy
Prevent and manage where necessary medical and dental
emergency situations encountered in clinical dental practice,
including oro-facial infections and trauma to the teeth, mouth and
jaws
Evaluate systematically all treatment outcomes, including
information on a patient’s and/or patient’s family/carer’s
satisfaction/dissatisfaction with treatment and providing and/or
recommending additional action and planning for the maintenance
of oral health
Physiotherapy
Form a preliminary hypothesis
•
The information collected is analysed
•
The factors influencing clinical presentation are identified
•
Assessment needs, including priority and urgency, are
identified
•
Differential diagnoses are hypothesised
•
Potential diagnoses are checked to ensure client needs are
within the practitioner’s scope of expertise
Design and conduct an assessment
•
An appropriate assessment plan is formulated, including
selecting tests to measure impairment and activity
limitation
•
Potential problems and contraindications to assessment are
identified
•
The assessment process is modified in recognition of factors
such as the client’s age, occupation, pain, co-morbidities,
cultural background, ability to communicate, level of
understanding, and the assessment environment
•
Appropriate assessment tools are used
•
A systematic, safe, efficient and goal-oriented physical
examination appropriate to physiotherapy is conducted
•
Examination findings are assessed against the preliminary
hypothesis
•
Further testing and examination is conducted or scheduled
as required
Conduct assessment safely
•
Risk identification, assessment and reporting procedures are
applied
•
Appropriate modifications are implemented to address risks
for the client or the physiotherapist undertaking the
assessment
•
Referrals are made to other service providers where clinical
presentation is not consistent with the diagnosis, the client is
not progressing as expected or is unexpectedly or
significantly deteriorating
Prioritise client needs
•
The problems and priorities of the client are identified in
collaboration with the client
•
Presenting symptoms and their interrelationships are
identified
•
Possible sources/mechanisms of presenting symptoms are
considered and compared with preliminary diagnosis
•
Realistic, shared goals that address the client’s problems,
needs, expectations, potential for change and lifestyle
modifications are developed and prioritised in consultation
with the client
•
Options for physiotherapy intervention are identified and
justified, based on the needs identified and best practice
evidence
•
Indications, contraindications and risks associated with
49
intervention are identified and appropriate action is taken
Interventions are selected with consideration to assessment
findings from other health service providers, pathology,
cost, client profile, needs and choices
•
Intervention selected is up to date, reflects best evidence
and follows best practice
•
The client is referred to other relevant colleagues when the
issues or problems identified are not appropriate for
physiotherapy or require a multidisciplinary approach
Prepare equipment and treatment area appropriate to the
intervention
•
Equipment is selected appropriate to the physiotherapy
intervention
•
Equipment is checked to ensure readiness for safe
operation and use
•
The treatment area, including equipment, is prepared for
intervention to maximise effectiveness, efficiency, safety
and privacy for the client
Implement intervention safely and effectively
•
Interventions are conducted safely and effectively
•
Risks to the client and the physiotherapist are identified and
managed
•
Appropriate precautions are applied
•
Appropriate mechanical equipment is used to assist in
client transfer and handling
•
Infection control procedures are implemented
•
Intervention is implemented sensitively to minimise distress
•
Intervention implemented is consistent with the agreed
intervention program
•
Strategies are used to motivate the client to participate in
the intervention program
•
Quality interventions are provided that best meet the
needs of the client, within the resource constraints of the
organisation
•
The client is monitored throughout the intervention and
appropriate modifications are made for the client’s
comfort and according to the client’s condition
•
Aboriginal
Health
Promoting culturally safe health care
Implementing safe and appropriate care according to care
planning principles
Occupational
Therapy
Adopts a client centered approach to practise
Demonstrates client centeredness during intervention
Promotes client occupational performance and participation
Selects and implements intervention strategies and methods
appropriate to the client
Selects and implements intervention strategies and methods
appropriate to the working environment
Demonstrates an understanding of, and commitment to, principles
and methods of quality improvement
Dietetics
Uses dietary methodology to collect retrospective, current and
prospective food and nutrient intakes for individuals which identify
nutrient and food intake patterns as required by the situation
Identifies appropriate dietary methodology to collect retrospective,
current and prospective food and nutrient intakes for groups and
populations which identify nutrient and food intake patterns as
required by the situation
Uses client-centred counselling skills to facilitate nutrition and lifestyle
change and supports clients to self manage
Assists client to clarify issues, identify the barriers to resolution of the
problem, and identify appropriate goals and strategies
Negotiates client oriented goals and strategies
Demonstrates safe practice
•
Exercises professional duty of care in accordance with the
50
•
•
Teamwork
DAA Code of Professional Conduct and the organisation’s
guidelines or protocols
Refers clients/patients/issues to appropriate professional
when beyond own level or area of competence
Develops and maintains a credible professional role by
commitment to excellence of practice
Paramedicine
Operates within a framework of making informed, evidence based,
reasonable and professional judgments about their practice, with
acting in the best interests of their patients as their prime concern
Makes sensible, practical decisions about their practice, taking
account of all relevant information and the best interests of the
people who use or are affected by the service that is being provided
Acts in the best interests of patients and service users at all times;
Operates within the requirements of approved Paramedic
Professional Competency Standards and their employment
conditions/relationship;
Demonstrates the need to respect, and so far as possible uphold, the
rights, dignity, values and autonomy of every patient/service user This
includes their role in the diagnostic and therapeutic process and in
maintaining health and wellbeing;
Assesses a situation, determines the nature and severity of the
problem and calls upon the required knowledge and experience to
provide a response that is in the best interest of the patient/s;
Exercises personal initiative in providing care that is in the best
interest of the patient/s
Effectively supervises tasks that they have asked other people to
perform
Considers the health and social care needs of patients and carers in
the assessment process
Maintains the safety of both patients and those involved in their
care;
Positions for safe and effective interventions;
Knows the indications and contra-indications of using specific
paramedic interventions including their modifications;
Responds to urgent and non-urgent requests for assistance in a low
risk manner in accordance with relevant road safety legislation,
organisational directives, policies and procedures;
Utilises appropriate transport platforms taking into account clinical
need, time criticality and environmental considerations;
Co-operates with and utilises the support of other emergency service
and rescue organisations to facilitate patient access / egress /
extrication in the most effective manner
Medicine
Understand and describe the roles and relationships between health
agencies and services, and explain the principles of efficient and
equitable allocation of finite resources, to meet individual,
community and national health needs
Describe and respect the roles and expertise of other health care
professionals, and demonstrate ability to learn and work effectively
as a member of an inter-professional team or other professional
group
Nursing
Clarifies responsibility for aspects of care with other members of the
health team
Consults relevant members of the health care team when required
Contributes to the professional development of others:
•
demonstrates an increasing responsibility to share
knowledge with colleagues
•
supports health care students to meet their learning
objectives in cooperation with other members of the health
care team
•
facilitates mutual sharing of knowledge and experience
with colleagues relating to individual/group/unit problems
•
contributes to orientation and ongoing education
51
programs
acts as a role model to other members of the health care
team
•
participates where possible in preceptorship, coaching and
mentoring to assist and develop colleagues
•
participates where appropriate in teaching others including
students of nursing and other health disciplines, and
inexperienced nurses, and
•
contributes to formal and informal professional
development
Collaborative and therapeutic practice
Relates to establishing, sustaining and concluding professional
relationships with individuals/groups This also contains those
competencies that relate to nurses understanding their contribution
to the interdisciplinary health care team
Establishes, maintains and appropriately concludes therapeutic
relationships
Establishes therapeutic relationships that are goal directed and
recognises professional boundaries: demonstrates empathy, trust
and respect for the dignity and potential of the individual/group
Interacts with individuals/groups in a supportive manner
Effectively initiates, maintains and concludes interpersonal
interactions
Collaborates with the interdisciplinary health care team to provide
comprehensive nursing care
Recognises that the membership and roles of health care teams and
service providers will vary depending on an individual’s/group’s
needs and health care setting:
•
recognises the impact and role of population, primary
health and partnership health care models
•
recognises when to negotiate with, or refer to, other health
care or service providers
•
establishes positive and productive working relationships
with colleagues, and
•
recognises and understands the separate and
interdependent roles and functions of health care team
members
Demonstrates an understanding of how collaboration has an impact
on the safe and effective provision of comprehensive care
Establishes and maintains effective and collaborative working
relationships with other members of the health care team
Consults with relevant health care professionals and service providers
to facilitate continuity of care
Recognises the contribution of, and liaises with, relevant community
and support services
•
Midwifery
Establishes, maintains and evaluates professional relationships with
other health care providers
Collaborates with, and refers women to, appropriate community
agencies and support networks
Contributes to, and evaluates, the learning experiences and
professional development of others
Dentistry
Contribute to teams of health care practitioners in delivering health
care in a cooperative, collaborative and integrative manner
Physiotherapy
Effective working relationships with colleagues and team members
are established and maintained
Written and verbal communication with health professionals and
other service providers follows accepted protocols and procedures
to ensure information is conveyed clearly and accurately
Issues relevant to evidence-based practice are discussed with
colleagues, supervisors and other health professionals
Work effectively within a team
•
Collaborative working arrangements with others are
established and practised to provide an effective teambased approach to service delivery
•
Input is provided to meetings and planning discussions
52
•
•
•
•
•
A holistic approach to client care is promoted
Support and respect for colleagues and other professionals
is provided
Advocacy is provided for the client, community and
physiotherapy profession
The physiotherapy perspective is provided in interprofessional teams, to the client’s benefit
Risk reduction strategies are promoted to increase
awareness amongst health professionals, communities and
clients
Aboriginal
Health
Occupational
Therapy
Sharing and creating knowledge
Collaborating and communicating with other health professionals
Engages in critical, collaborative professional reasoning processes to
determine priorities for intervention
Dietetics
Interprets nutritional information and communicates it using socially
and culturally appropriate language
Participates in multi-disciplinary team activities (such as case
conferencing) to achieve nutrition goals
Identifies opportunities to collaborate with other
professionals/organisations to improve nutrition outcomes
Demonstrates willingness to share information and act as a resource
person to, and advocate for, colleagues, community and other
agencies
Discusses and explores ideas with colleagues/others on an ongoing
basis
Seeks external ideas
Develops cooperative relationships with stakeholders in the food
system to positively influence nutrition outcomes
Develops sustainable collaborative relationships and networks
•
Contributes effectively to work undertaken as part of a
multi-disciplinary team
•
Builds relationships with stakeholders
•
Acknowledges the different ways that different people may
contribute to building or enhancing a team
Paramedicine
Develops and maintains professional relationships
Works, where appropriate, in partnership with other professionals and
support staff
Builds and sustains collaborative professional relationships as a
member of a team;
Makes appropriate referrals to other health care
professionals/service providers;
Demonstrates an understanding of the range and limitations of
operational relationships between Paramedics and other healthcare
professionals;
Demonstrates an understanding of the principles and practices of
other healthcare professionals and healthcare systems and how they
interact with the role of a Paramedic;
Consults effectively with relevant health care professionals and
service providers to facilitate continuity of care
Contributes effectively to work undertaken as part of a multidisciplinary team
Participates in guiding the learning of others;
•
shares knowledge with colleagues;
•
supports health care students to meet their learning
objectives;
•
shares knowledge and experience with colleagues relating
to individual/group/unit problems;
•
contributes to orientation and ongoing education
programs;
•
acts as a role model to other members of the health care
team;
53
•
•
Professionalism
(including law
and ethics)
participates where possible in coaching and mentoring to
assist and develop colleagues;
participates where appropriate in teaching others including
Paramedic students and those of other health disciplines
and developing less experienced Paramedics
Psychology
Collaborate effectively, demonstrating an ability to: work with groups
to complete projects within reasonable timeframes; manage
conflicts appropriately and ethically
Medicine
Demonstrate professional values including commitment to high
quality clinical standards, compassion, empathy and respect for all
patients Demonstrate the qualities of integrity, honesty, leadership
and partnership to patients, the profession and society
Describe the principles and practice of professionalism and
leadership in health care
Identify the boundaries that define professional and therapeutic
relationships and demonstrate respect for these in clinical practice
Describe and apply the fundamental legal responsibilities of health
professionals especially those relating to ability to complete relevant
certificates and documents, informed consent, duty of care to
patients and colleagues, privacy, confidentiality, mandatory
reporting and notification Demonstrate awareness of financial and
other conflicts of interest
Explain the main principles of ethical practice and apply these to
learning scenarios in clinical practice
Nursing
Integrates organisational policies and guidelines with professional
standards:
•
maintains current knowledge of and incorporates relevant
professional standards into practice
•
maintains current knowledge of and incorporates
organisational policies and guidelines into practice
•
reviews and provides feedback on the relevance of
organisational policies and professional standards
procedures to practice
Demonstrates accountability and responsibility for own actions within
nursing practice
Demonstrates an understanding of standards and practices of
professional boundaries and therapeutic relationships
Identifies legislation governing nursing practice
Describes nursing practice within the requirements of common law
Describes and adheres to legal requirements for medications
Identifies legal implications of nursing interventions
Actions demonstrate awareness of legal implications of nursing
practice
Identifies and explains effects of legislation on the care of
individuals/groups
Identifies and explains effects of legislation in the area of health,
and
Identifies unprofessional practice as it relates to confidentiality and
privacy legislation
Practises in accordance with the nursing profession’s codes of ethics
and conduct:
•
accepts individuals/groups regardless of race, culture,
religion, age, gender, sexual preference, physical or
mental state
•
ensures that personal values and attitudes are not imposed
on others
•
conducts assessments that are sensitive to the needs of
individuals/groups
•
recognises and accepts the rights of others
•
maintains an effective process of care when confronted
by differing values, beliefs and biases
•
seeks assistance to resolve situations involving moral
conflict, and
•
identifies and attempts to overcome factors which may
constrain ethical decisions, in consultation with the health
care team
Maintains an effective process of care when confronted by differing
54
values, beliefs and biases
Maintains confidentiality in discussions about an individual/group’s
needs and progress
Midwifery
Functions in accordance with legislation and common law affecting
midwifery practice
•
Demonstrates and acts upon knowledge of legislation and
common law pertinent to midwifery practice
•
Complies with policies and guidelines that have legal and
professional implications for practice
•
Formulates documentation according to legal and
professional guidelines
•
Fulfils the duty of care in the course of midwifery practice
Bases midwifery practice on ethical decision making
•
Practises in accordance with the endorsed Code of Ethics
and relevant state/ territories and commonwealth privacy
obligations under law
Identifies personal beliefs and develops these in ways that enhance
midwifery practice
•
Addresses the impact of personal beliefs and experiences
on the provision of midwifery care
•
Appraises and addresses the impact of power relations on
midwifery practice
Dentistry
Demonstrate appropriate caring behaviour towards patients and
respect professional boundaries in relationships between themselves
and patients and members of the community
Work productively in his or her role in the dental team and display
appropriate professional behaviour towards other team members
Recognise and respect patients’ rights, particularly with regard to
confidentiality, privacy, informed consent
Understand the ethical principles and legal responsibilities involved in
the provision of dental care to individual patients, to communities
and populations, practising with personal and professional integrity,
honesty and trustworthiness
Understand and apply Commonwealth, State and Territory
legislation relevant to practise as a dentist
Ensure the personal health information of patients is shared only with
relevant health care providers and where permitted by law
Obtain and record informed consent for all forms of treatment
Physiotherapy
Relationships with clients and colleagues are in accordance with
accepted standards of conduct for health professionals
Demonstrate practice that is ethical and in accordance with
relevant legal and regulatory requirements
•
Compliance with relevant legislation, standards and codes
of conduct is demonstrated in all aspects of work
•
Compliance with the medico-legal requirements relating to
informed consent and confidentiality of client information
•
Compliance with privacy legislation
•
Work practice and environment comply with occupational
health and safety standards and legislation
Prepare and provide documentation according to legal
requirements and accepted procedures and standards
•
All documentation is legible, accurate and concise
•
Documentation is provided that meets the needs of the
recipient
•
All records comply with legal accountability, confidentiality
requirements, accepted procedures and standards
•
Documentation is produced that is comprehensive and
provides adequate evidence of assessment and
intervention planning
Collect client information
•
Informed consent is obtained as appropriate for assessment
Work complies with the relevant guidelines, legislation, healthcare
initiatives and the Australian healthcare system
55
Aboriginal
Health
Understanding and professionally managing relationships with family
and community
Practising ethically
Understanding and practising within confidentiality guidelines
Understanding and practising within legislative frameworks and
policies
Occupational
Therapy
Promotes and facilitates occupation through the application of
professional knowledge, skills, attitudes and evidence appropriate to
the practice context
Demonstrates professional knowledge, skills, and attitudes
appropriate for the working environment
Adopts an efficient, effective and systematic approach to daily
workload management
Works effectively within the structure of the workplace environment
Practises in a professional manner that meets ethical and legal
responsibilities
Dietetics
Maintains clear and concise records, in accordance with the
organisation’s policy and legal requirements, of all facets of the
nutrition care process
Uses appropriate behaviour change, health promotion, social
marketing, communication, community development and public
health policy frameworks in the planning of nutrition programs
Considers confidentiality of information and records
Applies food legislation and regulations to develop and evaluate
food service systems to maintain food safety
Develops recommendations for the review of systems or policies or
procedures
Prepares and implements achievable quality activities, consistent
with policy and procedures
Complies with legislation and regulations which define ethical
behaviour, including maintaining confidentiality
Paramedicine
Demonstrates accepted standards of personal conduct
Behaves with honesty, integrity and impartiality to ensure that their
behaviour does not damage the public’s confidence in themselves
or their employer
Demonstrates the principles, application and need for quality control
and quality assurance in Paramedic practice;
Demonstrates an awareness of the role of audit and review in quality
management, including quality control, quality assurance and the
use of appropriate outcome measures;
Operates within the current legislation applicable to ambulance
operations and paramedic practice;
•
practices in accordance with the applicable legislative
requirements in the country or state of employment
governing the use of prescription-only medicines by
Paramedics;
•
practices in a non-discriminatory manner, regardless of
individuals or groups race, culture, religion, age, gender,
sexual preference, physical or mental state;
•
maintains the privacy and confidentiality of information;
•
obtains informed consent wherever practicable
Recognises the need to handle these records and all other
information in accordance with applicable privacy legislation,
policies, protocols and guidelines;
•
uses only accepted terminology in completing patient
care records
Psychology
Display high standards of personal and professional integrity in
relationships with others
56
Use information in an ethical manner (eg, acknowledge and respect
the work and intellectual property rights of others through
appropriate citations in oral and written communication)
Recognise how privilege, power, and oppression may affect
prejudice, discrimination, and inequity
Explain how prejudicial attitudes and discriminatory behaviours might
exist in oneself and in others
Apply knowledge of legislative frameworks (including privacy,
human rights)
Selfreflection/Selfawareness/selfmanagement
Medicine
Self-evaluate their own professional practice; demonstrate lifelong
learning behaviours and fundamental skills in educating colleagues
Recognise the limits of their own expertise and involve other
professionals as needed to contribute to patient care
Demonstrate awareness of factors that affect doctors’ health and
wellbeing, including fatigue, stress management and infection
control, to mitigate health risks of professional practice
Recognise their own health needs, when to consult and follow
advice of a health professional and identify risks posed to patients by
their own health
Nursing
Demonstrates awareness and understanding of developments in
nursing that have an impact on the individual’s capacity to practise
nursing, and
Considers individual health and wellbeing in relation to being fit for
practice
Seeks clarification when questions, directions and decisions are
unclear or not understood
Seeks feedback from a wide range of sources to improve the quality
of nursing care
Participates in professional development to enhance nursing
practice:
•
reflects on own practice to identify Professional
development needs
•
seeks additional knowledge and/or information when
presented with unfamiliar situations
•
seeks support from colleagues in identifying learning needs
•
participates actively in ongoing professional development,
and
•
maintains records of involvement in professional
development which includes both formal and informal
activities
Uses reflective practice to identify personal needs and seek
appropriate support
Midwifery
Acts to enhance the professional development of self and others
Assesses and acts upon own professional development needs
Dentistry
Recognise personal limitations and know when to refer or seek
advice appropriately
Employ a critically reflective approach to practice which involves
learning from experience and participating in and contributing to
peer review
Demonstrate an ethos of lifelong professional growth and
development, and support continuing professional development for
all members of the dental team
Maintain their own health and understand its importance in relation
to occupational hazards and its impact on the ability to practise as a
dentist
Understand his or her limitations and know when and how to refer a
patient for an appropriate opinion and/or treatment, where the
diagnosis and/or treatments are beyond his or her skills or to confirm
prescribed treatment
Physiotherapy
Demonstrate strategies to maintain and extend professional
competence
57
•
Self reflection is used to maintain and extend professional
competence
•
Feedback is sought from supervisors, peers and other health
professionals, and acted upon to improve own practice
•
An understanding of the need for a commitment to
continuous professional development is demonstrated
Operate within individual and professional strengths and limitations
•
A self assessment is made about the capacity to operate
safely and effectively, based on knowledge, impairments,
activity limitations, participation restrictions, skill level, the
environment and the client profile and needs
•
Appropriate action is taken to manage own health factors
that may affect the capacity to operate safely and
effectively
•
Services to the client are in accordance with defined work
roles and the bounds of personal and professional
competence and strengths
•
Assistance is sought to complement own limitations so that
services to the client are not compromised either in safety
or effectiveness
•
The client is referred to relevant professionals, including
other physiotherapists, when limitations of skills or job role
prevent the client’s needs being adequately addressed
Knowledge and information needs are identified
Identify areas that are outside skills and expertise and refer client
appropriately
•
Conditions that are not amenable to physiotherapy
intervention or are beyond the management skills and
knowledge of the practitioner are identified
•
Appropriate referrals are made to other practitioners,
including physiotherapists, based on knowledge of
presenting condition and management options and own
skill levels
Strategies are implemented to minimise the risks of work related injury
or harm to self or others
Referrals are made to physiotherapists with specialised skills and to
other service providers as required
Aboriginal
Health
Occupational
Therapy
Reflecting on and developing own practice
Dietetics
Accepts responsibility for and manages, implements and evaluates
personal professional development
Demonstrates consistent, reflective practice in collaboration with
peers and mentors
Paramedicine
Provides their employer with relevant information that may affect
their ability to practice
Limits their work or stops practicing if their performance or judgment
is affected by their health or other personal factors
Operates within the limits of their practice, seeks advice or refers to
another professional;
Recognises that they are responsible for and must be able to justify
their decisions within the particular employers approved scope of
practice;
Utilises a range of integrated skills and self-awareness to manage
clinical challenges effectively in unfamiliar circumstances or
situations
Applies effective self-management of workload and resources and is
able to practice accordingly within the individual activity
Develops and maintains personal health and wellbeing strategies
Maintains and enhances competence through lifelong learning and
continuing professional development activities
Engages in lifelong learning processes and activities to maintain
professional competence
58
•
practices safe manual handling techniques within the
scope of paramedic duties
•
maintains physical health, fitness and nutrition
•
maintains psychological wellbeing:
•
actively maintains a safe working environment for self and
partner;
Considers feedback from colleagues about and critically reflects on
their own Paramedic practice;
Maintains an effective audit trail and work towards continual
improvement;
•
participates in quality assurance programmes, where
appropriate or required;
•
reflects on practice and the application of such reflection
to their future practice;
•
participates in case conferences and other methods of
review
Contributes to formal and informal professional development;
•
maintains records of their involvement in both formal and
informal professional development activities
Cultural
understanding
Psychology
Explain how prejudicial attitudes and discriminatory behaviours
might exist in oneself and in others
Recognise the limitations of one’s psychological knowledge and
skills, and value life-long learning
Reflect on one’s experiences and learn from them in order to identify
and articulate one’s personal, sociocultural, and professional values;
demonstrate insightful awareness of one’s feelings, motives, and
attitudes based on psychological principles
Apply psychological principles to promote personal development
through self-regulation in setting and achieving career and personal
goals; self-assess performance accurately; incorporate feedback for
improved performance; purposefully evaluate the quality of one’s
thinking (metacognition)
Demonstrate a capacity for independent learning to sustain
personal and professional development in the changing world of
the science and practice of psychology
Medicine
Understand and describe the factors that contribute to the health
and wellbeing of Aboriginal and Torres Strait Islander peoples and/or
Māori, including history, spirituality and relationship to land, diversity
of cultures and communities, epidemiology, social and political
determinants of health and health experiences Demonstrate
effective and culturally competent communication and care for
Aboriginal and Torres Strait Islander peoples and/or Māori
Nursing
Practises in a way that acknowledges the dignity, culture, values,
beliefs and rights of individuals/groups:
•
demonstrates respect for individual/group common and
legal rights in relation to health care
•
identifies and adheres to strategies to promote and
protect individual/group rights
•
considers individual/group preferences when providing
care
•
clarifies individual/group requests to change and/or refuse
care with relevant members of the health care team
•
advocates for individuals/groups when rights are
overlooked and/or compromised
•
accepts individuals/groups to whom care is provided
regardless of race, culture, religion, age, gender, sexual
preference, physical or mental state
•
ensures that personal values and attitudes are not imposed
on others
•
undertakes assessments which are sensitive to the needs of
individuals/groups
Protects the rights of individuals and groups and facilitates informed
decisions
Identifies and explains policies/practices which infringe on the rights
59
of individuals or groups
Clarifies policies, procedures and guidelines when rights of individuals
or groups are compromised, and
Demonstrates sensitivity, awareness and respect for cultural identity
as part of an individual’s/ group’s perceptions of security
Demonstrates sensitivity, awareness and respect in
regard to an individual’s/group’s spiritual needs
Dentistry
Understand systems of health care provision in a culturally diverse
society including their advantages and limitations, the principles of
efficient and equitable allocation and use of finite resources, and
recognition of local and national needs in health care and service
delivery
Understand and apply the principles of culturally safe and sensitive
practice and provide care in an empathic way that is free of
discrimination
Physiotherapy
Adapt communication style recognising cultural safety, and cultural
and linguistic diversity
•
Respect for cultural and linguistic diversity is demonstrated
in all communication with the client, colleagues and other
service providers so that effective relationships are
developed and maintained
•
When required, a third party is requested to be present for
reasons including cultural sensitivity and the provision of
interpreter services
•
Appropriate effort is applied to sensitively recognise,
negotiate and where possible resolve conflicts, taking into
account cultural considerations
Aboriginal
Health
Providing culturally safe health care
•
Knowing and respecting our history, context, culture and
customs
•
Engaging and consulting respectfully with the community
and its elders
•
Addressing local community health issues and needs
•
Advocating for the rights and needs of the individual and
the community
•
Promoting culturally safe health care
Understanding the social, spiritual and cultural conditions which
impact on emotional and physical wellbeing
Assessing, identifying and communicating health care needs
considering community values, beliefs and protocols
Occupational
Therapy
Dietetics
Practises in a culturally safe professional manner
Interprets nutritional information and communicates it using socially
and culturally appropriate language
Develops education material that is evidence-based, culturally
sensitive, and pitched at the appropriate literacy level, to meet the
needs of the target group
Communicates with individuals, groups, organisations and
communities from various cultural socio-economic, organisational
and professional backgrounds to enable them to take actions to
improve nutrition and health outcomes applying the principles of
learning theory
Communicates in a way which respects customs of other cultures,
using socially and culturally appropriate strategies
Uses an interpreter appropriately to communicate nutrition and
health information
Identifies individual, socio-economic, cultural and environmental
determinants, including equity and social justice issues
Demonstrates cultural competency
Understands what is meant by cultural awareness with respect to the
60
Aboriginal and Torres Strait Islander and Culturally and Linguistically
Diverse (CALD) communities and is aware of the skills required for
communicating in a culturally respectful way
Has a working knowledge of the nutrition issues and diet related
diseases impacting on the health of Aboriginal and Torres Strait
Islanders and people from CALD communities
Has an awareness of the current policy and implementation
frameworks for Aboriginal and Torres Strait Islander and CALD
communities
Managing
complex clinical
scenarios
Organisational
Paramedicine
Adapts practice to meet the needs of different groups distinguished
by, for example, physical, psychological, environmental, cultural or
socioeconomic factors within their authorised scope of practice;
Demonstrates sensitivity to the factors which shape lifestyle that may
impact on the individual’s health and affect the interaction between
the patient and Paramedic
Psychology
Recognise and respect social, cultural, linguistic, spiritual and gender
diversity
Explain how the science and practice of psychology is influenced by
social, historical, professional, and cultural contexts
Identify and describe the sociocultural and international contexts
that influence individual differences in beliefs, values, and behaviour
Nursing
Responds effectively to unexpected or rapidly changing situations
•
responds effectively to emergencies
•
maintains self-control in the clinical setting and under stress
conditions
•
implements crisis interventions and emergency routines as
necessary
•
maintains current knowledge of emergency plans and
procedures to maximise effectiveness in crisis situations, and
•
participates in emergency management practices and
drills according to agency policy
Midwifery
Assesses, plans, provides and evaluates safe and effective midwifery
care for the woman and/or baby with complex needs
•
Uses a range of midwifery knowledge and skills to provide
midwifery care for the woman and/or her baby with
complex needs as part of a collaborative team
•
Recognises and responds effectively in emergencies or
urgent situations
Physiotherapy
Manage adverse events
•
Potential adverse events are identified, and relevant
precautionary measures are taken, including strategies to
manage personal safety
•
Adverse events are recognised, managed appropriately,
reported and clearly documented
•
Emergency procedures for the workplace are identified
and are able to be carried out as required
Paramedicine
Utilises a range of integrated skills and self-awareness to manage
clinical challenges effectively in unfamiliar circumstances or
situations
Maintains self control in the clinical setting and under stressful
conditions
Selects or modifies approaches to meet the needs of patients, their
relatives and carers, when presented in emergency and urgent
situations;
Modifies and adapts their practice appropriate to the emergency
environment
Dietetics
Applies organisational skills in the practice of nutrition and dietetics
61
skills
Research skills
(critical thinking,
analysis,
evaluation,
problem solving)
•
Manages workload and resources to complete tasks within
required timeframes
•
Applies the principles of personnel management, using
principles of human resource management and industrial
relations
•
Allocates resources (time, personnel, other) according to
established priorities
•
Performs and manages administration tasks effectively (eg
makes appointments, responds to referrals, maintains
records and statistics)
Applies management principles in the practice of nutrition and
dietetics
•
Applies the strategic or organisational planning process to
the nutrition and dietetics service
•
Develops a case to justify program, service, product, or
procedure
•
Understands and performs simple budgeting and cost
control measures
Applies quality management principles to all aspects of professional
practice
Paramedicine
Records information systematically in an accessible and retrievable
form;
Keeps accurate, comprehensive, logical, legible and concise
records;
Dentistry
Understand basic principles of practice administration, financial and
personnel management in a dental practice
Maintain an accurate, consistent and legible record of patient
management including referral, delegation or handover
Medicine
Access, critically appraise, interpret and apply evidence from the
medical and scientific literature
Apply knowledge of common scientific methods to formulate
relevant research questions and select applicable study designs
Integrate and interpret findings from the history and examination, to
arrive at an initial assessment including a relevant differential
diagnosis Discriminate between possible differential diagnoses, justify
the decisions taken and describe the processes for evaluating these
Select and justify common investigations, with regard to the
pathological basis of disease, utility, safety and cost effectiveness,
and interpret their results
Make clinical judgements and decisions based on the available
evidence Identify and justify relevant management options alone or
in conjunction with colleagues, according to level of training and
experience
Retrieve, interpret and record information effectively in clinical data
systems (both paper and electronic)
Nursing
Performs nursing interventions following comprehensive and
accurate assessments
Questions and/or clarifies orders and decisions that are unclear, not
understood or questionable, and
Assesses consequences of various outcomes of decision making
Demonstrates analytical skills in accessing and evaluating health
information and research evidence:
•
demonstrates understanding of the registered nurse role in
contributing to nursing research
•
undertakes critical analysis of research findings in
considering their application to practice
•
maintains accurate documentation of information which
could be used in nursing research, and
•
clarifies when resources are not understood or their
application is questionable
Evaluates progress towards expected individual/group health
outcomes in consultation with individuals/groups, significant others
and interdisciplinary health care team
Determines progress of individuals/groups toward planned
62
outcomes:
•
recognises when individual’s/group’s progress and
expected progress differ and modifies plans and actions
accordingly
•
discusses progress with the individual/group
•
evaluates individual/group responses to interventions, and
•
assesses the effectiveness of the plan of care in achieving
planned outcomes
Midwifery
Uses research to inform midwifery practice
•
Ensures research evidence is incorporated into practice
•
Interprets evidence as a basis to inform practice and
decision making
Dentistry
Utilise critical thinking, problem-solving skills and emotional
intelligence
Apply decision-making, clinical reasoning and judgment to develop
a differential, provisional or definitive diagnosis by interpreting and
correlating findings from the history, clinical and radiographic
examination and other diagnostic tests, taking into account the
social and cultural background of the patient and the longer term
consequences on patients’ oral and general health
Evaluate and integrate emerging trends in health care as
appropriate
Formulate treatment plans which integrate research outcomes with
clinical expertise and patient views
Locate and evaluate evidence in a critical and scientific manner to
support professional practice and use information technology
appropriately as an essential resource for modern dental practice
Evaluate the validity of claims related to the risks/benefits of products
and techniques
Perform an appropriate physical examination, interpret the findings
and organise further investigations when necessary in order to arrive
at an appropriate diagnosis
Select appropriate clinical, laboratory and other diagnostic
procedures and tests, understand their diagnostic reliability and
validity, and interpret their results
Critically reflects and makes recommendations about the nutrition
program based on evaluation data
Physiotherapy
A range of information relevant to physiotherapy practice is
accessed
Apply an evidence-based approach to own practice
•
A working knowledge of commonly used research
methodologies is demonstrated
•
Information from a range of sources is critically evaluated
for the impact on own work
•
Practices are critically evaluated in the light of available
evidence to determine efficiency
Occupational
Therapy
Demonstrates ability to understand and conduct multiple evaluation
methods and techniques
Dietetics
Conducts or uses nutrition research methodology, research principles
and evidence-based practice including qualitative and quantitative
research methods
Accurately interprets dietary, health, medical, anthropometric, and
body composition data against standards relevant to the nutritional
issues
Makes judgements about potential impact of health and medical,
social, cultural, psychological, economic, personal and
environmental factors on nutrition
Integrates assessment data in order to assign priorities for nutrition
63
and resource planning
Draws justifiable conclusions from all data
Defines nutrition problems/diagnoses as a prelude to planning
management
Interprets available documentation to identify problems
Organises, interprets and prioritises data to undertake nutritional
diagnoses
Refers to all available evidence to inform clinical judgement
Uses qualitative and/or quantitative methods to collect and analyse
data to identify and inform program development and nutrition
issues
Uses qualitative and/or quantitative methods to collect and analyse
data to identify food service and/or nutrition issues
Evaluates and disseminates results of activities
Evaluates outcomes using standard benchmarks and procedures,
where appropriate
Critically reflects on evaluation data in the context of plans, goals
and implementation activities, where possible
Adopts a questioning and critical approach in all aspects of
practice
•
Formulates a clear understanding of the nature of a
practice problem
•
Applies an evidence-based approach to practice
•
Identifies and selects appropriate research methods to
investigate and resolve practice problems
•
Applies valid and relevant conclusions and
recommendations to practice
Evaluates practice on an ongoing basis
•
Monitors and reviews the ongoing effectiveness of practice
and modifies it accordingly
Applies the research process using appropriate research methods,
ethical processes and procedures and statistical analysis
•
Critically reviews the literature
•
Utilises ethical procedures in the research process
•
Identifies and selects appropriate research methods to
investigate and resolve practice problems
•
Collects and interprets information, including qualitative
and quantitative data
•
Documents outcomes of research using the research
process
Applies evaluation findings into practice
•
Applies evidence and judgement to food and nutrition
issues
•
Disseminates outcomes of research in professional and
scientific fora
Creates solutions which match and solve problems
Demonstrates initiative by proactively developing solutions to
problems
Paramedicine
Makes sensible, practical decisions about their practice, taking
account of all relevant information and the best interests of the
people who use or are affected by the service that is being provided
Uses clinical reasoning and problem-solving skills to determine clinical
judgments and appropriate actions:
•
demonstrates a logical and systematic approach to
problem solving and situation analysis;
•
analyses and critically evaluates the information collected
to make clinical judgments;
•
recognises that clinical judgments involve consideration of
conflicting information and evidence;
•
formulates a diagnosis informed by the patient assessment
and analysis of context and situation;
•
identifies the time criticality of treatment and transport
Monitors and evaluates the quality of practice and the value of
contributing to the generation of data for quality assurance and
64
improvement programs;
•
makes reasoned decisions to initiate, continue, modify or
cease treatment or the use of techniques or procedures
and record the decisions and reasoning appropriately
Practices within an evidence based framework:
•
recognises the value of research to the critical evaluation
of practice;
•
participates in and evaluates research outcomes and
incorporates these into evidence based practice where
relevant;
•
participates in review of policies, procedures and
guidelines based on relevant research
•
demonstrates awareness of a range of research
methodologies;
•
identifies problems/ issues which may be investigated
through research
Psychology
Apply knowledge of the scientific method in thinking about problems
related to behaviour and mental processes
Question claims that arise from myth, stereotype, pseudo-science or
untested assumptions
Demonstrate an attitude of critical thinking that includes persistence,
open-mindedness, and intellectual engagement
Demonstrate a capacity for higher-order analysis, including the
capacity to identify recurrent patterns in human behaviour
Evaluate the quality of information, including differentiating
empirical evidence from speculation
Identify and evaluate the source and context of behaviour
Recognise and defend against the major fallacies of human thinking
Evaluate issues and behaviour using different theoretical and
methodological approaches
Use reasoning and evidence to recognise, develop, defend, and
criticise arguments and persuasive appeals
Demonstrate creative and pragmatic problem solving
Exhibit a scientific attitude in critically thinking about, and learning
about, human behaviour, and in creative and pragmatic problem
solving
Apply psychological concepts, theories, and research findings to
solve problems in everyday life and in society
65
Table 1: Summary of data extracted from eligible reviews
Citation of reviews included in the study
Aim
Population
Bokken L, Linssen T, Scherpbier A, van der
Vleuten C, Rethans J-J. Feedback by simulated
patients in undergraduate medical education: a
systematic review of the literature. Medical
Education. 2009;43(3):202-10.
To provide a systematic
overview of the ways in
which SPs provide
feedback to
undergraduate medical
students, the domains in
which SPs provide
feedback and the ways in
which SPs are trained to
provide feedback.
To explore the scope and
quality of evidence
relating to communication
skills training for dental
students.
Medical
students
Carey JA, Madill A, Manogue M.
Communications skills in dental education: a
systematic research review. Eur J Dent Educ.
2010;14(2):69-78.
Dental students
Simulation modalities OSCEs, task trainers, VR,
animal, cadaveric,
virtual patients, SPs,
hybrid, role-play,
manikin, game, OTHER
(State)
SPs
Years
Study findings
Review
There appear to be no clear standards
with regard to effective feedback
training for SPs. Furthermore, the
processes by which feedback is
provided by SPs and the selection of
domain(s) in which SPs give feedback
often seem to lack a solid scientific
basis.
Role-play; SPs
Up to
2007
The review found extensive use of
didactic learning and clinical role-play
involving SPs. Reported assessment
methods focus mainly on observer
evaluation of student interactions at
consultation. The reviews report weak
evidence for the impact of
communication skills training. The studies
focused on pre and post operative
communication rather than intraoperative treatment. Patient
involvement in training appears to be
minimal. This review recommends that
several areas of methodology be
addressed in future studies, the scope of
research extended to include intraoperative communication, and that the
role of real patients in the development
of communication skills be active rather
than passive.
66
Cleland JA, Abe K, Rethans J-J. The use of
simulated patients in medical education: AMEE
Guide No 42. Medical Teacher. 2009;31(6):47786.
To provide a detailed
overview of how to recruit,
train and use SPs
appropriately for both
teaching and assessment
purposes.
Medical
students
SPs
Review
Cook DA, Erwin PJ, Triola MM. Computeried
virtual patients in health professions education: a
systematic review and meta-analysis. Academic
Medicine. 2010;85(10):1589-602.
To summarise the effect of
virtual patients compared
with no intervention and
alternate instructional
methods, and elucidate
features of effective virtual
patient design.
All health
professionals
and students
VPs
Up to
2009
Cook DA, Triola MM. Virtual patients: A critical
literature review and proposed next steps.
Medical Education. 2009;43(4):303-11.
To summarise research on
VPs, highlight the
spectrum of potential
variation and identify an
agenda for future
research and critically
consider the role of VPs in
the educational
armamentarium.
To summarise the
outcomes of technologyenhanced simulation
training for health
professions learners in
comparison with no
intervention. Asked two
questions: 1) To what
extent are simulation
technologies for training
All health
professionals
and students
VPs
1971 to
2008
All health
professionals
and students
All technology based
simulators
Up to
2011
Cook, D. A., Hatala, R., Brydges, R., Zendejas, B.,
Szostek, J. H., Wang, A. T., . . . Hamstra, S. J.
(2011). Technology-enhanced simulation for
health professions education: a systematic
review and meta-analysis .JAMA, 306(9), 978-988.
SPs can be used for teaching and
assessment of consultation and
clinical/physical examination skills, in
simulated teaching environments or in
situ. All SPs play roles but SPs have also
been used successfully to give
feedback and evaluate student
performance. Clearly, given this
potential level of involvement in
medical training, it is critical to recruit,
train and use SPs appropriately.
Virtual patients are associated with
large positive effects compared with no
intervention. Effects in comparison with
non-computer instruction are on
average small. Comparisons of VP
designs suggest that repetition until
demonstration of mastery, advance
organisers, enhanced feedback, and
explicitly contrasting cases can improve
learning outcomes.
Virtual patients should be designed and
used to promote clinical reasoning skills.
In general, simulation training was
associated with moderate to large,
statistically significant positive results but
with high inconsistency.
67
Fisher, D. and King, L. (2013). An integrative
literature review on preparing nursing students
through simulation to recognie and respond to
the deteriorating patient. Journal of Advanced
Nursing, 69(11), 2375-2388.
Flanagan, B., O. Clavisi, and D. Nestel, Efficacy
and effectiveness of simulation-based training for
learning and assessment in healthcare, 2007,
Department of Human Services (Victoria):
Melbourne.
healthcare professionals
associated with improved
outcomes in comparison
with no intervention? 2)
How do outcomes vary for
different simulation
instructional designs?
Focused on 5 features
(curricular integration,
distributed practice,
feedback, mastery
learning, range of
difficulty)
To synthesise studies that
explored simulation as
preparation of nursing
students for recognition
and response to the
deteriorating patient.
To identify efficacy and
effectiveness of
simulation-based training
for learning and
assessment in health care
Nursing
students
Not stated
2004-2012
All health
professional
students and
clinicians
Most simulation
modalities
1950-2007
Simulation exposes students to a
broader range of experiences whilst
in a safe environment with transference
of skills to clinical practice occurring.
Confidence, clinical judgment,
knowledge and competence, all vital in
the care of a deteriorating patient, were
enhanced. However, evidence of
simulation used specifically to prepare
nursing students to recognise and
respond to the deteriorating patient
appeared limited. This educational field
appears rich for interprofessional
collaboration and further research.
The search strategy identified 3753
articles of which 458 were selected for
inclusion after review of the abstract. •
There is a positive relationship between
simulation-based activities and learning
outcomes.
• There is substantial evidence for
simulation-based activities at levels one
and two of Kirkpatrick’s framework.
Some evidence exists at level three, and
there are a small number of studies
where there is clear evidence of direct
benefit to patients (modified Kirkpatrick
68
level five).
• Most studies report high levels of
participant satisfaction with simulationbased activities with few studies
reporting dissatisfaction.
• Simulation is usually used as part of
broader programs. Therefore, it is difficult
to isolate simulation from other
educational methods. In fact it would
be unhelpful to separate simulation in
this way since it is likely to be the
“whole” program rather than an
isolated element that is important.
• For each question in this review, the
authors identified gaps by population
group, simulation modality and topic.
• Most studies relate to the medical
profession.
• Gaba (2007) proposes a classification
of simulations across 11 dimensions. This
may be valuable as a basis of
comparison in future studies.
Jull, G., et al., Health Workforce Australia
National Simulated Learning Project - Report for
Physiotherapy, in Simulated Learning
Environments Program2010, Health Workforce
Australia: Adelaide, SA, Australia.
To gather information from
a literature review, two
electronic surveys of
accredited schools of
physiotherapy (including
schools in the
accreditation process)
and discussions with
physiotherapy academics
at universities around
Australia in order to
identify current and
potential use of simulation
in physiotherapy
education.
Physiotherapy
students
Manikin, role-play, SP,
task trainers
1950 to
2010
The literature review revealed that the
use of simulated learning platforms in
education of future health practitioners
has dramatically increased in the last
two decades. This has been in response
to the many potential benefits to be
gained by the student as well as to the
increasing difficulties in obtaining
sufficient clinical placement
opportunities and ‘clinical material’ for
educating future health professionals.
Preliminary research suggests that
simulated learning can enhance
students’ skills, confidence and
competence. Practice is in a safe
environment, with no risk to patients.
Until recently, high quality research into
69
Kaakinen, J. and E. Arwood, Systematic review of
nursing simulation literature for use of learning
theory. International Journal of Nursing
Education Scholarship, 2009. 6(1(16)): p. 1-20.
To determine how
learning theory was used
to design and assess
learning that occurs in
simulations.
Nursing
students
2000-2007
Kiersma, M., K. Plake, and P. Darbishare, Patient
safety instruction in US Health professions
education. American Journal of Pharmaceutical
Education, 2011. 75(8): p. 162.
To describe patient safety
instruction in health
professional curricula,
including medicine,
nursing, pharmacy, and
dentistry.
Medical,
nursing,
pharmacy and
dentistry
students
OSCE, SPs, role-play
1966-2010
Lapkin, S., et al., The effectiveness of using
human patient simulation manikins in the
teaching of clinical reasoning skills to
undergraduate nursing students: a systematic
review. The JBI Database of Systematic Reviews
and Implementation Reports, 2010. 8(16): p. 661694.
Laschinger, S., et al., Effectiveness of simulation
on health profession students' knowledge, skills,
confidence and satisfaction. JBI Library of
Systematic Reviews, 2008. 6(7): p. 265-309.
To identify best available
evidence for the
effectiveness of human
patient simulation
manikins in developing
clinical reasoning skills to
undergraduate nurses.
To identify the best
available evidence on the
effectiveness of using
simulated learning
Undergraduate
nursing
students
Manikin
1999-2010
Nursing,
medical and
rehabilitation
students
Manikin, task trainer
1995-2006
the impact of simulated learning
platforms on skill acquisition and
graduate outcomes has been limited.
Preliminary results from a recent
Australian randomised trial are providing
evidence that students can meet the
Australian Standards for Physiotherapy
when simulated learning platforms are
incorporated as part of the traditional
clinical education program
Most nursing faculty approach
simulation from a teaching paradigm
rather than a learning paradigm. For
simulation to foster student learning
there must be a fundamental shift in
paradigm and a foundational learning
theory to design and evaluate
simulation.
Safe, patient-centred care is directly
influenced by the quality of education
that healthcare professions students
receive. Almost half (43%) the patient
safety curricula included a simulation
component however they are almost all
discipline specific. Self-assessment was
commonly used as an educational
method. Several studies reported
improvements in knowledge, attitudes
and skills of participants.
Manikins improve knowledge acquisition
and critical thinking and enhances
students' satisfaction with learning. There
is a lack of unequivocal evidence of the
effectiveness of using high-fidelity
manikins in the teaching clinical
reasoning skills to undergraduate nurses.
There is high learner satisfaction with
using simulators to learn clinical skills. The
studies demonstrated that human
patient simulators which are used for
70
experiences in prelicensure health profession
education.
Leigh, G. T. (2008). High-fidelity patient simulation
and nursing students' self-efficacy: a review of
the literature. [Review]. International Journal of
Nursing Education Scholarship, 5, Article 37. doi:
http://dx.doi.org/10.2202/1548-923X.1613
To examine the effects of
high fidelity human
patient simulation
(manikins) on student's
self-efficacy and
confidence
Nursing
students
Manikin
The past
decade
teaching higher level skills, such as
airway management, and physiological
concepts are useful. While there are
short-term gains in knowledge and skill
performance, it is evident that
performance of skills over time after
initial training decline. simulation can be
used as an adjunct for clinical practice,
not a replacement for everyday
practice. Students enjoyed the sessions
and using the models purportedly
makes learning easier. However, it
remains unclear whether the skills
learned through a simulation experience
transfer into real-world settings. More
research is needed to evaluate whether
the skills acquired with this teaching
methodology transfer to the practice
setting such as the impact of simulation
training on team function.
High fidelity manikins are effective when
used with sound educational practices.
From participants’ perspectives, high
fidelity manikins were valuable to apply
knowledge to practice, learn from their
mistakes, learn from their peers and to
identify gaps in their knowledge. Faculty
believe the benefits manikins can
prepare students to perform in real
clinical settings and that the
experiences in the simulation
environment can transfer to clinical
practice. Simulation is most beneficial
when the participant believes it to be
legitimate, authentic and realistic.
Multiple studies reveal learners and
educators perceptions that simulation
improves clinical performance. Nursing
students believed manikins improved
both critical thinking skills and
71
Levett-Jones, T., Examining the impact of
simulated patients and information and
communication technology on nursing students’
clinical reasoning, 2011, Australian Learning and
Teaching Council Ltd.: Surry Hills, NSW, Australia.
To identify best available
evidence for manikinbased simulations on
nursing students clinical
reasoning.
Nursing
students
Manikin
1999-2010
Lonne, B., R. Daniels, and J. King, Visioning
technology based simulated learning
environments in the social work curriculum, in
Simulated Learning Environments Program 2010,
Health Workforce Australia: Adelaide, SA,
Australia.
To detail the current uses
of SLEs in social work
education, report on a
number of studies that
gathered the perspectives
of staff and students using
SLEs, and provide a
summary of the benefits
and limitations of SLEs from
the literature.
To evaluate the
effectiveness of medical
Social work
students
SPs, virtual worlds, roleplay
2005-2010
Medical
students and
Manikin, VR, task trainer
1998-2006
Lynagh, M., et al. (2007). "A systematic review of
medical skills laboratory training: where to from
confidence. Students rate debriefing
and direct feedback as a major
advantage of high fidelity manikins. The
review did not find conclusive evidence
for the impact of high fidelity manikins
on nurses' self-efficacy when compared
with other methods.
Overall the survey results demonstrate
that Australian schools of nursing are
actively involved in, and committed to,
the development of simulation, and to a
lesser extent, ICT. The adequacy of
equipment and facilities is a major
barrier to adoption and staff training
was the major constraint on the
implementation of simulation and ICT.
These findings are consistent with the
literature, which identifies the need for
significant financial and personal
investment and the need for teaching
staff to develop new skill sets for
effective implementation of simulation
(O’Donnell and Goode, 2008). The
survey results indicate that the impetus
to increase the use of simulation and ICT
into nursing programs must be matched
with an increase in equipment,
infrastructure and staff training.
The available sources reveal the use of
SLEs in social work education to support
students doing their field education
placements, for distance education, to
teach clinical skills, and to enhance
students’ understanding of potential
client issues. These uses take various
forms, and the literature tends to
describe them rather than evaluate
them.
Medical skills laboratories lead to
improvement in procedural skills
72
here?" Medical Education 41(9): 879-887.
skills laboratories or
simulators, if skills are
transferable to clinical
performance and
maintained over time.
postgraduate
medical
trainees
May, W., et al. (2009). "A ten-year review of the
literature on the use of standardized patients in
teaching and learning: 1996-2005." Medical
Teacher 31(6): 487-492.
To review the body of
literature on the
educational application
of SPs in teaching and
learning
To identify the
advantages and
disadvantages of
simulation education as a
teaching, learning and
assessment methodology
within pre-registration
nurse education.
All healthcare
professionals
and students
SPs
Review
Nursing
students
SPs, task trainers,
manikins
Not stated
To review and critically
evaluate historical and
contemporary research
on simulation-based
medical education
(SBME). It also presents
and discusses 12 features
and best practices of
SBME that teachers should
know in order to use
medical simulation
technology to maximum
educational benefit.
To identify best practice
recommendations to
enhance collaborative
healthcare using
interprofessional simulation
All health
professional
students and
clinicians
Manikin
2003-2009
Health
professional
students
Manikin, role-play, SP
2005-2011
McCallum, J. (2007). The debate in favour of
using simulation education in pre-registration
adult nursing. [Review]. Nurse Education Today,
27(8), 825-831.
McGaghie, W. C., Issenberg, S. B., Petrusa, E. R.,
and Scalese, R. J. (2010). A critical review of
simulation-based medical education research:
2003-2009. Med Educ, 44(1), 50-63.
Murdoch, N., J. Bottorff, and D. McCullogh,
Simulation education approaches to enhance
collaborative healthcare: A best practices
review. International Journal of Nursing
Education Scholarship, 2013. 2013(10): p. 307-321.
compared with standard or no training
at all when assessed by simulator
performance and immediately posttraining. However, there is a lack of well
designed trials addressing the crucial
issues of transferability to clinical
practice and retention of skills over time.
Most studies reported that the
educational use of SPs was valuable.
More rigorous studies would support the
evidence-based contribution of SPs in
teaching and learning.
There is evidence that nursing students
want more simulation education as a
way of learning clinical skills, but
additionally this can help them learn
from making mistakes and repeatedly
practice skills, which would not
appropriate with actual patients.
Simulation also removes some of the
pressure on assessments in real clinical
settings.
The historical and contemporary
research synthesis is reported to inform
the medical education community
about 12 features and best practices of
SBME: (i) feedback; (ii) deliberate
practice; (iii) curriculum integration; (iv)
outcome measurement; (v) simulation
fidelity; (vi) skill acquisition and
maintenance; (vii) mastery learning; (viii)
transfer to practice; (ix) team training;
(x) high-stakes testing; (xi) instructor
training, and (xii) educational and
professional context.
There is growing evidence to suggest
that interprofessional simulation is valued
by learners and a useful strategy for
educators to implement collaborative
learning in health professions programs.
73
education innovations for
learners in pre-licensure
nursing programs.
Okuda, Y., Bryson, E. O., DeMaria, S., Jr.,
Jacobson, L., Quinones, J., Shen, B.,Levine, A. I.
(2009). The utility of simulation in medical
education: what is the evidence? [Review].
Mount Sinai Journal of Medicine, 76(4), 330-343.
doi: http://dx.doi.org/10.1002/msj.20127
To explore the utility of
simulation in medical
education.
Medical
students
Manikins, task trainers,
SPs
Not stated
Pittman, O. A. (2012). The use of simulation with
advanced practice nursing students. [Review].
Journal of the American Academy of Nurse
Practitioners, 24(9), 516-520. doi:
http://dx.doi.org/10.1111/j.17457599.2012.00760.x
To review use of
simulation in the
education of advanced
practice nurses and to
describe an innovative
simulation program for
family nurse practitioner
(NP) students.
Nursing
students
SPs, task trainers,
manikins, hybrid
Not stated
Rothgeb, M. K. (2008). Creating a nursing
simulation laboratory: a literature review.
[Review]. Journal of Nursing Education, 47(11),
489-494.
Stroud, L., Wong, B. M., Hollenberg, E., Levinson,
W. (2013). Teaching medical error disclosure to
physicians-in-training: a scoping review.
[Review]. Academic Medicine, 88(6), 884-892.
doi:
http://dx.doi.org/10.1097/ACM.0b013e31828f898f
Wallman, A., Vaudan, C., Sporrong, S. K. (2013).
Communications training in pharmacy
To explore the current
state of nursing simulation
laboratories.
Nursing
students
Role-play; SPs, manikins,
task trainer
Not stated
To identify studies of error
disclosure involving junior
doctors or medical
students.
Junior doctors
Role-play; SPs
1960-2011
To identify communication
training strategies in
Pharmacy
students
SPs, VPs
1995-2010
Most studies supported the argument
that IPE simulation experiences in later
years of the curricula have positive
outcomes for learners. There is limited
use of theories to guide and design of
IPE simulation. Many tool used in the
assessment of outcomes may not
provide valid and reliable data.
Patients are more willing to have
students perform procedures if they
have simulation training. Simulation has
benefits and limitations although it is
here to stay. Funding models need to be
developed to facilitate access to
simulation and address issues of faculty
development.
The literature on the use of simulation in
primary care APN programs is scant, but
simulation seems to represent an active
learning strategy that would be of
benefit to primary care APN students in
increasing knowledge and confidence
about the management of clinical
situations. Students can also work with
faculty to create simulation experiences
based on the knowledge of their own
learning needs and expertise in
specialty areas of nursing.
Many students are familiar with the use if
simulation and other technologies in
their non-working lives. Students expect
hands on learning opportunities.
Studies of existing error disclosure
curricula demonstrate improvements in
learners' knowledge, skills and attitudes,
at least in the short-term.
SPs were the most common simulation
modality contributing to communication
74
education, 1995-2010. [Review]. American
Journal of Pharmaceutical Education, 77(2), 36.
doi: http://dx.doi.org/10.5688/ajpe77236
pharmacy education.
Walsh, L.J., et al., Use of Simulated Learning
Environments in Dentistry and Oral Health
Curricula, in Simulated Learning Environments
Program2010, Health Workforce Australia:
Adelaide, SA, Australia.
To explore the use of
simulation in dental
education.
Dental students
and trainees
Task trainees, role-play,
SPs, VR, manikin, virtual
world, VP
Up to
2010
skills training of pharmacy students. Most
educational interventions were assessed
by subjective measures. Many of these
programs were not well integrated into
the broader curricula.
Many benefits of each simulation
modality type identified for dental
students, similar to those reported across
other professions. Simulation was found
to enhance decision-making in a
diverse range of dental topics - oral
medicine, orthodontics, jaw joint
dysfunction, orofacial pain,
endodontics, prosthodontics, removal
partial denture design, geriatric
dentistry. Virtual microscopy ha been a
major area of development in dental
education to improve students'
knowledge of normal and pathological
oral tissues. Haptic devices were also
valued by dental students offering 3D
VR graphics and tactile sensation
allowing the student to feel a variety of
dental instruments.
75
Table 2: Summary of data extracted from eligible papers
Citation
Aim
Aamodt CB, Virtue DW, Dobbie
AE. Trained standardized patients
can train their peers to provide
well-rated, cost-effective physical
exam skills training to first-year
medical students. Family
Medicine. 2006;38(5):326-9.
To investigate the
feasibility, acceptability,
and cost-effectiveness of
training medical students
using teaching
associates trained by a
lay expert instead of a
clinician.
Abdelkhalek, N. M., Hussein, A. M.,
Sulaiman, N., & Hamdy, H. (2009).
Faculty as simulated patients
(FSPs) in assessing medical
students' clinical reasoning skills.
Education for Health, 22(3), 323.
To evaluate student and
faculty perceptions of
using a faculty member
simultaneously as both
the simulated patient
and the assessor in
OSCEs.
Population
Medical
students
Medical
students
Simulation
modalities OSCEs, task
trainers, Virtual
reality (VR),
animal,
cadaveric,
Virtual patients
(VPs),
Simulated
patients (SPs),
hybrid, roleplay, manikin,
game, Virtual
world, OTHER
(State)
OTHER (physical
examination
teaching
associates)
OSCE
Study design:
mixed methods
or quant or qual
or descriptive
or review
Study findings - from
abstract
Country
Quality - very
strong or strong
or weak or very
weak or not
applicable
Quantitative
This program was rated
highly by students, and is
cost-effective, and
generalisable to other
institutions.
USA
Very weak
Quantitative
Student and faculty
perceptions about the
simultaneous use of
faculty as simulated
patients and assessors
were generally positive.
The results of this study
encouraged the
program to continue
using faculty SPs on
formative and
summative OSCE
assessments.
USA
Weak
76
Aboumatar, H. J., Thompson, D.,
Wu, A., Dawson, P., Colbert, J.,
Marsteller, J., . . . Pronovost, P.
(2012). Development and
evaluation of a 3-day patient
safety curriculum to advance
knowledge, self-efficacy and
system thinking among medical
students. BMJ Quality and Safety,
21(5),416-22.
To develop a patient
safety curriculum and
evaluate its impact on
medical students' safety
knowledge, self-efficacy
and system thinking.
Medical
students
Not stated
Quantitative
Ackermann, A. D., Kenny, G., &
Walker, C. (2007). Simulator
programs for new nurses'
orientation: a retention strategy.
[Evaluation Studies]. Journal for
Nurses in Staff Development JNSD, 23(3), 136-139.
This article describes the
process of developing a
simulation program to
support role transition for
new nurses.
Nursing
students
Not stated
Descriptive
Acton, R. D., Chipman, J. G.,
Gilkeson, J., & Schmitz, C. C.
(2010). Synthesis versus imitation:
evaluation of a medical student
simulation curriculum via
Objective Structured Assessment
of Technical Skill. Journal of
Surgical Education, 67(3), 173-178.
To assess students' ability
to integrate tasks (e.g.,
gowning and gloving,
suturing) that are
typically taught in
isolation over a series of
linked sessions while
executing an
unrehearsed procedure
before and after a new
simulation curriculum
was introduced.
Medical
students
Animal; SP; Task
trainer
Quantitative
The patient safety
intersession resulted in
increased knowledge,
system-based thinking,
and self-efficacy scores
among students. Similar
intersessions can be
implemented at
medical, nursing,
pharmacy and other
allied health schools
separately or jointly as
part of required school
curricula.
A simulator program was
developed in Vassar
Brothers Medical Centre
to assist in the transition
of new graduate
registered nurses to
acute care practice.
An Objective Structured
Assessment of Technical
Skill (OSATS) was
administered to two
groups of medical
students after an animal
lab and a skills lab
curriculum. All students
had scope for
improvement but the SP
and task trainer program
was superior to the
animal lab. A program
that provides students
with the opportunity to
integrate skills proved
more valuable than
when skills were taught in
isolation.
USA
Weak
USA
Very weak
USA
Weak
77
Adachi K, Yoshimura A, Aso R,
Miyashita T, Yoshida D, Teramoto
A, et al. Clinical clerkship course
for medical students on lumbar
puncture using simulators. J
Nippon Med Sch. 2012;79(6):430-7.
To evaluate the
effectiveness of the
lumbar puncture
clerkship course in the
medical education
program.
Medical
students
Task trainer
Quantitative
Afonso, N., Amponsah, D., Yang,
J., Mendez, J., Bridge, P., Hays,
G., . . . Dulchavsky, S. (2010).
Adding new tools to the black
bag--introduction of ultrasound
into the physical diagnosis course.
Journal of General Internal
Medicine, 25(11), 1248-1252
To study the feasibility of
incorporating ultrasound
into physical diagnosis
(PD) courses and to
determine whether
learners can
demonstrate image
recognition and
acquisition skills.
Medical
students
SPs
Mixed methods
Al-Ali K, Marghalani H, Al-Yahya A,
Omar R. An assessment of
endodontic re-treatment
decision-making in an
educational setting. Int Endod J.
2005;38(7):470-6.
To test the applicability
of Praxis Concept (PC)
theory in endodontic retreatment decisionmaking amongst dental
students of similar
backgrounds, but from
two dental schools.
Dental students
OTHER
(simulated
radiography)
Quantitative
The lumbar puncture
simulators achieved
excellent overall
impressions and
represent useful tools for
training in lumbar
puncture procedures. In
addition to the
simulators, an
appropriate preparatory
text and a short lecture
before training seemed
to increase the
educational effect of this
lumbar puncture
clerkship course for
medical students.
Pre-post test data
revealed significant
improvements in image
recognition suggesting
that an introductory
ultrasound course is
effective in improving
medical students'
acquisition and
recognition of basic
cardiovascular and
abdominal ultrasound
images. The program
demonstrates the
feasibility of
incorporating portable
ultrasound as a learning
tool during medical
school.
The findings support the
explanatory potential of
PC theory in endodontic
re-treatment decisionmaking in the group
investigated, and
suggest that factors
besides disease status
alone, such as gender,
may contribute to the
Japan
Weak
USA
Very weak
USA
Weak
78
choices that clinicians
make.
Alexander, S. C., Keitz, S. A.,
Sloane, R., & Tulsky, J. A. (2006). A
Controlled Trial of a Short Course
to Improve Residents'
Communication with Patients at
the End of Life. Academic
Medicine, 81(11), 1008-1012
To evaluate the effect of
a short course to
improve residents'
communication skills
delivering bad news and
eliciting patients'
preferences for end-oflife care.
Junior doctors
SPs
Quantitative
Alinier G, Hunt B, Gordon R,
Harwood C. Effectiveness of
intermediate-fidelity simulation
training technology in
undergraduate nursing
education. J Adv Nurs.
2006;54(3):359-69.
To determine the effect
of scenario-based
simulation training on
nursing students' clinical
skills and competence.
Nursing
students
Manikin; OSCEs
Quantitative
Allen SS, Miller J, Ratner E, Santilli J.
The educational and financial
impact of using patient educators
to teach introductory physical
exam skills. Medical Teacher.
2011;33(11):911-8.
Amer RS, Denehy GE, Cobb DS,
Dawson DV, Cunningham-Ford
MA, Bergeron C. Development
and evaluation of an interactive
dental video game to teach
dentin bonding. J Dent Educ.
2011;75(6):823-31.
To determine whether
Patient Educators (PEs) in
an introductory clinical
medicine (ICM) course
were: (1) as effective as
physician faculty in
teaching the physical
exam, (2) impacted
consistency of student
performance on a final
practical exam, and (3)
whether this model was
cost effective.
To compare the change
in clinical knowledge
and practical clinical skill
of first-year dental
students who watch a
clinical video recording
of the three-step etchand-rinse resin bonding
system to those using an
interactive dental video
Medical
students
Dental students
OSCEs,
OTHER(Patient
Educators)
Games
Residents attending the
course demonstrated
statistically significant
increases in their overall
skill ratings in the delivery
of bad news, with
improvement in the
specific areas of
information giving and
responding to emotional
cues.
Intermediate-fidelity
simulation is a useful
training technique. It
enables small groups of
students to practise in a
safe and controlled
environment how to
react adequately in a
critical patient care
situation.
USA
Strong
UK
Strong
Quantitative
In terms of sustainability
and student
performance, the use of
trained lay educators
has equivalent
outcomes and is less
costly for physical exam
instruction in the preclinical years.
USA
Weak
Quantitative
There was no statistically
significant difference
between teaching
methods in regards to
change in either
knowledge or clinical
skills, with one minor
exception relating to the
wetness of dentin
following etching.
USA
Strong
79
game teaching the
same procedure.
Students expressed their
preference for an
interactive self-paced
method of teaching.
Ander DS, Heilpern K, Goertz F,
Click L, Kahn S. Effectiveness of a
simulation-based medical student
course on managing lifethreatening medical conditions.
Simul. 2009;4(4):207-11.
To assess the
competency and the
comfort level of medical
students in lifesaving skills
after a simulation-based
training session and then
determine skill retention
after one year.
Medical
students
Manikin
Quantitative
Andrade AD, Bagri A, Zaw K, Roos
BA, Ruiz JG. Avatar-mediated
training in the delivery of bad
news in a virtual world. J Palliat
Med. 2010;13(12):1415-9.
To study the feasibility of
creating SP avatars in a
virtual world for the task
of training medical
trainees to deliver bad
news.
Medical
students
VR; OTHER(SP
avatar)
Quantitative
A short course in
simulation-based lifesaving clinical skills is an
effective means to
teach the third year
medical students. A
decline in competency
over time was observed
for recognition of
ventricular fibrillation,
defibrillation, airway
management, and
management of a
choking child.
Cardiopulmonary
resuscitation and
automatic external
defibrillator competency
did not decrease over
time.
Participants viewed the
avatar-mediated
training as an excellent
approach for learning
how to deliver bad news
but believed it could not
substitute for real patient
interactions. However,
participant self-efficacy
improved, which
suggests that avatarmediated training in a
virtual world is a viable
educational approach
for skill training in
delivering bad news.
USA
Weak
USA
Weak
80
Anker AE, Feeley TH, Friedman E,
Kruegler J. Teaching organ and
tissue donation in medical and
nursing education: a needs
assessment. Prog Transplant.
2009;19(4):343-8.
To describe medical and
nursing students' training
in organ donation by
examining curriculum
content and methods of
instruction by using a
national sample of
medical schools and a
statewide sample (New
York) of nursing schools.
Nursing
students
SPs
Quantitative
Aper L, Reniers J, Koole S, Valcke
M, Derese A. Impact of three
alternative consultation training
formats on self-efficacy and
consultation skills of medical
students. Medical Teacher.
2012;34(7):e500-7.
To investigate the
impact of three
consultation training
formats on students' selfefficacy beliefs and their
consultation skills
acquisition.
Medical
students
SPs
Quantitative
Arevalo CR, Bayne SC, Beeley JA,
Brayshaw CJ, Cox MJ, Donaldson
NH, et al. Framework for elearning assessment in dental
education: a global model for the
future. J Dent Educ.
2013;77(5):564-75.
To demonstrate
strategies for a global
approach to e-curricula
in dental education by
considering a collection
of outcome assessment
tools. By combining the
outcomes for overall
assessment, a global
model for a pilot project
that applies eassessment tools to
virtual learning
environments (VLE),
including haptics, is
presented.
Dental students
VR: Manikin
Mixed methods
Although many
educational programs
include an organ
donation component, a
significant proportion of
schools failed to provide
instruction on donation
consent processes,
definitions of brain and
cardiac death, and the
discussion of organ
donation during a
routine health care visit.
Most schools rely on
lectures as the sole
method of instruction.
Each consultation
training contributes to
the learning process in a
different way.
Autonomous training
had a significant positive
effect on students' selfefficacy while traditional
training and the online
training did only
positively influence the
cognitive component of
the consultation
competence.
Equivalence for student
performance for haptic
versus traditional
preparation methods
was established, thus
establishing the validity
of the haptic solution for
performing these
exercises.
USA
Belgium
UK
Very weak
Strong
Very weak
81
Ashcraft AS, Opton L, Bridges RA,
Caballero S, Veesart A, Weaver C.
Simulation evaluation using a
modified Lasater Clinical
Judgment Rubric. Nurs Educ
Perspect. 2013;34(2):122-6.
To describe the process
for evaluating senior
nursing students in a
simulation laboratory
using a modified Lasater
Clinical Judgment Rubric
(LCJR).
Nursing
students
Manikin
Quantitative
Austin Z, Gregory P, Tabak D.
Simulated patients vs.
standardized patients in objective
structured clinical examinations.
Am J Pharm Educ. 2006;70(5):119.
To describe the use of
patient-actors as
educators in a seniorlevel pharmacy practice
course, and to contrast
the value and
application of
"standardised patient"
and "simulated patient"
educational
methodologies.
Pharmacy
students
SPs; OSCEs
Mixed methods
The modified LCJR rubric
measured student
performance more
holistically than a
procedural checklist and
provided objective
criteria for evaluation.
These findings suggest
that a well-constructed
rubric provides a
mechanism to evaluate
student performance in
simulation by focusing on
clinical reasoning
essential for patient
safety and allowing
numeric evaluation of
performance.
Students responded
positively to the shift from
"standardised" patients
to "simulated" patients,
recognising their value in
teaching clinical and
pharmaceutical care
skills. Concerns were
expressed regarding
objectivity in assessment
and individual grading.
Long-term follow-up
suggests students valued
this approach to
education and that it
provided them with a
foundation for better
understanding of the
psychosocial needs of
patients. Simulatedpatient educators can
play an important role in
the pharmacy
curriculum, and can
complement
practitioner-educators in
providing students with a
real-world context for
understanding complex
USA
Weak
Canada
Weak
82
patient care needs.
Austin Z, Gregory PAM. Evaluating
the accuracy of pharmacy
students' self-assessment skills. Am
J Pharm Educ. 2007;71(5):89.
To evaluate the
accuracy of selfassessment skills of seniorlevel bachelor of
science pharmacy
students using a method
involving comparisons of
pharmacy students' selfassessment with
weighted average
assessments of peers,
standardised patients,
and pharmacistinstructors.
Pharmacy
students
SPs
Quantitative
Avisar L, Shiyovich A, AharonsonDaniel L, Nesher L.
Cardiopulmonary resuscitation
skills retention and self-confidence
of preclinical medical students. Isr
Med Assoc J. 2013;15(10):622-7.
To evaluate the retention
of CPR skills and
confidence in delivering
CPR by preclinical
medical students.
Medical
students
OSCEs; manikin
Quantitative
Baer AN, Freer JP, Milling DA,
Potter WR, Ruchlin H, Zinnerstrom
KH. Breaking bad news: use of
cancer survivors in role-playing
exercises. J Palliat Med.
2008;11(6):885-92.
To teach medical
students how to deliver a
diagnosis of cancer
using role-play with a
cancer survivor
volunteer.
Medical
students
Role-play
Descriptive
The quality and
accuracy of pharmacy
students' self-assessment
skills were not as strong
as expected. Further
work is necessary to
ensure this important
practice competency
and life skill is at the level
expected for
professional practice
and continuous
professional
development.
Confidence and CPR
skills of preclinical
medical students
deteriorate significantly
within 1 year posttraining, reaching an
unacceptable level 2
years post-training.
Refresher training is
recommended at least
every year.
Role-playing with cancer
survivor volunteers can
be an effective method
of teaching medical
students how to
communicate bad
news. Students
demonstrated a high
level of adherence to
preferred
communication
techniques and gained
significant confidence
with the task of "breaking
bad news."
Canada
Weak
Israel
Weak
USA
Very Weak
83
Baerheim A, Alraek TJ. Utilizing
theatrical tools in consultation
training. A way to facilitate
students' reflection on action?
Medical Teacher. 2005;27(7):6524.
To evaluate a program
that used a simulated
patient consultation to
give individual student a
group-based opportunity
to reflect.
Medical
students
SPs
Qualitative
Baez A. Development of an
objective structured clinical
examination (OSCE) for practicing
substance abuse intervention
competencies: An application in
social work education. Journal of
Social Work Practice in the
Addictions. 2005;5(3):3-20.
To report the evaluation
of a program that teach
medical, nursing, and
social work students
screening and brief
intervention skills, provide
a practice opportunity
and feedback to
students on their ability
to demonstrate
substance abuse skills,
and to expose students
to interdisciplinary
collaboration.
Medical
students;
Nursing
students; Social
work students
OSCEs
Quantitative
Baid H. The objective structured
clinical examination within
intensive care nursing education.
Nurs Crit Care. 2011;16(2):99-105.
To reflect back on a
recent experience of
introducing an OSCE into
a post-registered,
degree level intensive
care nursing program.
Nursing
students
OSCEs
Descriptive
The way of creating
fiction and manipulating
temporality in the
consultation training
described in this study
was paralleled by most
students' reports on
substantial learning feedforward abilities from
reflection on action.
While the OSCE proved
to be highly compatible
with the teaching and
practicing of substance
abuse intervention skills,
it is a tool that also has
relevance and
applicability for the
practicing and assessing
of many other social
work skills, and can be a
powerful addition to the
ways in which the field
approaches the
challenge of assessing
competence in more
direct ways.
Organising and
implementing an OSCE
for an intensive care
nursing program
required a great deal of
preparation and time of
the teacher but also
offered various benefits
and advantages
compared with other
forms of assessment.
Norway
USA
UK
Very Weak
Weak
Very Weak
84
Baillie L, Curzio J. Students' and
facilitators' perceptions of
simulation in practice learning.
Nurse Educ Pract. 2009;9(5):297306.
To present the results
from an evaluative study
of students' and
facilitators' perceptions
of simulation and its
application to clinical
practice.
Nursing
students
OSCEs
Quantitative
Barley GE, Fisher J, Dwinnell B,
White K. Teaching foundational
physical examination skills: study
results comparing lay teaching
associates and physician
instructors. Academic Medicine.
2006;81(10 Suppl):S95-7.
To determine the
differences in the
physical exam skills of
first-year medical
students learning
physical exam
exclusively from
standardised physical
examination teaching
associates (SPETAs) and
those learning from
physician faculty.
Medical
students
SPs
Quantitative
Students perceived that
simulation increased
their ability and
confidence in their
clinical placements and
they did not feel
disadvantaged by the
reduced clinical
placement hours. There
was no significant
difference between the
perceived confidence of
simulation and
comparison group
students at the end of
placement. Undertaking
simulated learning
during a clinical
placement appears to
be at least as effective
as learning during
practice placement
without simulation.
SPETA-trained students
performed equivalently
to physician faculty
trained students across
all stations. Students
taught by SPETAs
performed significantly
better on the abdominal
OSCE. Findings from this
study suggest that
SPETAs can effectively
teach foundational
physical examination
skills to medical students
at a similar and
sometimes better
performance level as
physician faculty.
UK
Weak
USA
Strong
85
Barry M, Noonan M, Bradshaw C,
Murphy-Tighe S. An exploration of
student midwives' experiences of
the Objective Structured Clinical
Examination assessment process.
Nurse Educ Today. 2012;32(6):6904.
To report on a qualitative
descriptive study that
explored midwifery
students’ experiences on
the OSCE process for
obstetric emergencies
within a university setting.
Midwifery
students
OSCEs
Qualitative
Barsuk JH, McGaghie WC, Cohen
ER, Balachandran JS, Wayne DB.
Use of simulation-based mastery
learning to improve the quality of
central venous catheter
placement in a medical intensive
care unit. J Hosp Med.
2009;4(7):397-403.
To evaluate the effect of
simulation-based
mastery learning on
Central venous catheter
(CVC) insertion skill.
Medical
students
Task trainer
Quantitative
Bateman J, Allen M, Samani D,
Kidd J, Davies D. Virtual patient
design: exploring what works and
why. A grounded theory study.
Medical Education.
2013;47(6):595-606.
To research the influence
of Virtual Patient (VP)
design on medical
undergraduates.
Medical
students
VP
Qualitative
Preparation for the OSCE
was considered central
to the process. Learning
via OSCEs was
perceived to be more
effective in comparison
to other forms of
assessment and
prepared students for
clinical practice. Positive
aspects of the process
and areas for
improvement were
identified. Using OSCEs
increased the depth of
learning for the students
with the steps taken in
preparation for the
OSCEs proving to be a
valuable learning tool.
Simulation-based
mastery learning
increased residents' skills
in simulated CVC
insertion, decreased the
number of needle passes
when performing actual
procedures, and
increased resident selfconfidence.
A theoretical model
describing how students
learn from VPs was
produced. This is the first
grounded theory study
to explore VP design. This
original research has
produced a theoretical
model which enhances
understanding of how
and why the delivery
and design of VPs
influence learning. The
model may be of
practical use to authors,
institutions and
Ireland
Very weak
USA
Strong
UK
Weak
86
researchers.
Battaglia JN, Kieser MA, Bruskiewitz
RH, Pitterle ME, Thorpe JM. An
online virtual-patient program to
teach pharmacists and pharmacy
students how to provide diabetesspecific medication therapy
management. Am J Pharm Educ.
2012;76(7):131.
To develop, implement,
and assess the
effectiveness of an
online medication
therapy management
(MTM) program to train
pharmacists and
pharmacy students in
providing MTM services
for patients with diabetes
and to increase their
intent to perform these
services.
Baxter P, Akhtar-Danesh N,
Landeen J, Norman G. Teaching
critical management skills to
senior nursing students:
videotaped or interactive handson instruction? Nurs Educ
Perspect. 2012;33(2):106-10.
To examine and
compare the
effectiveness of
videotape training versus
hands-on instruction in
preparing senior nursing
students to respond to
emergency clinical
situations.
Becker DE. The effect of patient
simulation on the critical thinking
of advanced practice nursing
students. Dissertation Abstracts
International: Section B: The
Sciences and Engineering.
2007;68(4-B):2221.
To examine the effect
patient simulation has on
the critical thinking of
nurse practitioner and
nurse anesthesia
students.
Pharmacy
students
Nursing
students
Nursing
students
VP
OSCEs; Manikin
Manikin
Quantitative
This online program using
a virtual patient
improved both
participants' belief that
they have control over
performing MTM, and
their knowledge of how
to perform MTM for
diabetic patients, which
may increase the
likelihood that
pharmacists and
pharmacy students will
perform MTM in the
future.
USA
Quantitative
Instruction on crisis
management with a
high-fidelity simulator,
using either video or
hands-on instruction, can
result in a significant
improvement in
performance.
Canada
Strong
Quantitative
Data analysis revealed
patient simulation to
increase critical thinking
during the management
planning and evaluation
stages. The current study
has provided additional
empirical evidence
supporting the use of
simulation during
problem-based learning,
case analysis to
enhance critical
thinking.
USA
Strong
Very weak
87
Beebe RI. Relationship between
fidelity and dose of human
patient simulation, critical thinking
skills, and knowledge in an
associate degree nursing
program. Dissertation Abstracts
International: Section B: The
Sciences and Engineering.
2014;74(7-B(E)):No Pagination
Specified.
To examine the
relationship between
human patient
simulation (HPS), critical
thinking skills, and
knowledge acquisition
after HPS was integrated
across the curriculum of
an associate degree
nursing program and to
determine if differences
existed in critical thinking
and knowledge of
students based on the
fidelity of HPS used and
amount of student
exposure to HPS.
Nursing
students
Manikin
Quantitative
Beischel KP. Variables affecting
learning in a simulation
experience: a mixed methods
study. West J Nurs Res.
2013;35(2):226-47.
To test a hypothesised
model describing the
direct effects of learning
variables on anxiety and
cognitive learning
outcomes in a highfidelity simulation (HFS)
experience.
Nursing
students
Manikin
Mixed methods
Bell K, Cole BA. Improving medical
students' success in promoting
health behavior change: a
curriculum evaluation. Journal of
General Internal Medicine.
2008;23(9):1503-6.
To design and evaluate
a formal curriculum to
teach medical students
the principles of
motivational interviewing
(MI) that will improve
knowledge, skills, and
confidence in the area
of counseling patients for
health behavior change.
Nursing
students
Role-play
Quantitative
Results supported the
use of HPS as an
effective teaching
strategy in lieu of a small
percentage of
traditional clinical
experiences. No
significant statistical
differences were
identified in knowledge
and critical thinking
based on the fidelity of
HPS used.
Anxiety did not
quantitatively mediate
cognitive learning
outcomes as theorised,
although students
qualitatively reported
debilitating levels of
anxiety. This study
advances nursing
education science by
providing evidence
concerning variables
affecting learning
outcomes in HFS.
Participation in a
focused curriculum on
the use of motivational
interviewing techniques
significantly improved
3rd year medical
students' knowledge,
confidence, and skills in
the area of behavior
change counseling.
These gains may help
students succeed in
promoting good health
habits in their future
patients.
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Benedict N, Schonder K, McGee
J. Promotion of self-directed
learning using virtual patient
cases. Am J Pharm Educ.
2013;77(7):151.
To assess the
effectiveness of virtual
patient cases to
promote self-directed
learning (SDL) in a
required advanced
therapeutics course.
Pharmacy
students
VP
Quantitative
Benedict N, Schonder K. Patient
simulation software to augment
an advanced pharmaceutics
course. Am J Pharm Educ.
2011;75(2):21.
To implement and assess
the effectiveness of
adding a
pharmaceutical care
simulation program to an
advanced therapeutics
course.
Pharmacy
students
VP
Quantitative
Pharmacy
students
VPs
Quantitative
Benedict N. Virtual patients and
problem-based learning in
advanced therapeutics. Am J
Pharm Educ. 2010;74(8):143.
Bennett AJ, Arnold LM, Welge JA.
Use of standardized patients
during a psychiatry clerkship.
Acad Psychiatry. 2006;30(3):18590.
To enhance student
learning of a complex
therapeutic concept
through the
incorporation of 2 casebased, active-learning
strategies with lecture in
a required advanced
therapeutics course.
To evaluate whether the
addition of a Psychiatry
Clinical SP Examination
(PCX) during the thirdyear clerkship improved
students' performances
on the psychiatry
component of the
Clinical Competency
Examination (CCX) that
is used to prepare fourthyear students for the
National Board of
Medical Examiners Step
2 Clinical Skills Exam
(Step 2 CSA).
Medical
students
SPs; OTHER
(PCX;CCX)
Quantitative
Completion of virtual
patient cases, designed
to replace lectures and
promote SDL, was
overwhelmingly
supported by students
and proved to be as
effective as traditional
teaching methods.
Patient simulation
software that used a
branched-outcome
decision model was an
effective supplement to
class lectures in an
advanced
pharmaceutics course
and was well-received
by pharmacy students.
Using a multifaceted
teaching approach,
combining active- and
passive-learning
strategies, the course
was well received by
students and fostered an
effective learning
environment.
The implementation of
the PCX during the
psychiatry clerkship
significantly improved
student performance on
several important
components of the CCX,
which is used to prepare
students for the Step 2
CSA. This suggests that
learning with SPs during
the clerkship may help
students improve their
interviewing and
interpersonal skills.
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Berg K, Majdan JF, Berg D, Veloski
J, Hojat M. A comparison of
medical students' self-reported
empathy with simulated patients'
assessments of the students'
empathy. Medical Teacher.
2011;33(5):388-91.
To examine associations
between SPs assessment
of medical students'
empathy and the
students' self-reported
empathy.
Medical
students
SPs; OSCEs
Quantitative
Berg K, Majdan JF, Berg D, Veloski
J, Hojat M. Medical students' selfreported empathy and simulated
patients' assessments of student
empathy: an analysis by gender
and ethnicity. Academic
Medicine. 2011;86(8):984-8.
To examine the
contribution of students'
gender and ethnicity to
assessments by SPs of
medical students'
empathy, and to
compare the results with
students' self-assessments
of their own empathy.
Medical
students
SPs; OSCEs
Quantitative
Bickenbach J, Schalte G, Beckers
S, Fries M, Derwall M, Rossaint R.
The intuitive use of laryngeal
airway tools by first year medical
students. BMC emerg. 2009;9:18.
To investigate the
intuitive use of airway
devices by first-year
medical students as well
as the effect of a simple,
but well-directed training
program. Retention of
skills was re-evaluated six
months thereafter.
Medical
students
Manikin
Quantitative
Biron VL, Harris M, Kurien G,
Campbell C, Lemelin P, Livy D, et
al. Teaching cricothyrotomy: a
multisensory surgical education
approach for final-year medical
students. J Surg Educ.
2013;70(2):248-53.
To evaluate the efficacy
of a multisensory
teaching approach in
imparting the necessary
knowledge, technical
skills, and confidence to
perform a
Medical
students
Cadaveric
Quantitative
While significant
associations exist
between students' selfreported scores and SPs'
evaluations of students'
empathy, the
associations are not
large enough to
conclude that the two
evaluations are
redundant.
Women scored higher
than men on all three
measures of empathy.
There was no significant
difference on selfreported empathy by
white and Asian
American students. SPs'
assessments indicated
less empathy for Asian
American students.
Untrained laypersons are
able to use different
airway devices in a
manikin and may
therefore provide a
secured airway even
without having any
detailed background
knowledge about the
tool. Minimal theoretical
instruction and practical
skill training can improve
their performance
significantly. However,
refreshment of
knowledge seems
justified after six months.
This study provides
further evidence that a
multisensory teaching
intervention effectively
improves the
knowledge, skill, and
confidence of fourth-
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Blackstock FC, Watson KM, Morris
NR, Jones A, Wright A, McMeeken
JM, et al. Simulation can
contribute a part of
cardiorespiratory physiotherapy
clinical education: two
randomized trials. Simul.
2013;8(1):32-42.
Blanch DC, Hall JA, Roter DL,
Frankel RM. Is it good to express
uncertainty to a patient?
Correlates and consequences for
medical students in a
standardized patient visit. Patient
Educ Couns. 2009;76(3):300-6.
Blank WA, Blankenfeld H,
Vogelmann R, Linde K, Schneider
A. Can near-peer medical
students effectively teach a new
curriculum in physical
examination? BMC Med Educ.
2013;13:165.
Blatt B, Plack M, Maring J, Mintz M,
Simmens SJ. Acting on reflection:
the effect of reflection on
students' clinical performance on
a standardized patient
examination. Journal of General
Internal Medicine. 2007;22(1):4954.
cricothyrotomy to a
cohort of fourth-year
medical students.
To evaluate, through
randomised controlled
trials (RCT), whether
education in simulated
learning environments
(SLEs) can partly replace
time in the clinical
environment for
physiotherapy
cardiorespiratory
practice.
To examine the
consequences of
expressions of
uncertainty (EOUs) in
medical student
interactions, with a
particular focus on the
gender of the expresser.
To investigate whether
adding a new near-peer
teaching course
developed with student
input plus patient
examination under
supervision in small
groups improves basic
clinical examination skills
in third year medical
students compared to a
traditional clinical
examination course
alone.
To determine whether
reflecting and revisiting
the "patient" during an
SP examination improves
junior medical students'
performance and to
analyse students'
perceptions of its value.
year medical students in
performing
cricothyrotomy.
Physiotherapy
students
Medical
students
Medical
students
Medical
students
SPs
SPs
OSCEs
SPs;
OTHER(CPX)
Quantitative
An SLE can replace
clinical time in
cardiorespiratory
physiotherapy practice.
Part education in the SLE
satisfied clinical
competency
requirements, and all
stakeholders were
satisfied.
Australia
Qualitative
There was an overall
negative perception of
medical students who
expressed uncertainty;
however, the strength of
the associations varied
due to medical student
gender.
USA
Quantitative
Adding a near-peer
teaching course to the
routine course
significantly improved
the clinical examination
skills of medical students
in an efficient manner in
the context of a
resource-constrained
setting.
Germany
Strong
Mixed methods
Offering medical
students the option to
reflect and revisit an SP
during a clinical skills
examination produced a
small but nontrivial
increase in clinical
performance. Students
perceived the reflectrevisit experience as
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enhancing patientcentred practices
(counselling, education)
as well as their own
medical decisionmaking and clinical
confidence.
Blum CA, Borglund S, Parcells D.
High-fidelity nursing simulation:
impact on student selfconfidence and clinical
competence. Int. 2010;7:Article
18.
To study the relationship
between simulation and
student self-confidence
and clinical
competence and to
report a novel approach
to measuring selfconfidence and
competence of entrylevel nursing students
Nursing
students
Manikin
Quantitative
Bokken L, Rethans J-J, Jobsis Q,
Duvivier R, Scherpbier A, van der
Vleuten C. Instructiveness of real
patients and simulated patients in
undergraduate medical
education: a randomized
experiment. Academic Medicine.
2010;85(1):148-54.
To evaluate which
contact (real patient or
SP) is perceived as most
instructive by students
and which variables
contribute to this.
Medical
students
SPs
Mixed methods
The results indicated an
overall improvement in
self-confidence and
competence across the
semester, however,
simulation did not
significantly enhance
these caring attributes.
The study highlights the
need for further
examination of teaching
strategies developed to
promote the transfer of
self-confidence and
competence from the
laboratory to the clinical
setting.
The general
instructiveness of both
real patient contacts
and SP contacts was
marked high. Several
differences between the
evaluations of real
patient contacts and SP
contacts were found. For
example, students
considered real patient
contacts less helpful in
practicing
communication skills and
considered the real
patients' feedback less
relevant. Students
consider authenticity an
important advantage of
real patients. However,
SPs were better informed
about the purpose of the
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consultation and
provided the student
with more specific
feedback.
Bokken L, Rethans J-J, van Heurn
L, Duvivier R, Scherpbier A, van
der Vleuten C. Students' views on
the use of real patients and
simulated patients in
undergraduate medical
education. Academic Medicine.
2009;84(7):958-63.
To determine students'
views about the
strengths and
weaknesses of real
patient interactions as
opposed to simulated
patient (SP) interactions
in the undergraduate
medical curriculum in
order to evaluate how
their strengths can be
optimally used and
weaknesses remedied.
Medical
students
SPs
Qualitative
Bokken L, van Dalen J, Rethans JJ. The case of "Miss Jacobs":
adolescent simulated patients
and the quality of their role
playing, feedback, and personal
impact. Simul. 2010;5(6):315-9.
To evaluate the effects
of performing a patient
role on adolescents
trained SPs for teaching
purposes (in contrast to
SPs) and evaluated the
quality of adolescent SPs'
role-playing and
feedback.
Medical
students
SPs
Quantitative
Bokken L, Van Dalen J, Scherpbier
A, Van Der Vleuten C, Rethans J-J.
Lessons learned from an
adolescent simulated patient
educational program: Five years
of experience. Medical Teacher.
2009;31(7):605-12.
To evaluate the views of
teachers, students and
adolescent SPs with
regard to the adolescent
SP program in an
undergraduate
curriculum and the
changes that were
made to the program in
the past five years (from
Medical
students
SPs
Quantitative
Both real patient
interactions and SP
interactions are
considered
indispensable to
undergraduate medical
education. Each
encounter has unique
strengths and
weaknesses from the
perspectives of students.
On the basis of strengths
and weaknesses that
were identified,
suggestions were made
for the use of real
patients and SPs in
undergraduate medical
education.
Generally, students and
teachers were satisfied
with the quality of the
role-playing and
feedback provided by
the adolescent SPs. The
adolescent SPs
experienced no
negative effects related
to their performance,
which confirms earlier
findings among
adolescent SPs.
Evaluations by teachers
and adolescent SPs
about the adolescent SP
program were very
positive. The quality of
the feedback by
adolescent SPs has
shown improvement
over the past five years,
although adolescents
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2002-2003 until 20062007).
Bonnetain E, Boucheix J-M, Hamet
M, Freysz M. Benefits of computer
screen-based simulation in
learning cardiac arrest
procedures. Medical Education.
2010;44(7):716-22.
To test the effectiveness
of transfer of learning
from a computer screenbased simulator to more
realistic situations such as
those encountered with
high-fidelity patient
simulators.
Medical
students
OTHER
(computer
screen based
simulation)
Quantitative
Bornais JA, Raiger JE, Krahn RE, ElMasri MM. Evaluating
undergraduate nursing students'
learning using standardized
patients. Journal of Professional
Nursing. 2012;28(5):291-6.
To examine the
effectiveness of using SPs
in improving health
assessment skills among
first-year nursing
students.
Nursing
students
SPs
Quantitative
Bosse HM, Nickel M, Huwendiek S,
Junger J, Schultz JH, Nikendei C.
Peer role-play and standardised
patients in communication
training: a comparative study on
the student perspective on
acceptability, realism, and
perceived effect. BMC Med Educ.
2010;10:27
To assess the student
perspective on
acceptability, realism,
and perceived effect of
communication training
with peer role-play and
SPs.
Medical
students
Role-play; SPs
Quantitative
find it quite difficult to
give feedback.
Teachers, students and
adolescent SPs have
highly valued the
adolescent SP program
over the past five years.
The program has been
changed on the basis of
the lessons learned and
has become mature.
Computer screen-based
simulation appears to be
effective in preparing
learners to use highfidelity patient simulators,
which present
simulations that are
closer to real-life
situations.
The findings suggest that
the use of SPs is an
effective educational
technique in
undergraduate nursing
education.
Role-play and SPs
represent comparably
valuable tools for the
training of specific
communication skills
from the student
perspective. Both
provide highly realistic
training scenarios and
warrant inclusion in
medical curricula. Given
the expense of SPs,
deciding which method
to employ should be
carefully weighed up.
From the perspective of
the students, SPs were
seen as a more useful
and more applicable
tool than role-play while
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94
role-play has the
potential to foster a
greater empathic
appreciation of the
patient perspective.
Botezatu M, Hult H, Fors UG. Virtual
patient simulation: what do
students make of it? A focus
group study. BMC Med Educ.
2010;10:91.
To explore the opinions
of medical students on
the educational use of a
VPS, the Web-based SP
application (Web-SP).
Medical
students
VPs
Qualitative
Bottenberg MM, Bryant GA,
Haack SL, North AM. Assessing
pharmacy students' ability to
accurately measure blood
pressure using a blood pressure
simulator arm. Am J Pharm Educ.
2013;77(5):98.
To compare student
accuracy in measuring
normal and high blood
pressures using a
simulator arm.
Pharmacy
students
Task trainer
Quantitative
Bourquin C, Stiefel F, Berney A,
Singy P. Dunno if you've any plans
for the future: medical student
indirect questioning in simulated
oncology interviews. BMC Med
Educ. 2012;12:8.
To investigate the
motives of medical
students for using “I don't
know questions” (IDKQs), such as "I don't know
if you have already
heard about
chemotherapies", in SP
Medical
students
SPs
Qualitative
Five main themes were
found to be associated
with successful VPs use in
medical curriculum:
Learning, Teaching,
Assessment, Authenticity
and Implementation.
Medical students
perceive VPs as
important learning and
assessment tools,
fostering clinical
reasoning, in preparation
for future clinical
practice as young
doctors. However, a
number of issues
regarding VP design,
authenticity and
implementation need to
be fulfilled, in order to
reach the potential
educational goals of
such applications.
Pharmacy students may
need additional
instruction and
experience with taking
high blood pressure
measurements to ensure
they are able to
accurately assess this
important vital sign.
IDK-Qs showed a
question design
difference between
medical students and
oncologists in SP
interviews. Among other
reasons for this
difference, the possible
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95
interviews during a
communication skills
course.
function of IDK-Qs as a
protective linguistic
strategy and marker for
psychological discomfort
is discussed.
Bowling AM. The effect of
simulation on knowledge, selfconfidence, and skill
performance. Dissertation
Abstracts International: Section B:
The Sciences and Engineering.
2012;73(6-B):3524.
To examine the effect of
two educational
interventions - mediumfidelity simulation and
low-fidelity simulation
(paper/pencil case
study) - on measures of
knowledge, selfconfidence, and skill
performance in junior
level BSN nursing
students.
Nursing
students
OSCEs, Task
trainer; OTHER
(paper/pencil
case study)
Quantitative
Branch C. Pharmacy students'
learning and satisfaction with
high-fidelity simulation to teach
drug-induced dyspepsia. Am J
Pharm Educ. 2013;77(2):30.
To assess second-year
pharmacy students'
acquisition of
pharmacotherapy
knowledge and clinical
competence from
participation in a highfidelity simulation, and to
determine the impact on
the simulation
experience of
implementing feedback
from previous students.
Pharmacy
students
Manikin; OSCEs
Quantitative
Medium-fidelity
simulation did not result
in a higher level of
knowledge or skill
performance than lowfidelity simulation.
Medium-fidelity
simulators have a higher
cost, both in dollars and
faculty time, than lowfidelity simulation.
Faculty members and
nursing institutions need
to identify what the
learning outcomes of the
educational experience
are and determine if a
lower technology, that is
less expensive and less
labour intensive, will
have the same learning
outcomes as the higher
technology
Participation in a highfidelity simulation
allowed pharmacy
students to apply
knowledge and skills
learned in the classroom.
Improved student
satisfaction with the
simulation suggests that
implementing feedback
obtained through
student course
evaluations can be an
effective means of
improving the
curriculum.
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Brim NM, Venkatan SK, Gordon
JA, Alexander EK. Long-term
educational impact of a simulator
curriculum on medical student
education in an internal medicine
clerkship. Simul. 2010;5(2):75-81.
To report the experience
of using manikin
simulation in an internal
medicine clerkship.
Medical
students
Manikin
Quantitative
Brimble M. Skills assessment using
video analysis in a simulated
environment: an evaluation.
Paediatr Nurs. 2008;20(7):26-31.
To explore student
perceptions and support
needs before, during
and after video
assessment in the
simulated environment.
Nursing
students
Not stated
Quantitative
Brindley PG, Simmonds MR,
Needham CJ, Simmonds KA.
Teaching airway management to
novices: a simulator manikin study
comparing the 'sniffing position'
and 'win with the chin' analogies.
Br J Anaesth. 2010;104(4):496-500.
To compare
performance following
the ‘sniffing position’
(widely promoted for
teaching airway
positioning before
intubation) instructions
with an alternate
analogy, 'win with the
chin' and to compare
performance following
simple anatomic
Medical
students
Task trainer
Quantitative
Manikin simulation is a
valuable and sustainable
addition to a third-year
internal medicine
clerkship. For some
students, simulation
provides otherwise
unavailable exposure to
core content material.
For the majority of
students, simulation also
provides the only means
of exposure to multiple
presentations of a single
illness. Together, these
data strongly suggest
that simulation promotes
both experiential
learning and
comparative analysis in
a clerkship setting.
This evaluation showed
that students regard the
use of video cameras in
the clinical skills
laboratory as a useful
tool for assessing
competency. Fewer
students expressed
concerns about this
approach after they had
experienced it and even
those who had concerns
recognised the benefits.
The 'win with the chin'
analogy resulted in
adequate airway
positioning significantly
more often than the
'sniffing position' or
control. The 'win with the
chin' and anatomic
instructions were
significantly better than
no instructions. Overall,
'win with the chin' was a
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instructions and no
instructions.
superior teaching
analogy and could
replace the 'sniffing
position' analogy.
Broder HL, Janal M. Promoting
interpersonal skills and cultural
sensitivity among dental students.
J Dent Educ. 2006;70(4):409-16.
To evaluate
interpersonal
communication skills
among third- and fourthyear dental students
during two clinical
communications (CC)
training programs: CC1
addressed
straightforward patient
care situations in
dentistry; CC2 added
cultural sensitivity issues
to the dental scenarios.
Dental students
OTHER (Patient
Instructors)
Quantitative
Brown J. Transferring clinical
communication skills from the
classroom to the clinical
environment: perceptions of a
group of medical students in the
United kingdom. Academic
Medicine. 2010;85(6):1052-9.
To better understand the
transfer of classroomlearned clinical
communication skills
(CCS) to the clinical
environment of the
hospital ward, where
they are practiced and
refined by students.
Medical
students
SPs
Qualitative
Brown RS, Graham CL, Richeson
N, Wu J, McDermott S. Evaluation
of medical student performance
on objective structured clinical
exams with standardized patients
with and without disabilities.
Academic Medicine.
2010;85(11):1766-71.
To investigate whether
medical students'
performance on a family
medicine clerkship OSCE
differed when the SP
had a disability versus
when the SP did not
have a disability.
Medical
students
SPs, OSCEs
Quantitative
Interpersonal
communication skills
improved during this
patient instructor
program for both CC1
and CC2 programs.
Performance scores at
the start of CC2 were
statistically lower than at
the end of CC1,
suggesting that
performance wanes
without practice.
Student evaluations of
the program were very
positive.
Four main themes
emerged, including
transfer mechanisms,
where simulated
practice with actors and
the clinical history
template were powerful
learning tools. These
findings indicate that
more needs to be done
to support, develop, and
embed CCS into the
professional practice of
medical students in the
clinical workplace.
Students performed
better when the SP did
not have a disability. This
suggests that greater
emphasis should be
placed on teaching
appropriate care of
patients with a disability.
USA
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Very weak
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98
Brydges R, Carnahan H, Rose D,
Dubrowski A. Comparing selfguided learning and educatorguided learning formats for
simulation-based clinical training.
J Adv Nurs. 2010;66(8):1832-44.
To test the over-arching
hypothesis that
progressive self-guided
learning offers
equivalent learning
benefit vs. proficiencybased training while
limiting the need to set
proficiency standards.
Nursing
Students
Task trainer;
Manikin; SPs
Quantitative
Brydges, R., et al., Coordinating
progressive levels of simulation
fidelity to maximize educational
benefit. Acad Med.2010. 85(5): p.
806-12.
To evaluate the
effectiveness of a novel,
simulation-based
educational model
rooted in scaffolding
theory that capitalises on
a systematic progressive
sequence of simulators
that increase in realism
and information content.
Medical
students
Task trainers,
SPs, hybrid
simulation
Mixed methods
Bunn W, Terpstra J. Cultivating
empathy for the mentally ill using
simulated auditory hallucinations.
Acad Psychiatry. 2009;33(6):45760.
To examine medical
student empathy preand post- simulated
auditory hallucination
experience.
Medical
Students
Role-play;
OTHER
(Auditory)
Quantitative
Progressive training and
proficiency-based
training resulted in
equivalent transfer test
performance, suggesting
that progressive students
effectively self-guided
when to transition
between simulators.
Students' preference for
the progressive practice
schedule indicates that
educators should
consider this sequence
for simulation-based
training.
Allowing students to
progress in their practice
on simulators of
increasing fidelity led to
superior transfer of a
broad range of clinical
skills. Further, this
progressive group was
resource-efficient, as
participants
concentrated on lower
resource-intensive
simulators. It is suggested
that clinical training
curricula incorporate
exposure to multiple
simulators to maximize
educational benefit and
potentially save
educator time.
Results suggest that
empathy may increase
when students are given
a brief glimpse into the
mind of a mentally ill
patient by listening to
simulated auditory
hallucinations. Specific
interventions to increase
empathy for the
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99
mentally ill can lead to a
better understanding of
how empathy can
improve patient care,
enhance the doctorpatient relationship, and
direct future educational
strategies.
Burchard KW, Rowland PA,
Berman NB, Hanissian PD, Carney
PA. Clerkship enhancement of
interpersonal skills. Am J Surg.
2005;189(6):643-6.
Burke J, Fayaz S, Graham K,
Matthew R, Field M. Peer-assisted
learning in the acquisition of
clinical skills: A supplementary
approach to musculoskeletal
system training. Medical Teacher.
2007;29(6):577-82.
Butter J, Grant TH, Egan M, Kaye
M, Wayne DB, Carrion-Carire V, et
al. Does ultrasound training boost
Year 1 medical student
competence and confidence
To determine if students
improve interpersonal
skills as the third year
progresses despite the
lack of any specific
curriculum or teaching
methods.
To evaluate whether
peer-assisted learning
(PAL) can be used to
improve students' clinical
examination skills.
To evaluate the added
value of ultrasound
training when Year 1
medical students learn
abdominal examination.
Medical
students
Medical
students
Medical
students
SPs
OSCEs
SPs
Quantitative
Despite the lack of skilldirected curriculum,
most medical students
showed improved
interpersonal skill
performance after a 16week clerkship. (Each
student completed a
clinical performance
examination before and
after clerkship consisting
of a videotaped SP
interview and physical
examination)
Developing an
interpersonal curriculum
for all third-year students
may not be necessary.
Because faculty are
being asked to do more
with less, it is believed
that efforts focused on
individual students
during the third year will
be more productive.
USA
Weak
Quantitative
This study shows that PAL
is a useful adjunct to MSS
training, and could be
incorporated into
medical curricula to
enhance clinical skills.
UK
Strong
Quantitative
Ultrasound training as an
adjunct to traditional
means of teaching
abdominal examination
improves students'
USA
Strong
100
when learning abdominal
examination? Medical Education.
2007;41(9):843-8.
physical examination
technique after students
have acquired skills with
basic examination
manoeuvres.
Butter J, McGaghie WC, Cohen
ER, Kaye ME, Wayne DB.
Simulation-based mastery learning
improves cardiac auscultation
skills in medical students. Journal
of General Internal Medicine.
2010;25(8):780-5.
To describe a mastery
model of cardiac
auscultation education
and evaluate its
effectiveness in
improving bedside
cardiac auscultation
skills.
Medical
students
Manikin
Quantitative
Cahan MA, Larkin AC, Starr S,
Wellman S, Haley H-L, Sullivan K, et
al. A human factors curriculum for
surgical clerkship students. Arch
Surg. 2010;145(12):1151-7.
To study if early
introduction of a full-day
human factors training
experience into the
surgical clerkship
curriculum will teach
effective
communication skills and
strategies to gain
professional satisfaction
from a career in surgery.
Medical
students
Not stated
Quantitative
Cardoza MP, Hood PA.
Comparative study of
baccalaureate nursing student
self-efficacy before and after
simulation. Comput Inform Nurs.
2012;30(3):142-7.
To examine two
separate groups of
senior baccalaureate
nursing students'
reported self-efficacy for
providing family-centred
care on the first day of
the paediatric semester
before and after
simulation and on the
last day of the
paediatric semester
before and after
simulation. In addition,
the relationship between
two senior
baccalaureate nursing
student groups' reported
Nursing
students
Manikin
Quantitative
A cardiac auscultation
curriculum consisting of
deliberate practice with
a computer-based
tutorial and a cardiac
patient simulator resulted
in improved assessment
of simulated heart
sounds and more
accurate examination of
actual patients.
The significant increase
in student-patient
communication scores
suggests that a brief
focused presentation
followed by simulation of
difficult patient
encounters can be
successful. A video
demonstration can
improve interdisciplinary
teamwork.
The concluding data
identified that senior
baccalaureate nursing
students have unrealistic
self-assessments of their
clinical knowledge and
nursing performance
capabilities before
simulation scenario
participation. The
perceived ability of
undergraduate students
to self-identify their
previously acquired
knowledge and
transferable clinical
reasoning to familycentred situations is
USA
Strong
USA
Strong
USA
Weak
101
self-efficacy at four data
points was examined.
inaccurate. Human
simulators are an
effective teaching and
learning modality in
measuring factors that
affect student
outcomes.
Carlson J, Abel M, Bridges D,
Tomkowiak J. The impact of a
diagnostic reminder system on
student clinical reasoning during
simulated case studies. Simul.
2011;6(1):11-7.
To explore the influence
of Isabel PRO, a webbased Diagnostic
Reminder System (DRS),
on student diagnostic
reasoning during
simulated encounters.
Medical
students
SPs; Manikin
Quantitative
Carter MB, Wesley G, Larson GM.
Didactic lecture versus
instructional standardized patient
interaction in the surgical
clerkship. Am J Surg.
2005;189(2):243-8.
To test the hypothesis
that SP interaction would
increase the selfconfidence of surgery
students in their history
and physical
examination (H and P)
skills as compared with
the classic lecture format
and that students would
perceive the SPI as a
valuable learning tool.
Medical
students
SPs
Quantitative
Despite limited
experience, students
were able to effectively
use a DRS to improve
their diagnostic
accuracy. Use of a DRS
within the context of a
patient case represents
a distinct clinical skill set
requiring appropriate
training. Providing
learners with gold
standard examples of
how to best use a
specific informatics tool
within specific clinical
situations is an essential
learning component.
Simulated case
scenarios offer an
appropriate platform for
introducing diagnostic
support tools to learners
within a clinical context.
The didactic lecture
format was not only
enjoyed and valued
more than the SPI but
surgery students also
perceived it as superior
to the SP in building
confidence in history
and physical
examination skills. These
findings suggest that
surgical educators
should develop ways to
improve students'
perceptions and
USA
Weak
USA
Strong
102
attitudes surrounding the
surgical SP interaction.
Carter MB, Wesley G, Larson GM.
Lecture versus standardized
patient interaction in the surgical
clerkship: a randomized
prospective cross-over study. Am J
Surg. 2006;191(2):262-7.
To test the hypothesis
that students would
enjoy and value an
instructional SP
interaction more than a
didactic lecture, and
that this perception
would be enhanced if
the lecture immediately
preceded the
instructional SP
interaction.
Medical
students
SPs
Quantitative
Cavaleiro AP, Guimaraes H,
Calheiros F. Training neonatal skills
with simulators? Acta Paediatr.
2009;98(4):636-9.
To compare two
different ways of learning
(self-study vs. simulation
sessions) the adequate
steps to resuscitate a
neonate in the 5th year
undergraduate medical
curriculum.
Medical
students
Manikin
Quantitative
Cazzell M, Rodriguez A.
Qualitative analysis of student
beliefs and attitudes after an
objective structured clinical
evaluation: implications for
affective domain learning in
undergraduate nursing
education. J Nurs Educ.
2011;50(12):711-4.
To explore the feelings,
beliefs, and attitudes of
senior-level
undergraduate pediatric
nursing students upon
completion of a
medication
administration Objective
Structured Clinical
Evaluation (OSCE).
Nursing
students
Manikin
Qualitative
The classic lecture
format is enjoyed and
valued as a learning tool
more by surgical
clerkship students than
the instructional SP
interaction, but having a
lecture just before an SP
interaction increased
perceived enjoyment
and value of the SP
interaction and
enhanced performance
on the SP checklist. These
data suggest that
educators can improve
student perceptions and
attitudes surrounding the
instructional SP
interaction by using
strategically timed
lectures.
Simulation-based training
of medical students in
management of
neonatal resuscitation
do not led to significant
differences on short-term
knowledge comparing
with traditional method
(self-study).
Students integrated the
attitude of safety first into
future practice but felt
that anxiety, loss of
control, reaction under
pressure, and no
feedback affected their
ability to connect the
OSCE performance with
future clinical practice.
The findings affect future
affective domain
considerations in the
USA
Strong
Portugal
Strong
USA
Very weak
103
development,
modification, and
assessment of OSCEs
across the
undergraduate nursing
curriculum.
Cederberg RA, Bentley DA, Halpin
R, Valenza JA. Use of virtual
patients in dental education: a
survey of U.S. and Canadian
dental schools. J Dent Educ.
2012;76(10):1358-64.
To determine the extent
to which virtual patients
are being utilised in
dental education by
conducting a survey that
was sent to sixty-seven
dental schools in the
United States and
Canada.
Cendan JC, Johnson TR.
Enhancing learning through
optimal sequencing of webbased and manikin simulators to
teach shock physiology in the
medical curriculum. Adv Physiol
Educ. 2011;35(4):402-7
To determine if student
knowledge and
satisfaction differ
between participation in
web-based and manikin
simulations for learning
shock physiology and
treatment and to
determine if a specific
training sequencing had
a differential effect on
learning.
Chang A, Boscardin C, Chou CL,
Loeser H, Hauer KE. Predicting
failing performance on a
standardized patient clinical
performance examination: the
importance of communication
and professionalism skills deficits.
Academic Medicine. 2009;84(10
Suppl):S101-4.
To determine which
assessment measures
identify medical students
at risk of failing a clinical
performance
examination (CPX).
Dental students
Medical
students
Medical
students
VPs
Manikin; OTHER
(web-based)
OTHER(CPX)
Quantitative
Survey results indicate
the use of virtual patients
in dental education for
pre-clinical or clinical
exercises related to
learning and honing
patient interviewing skills,
medical history taking,
recordkeeping, and
patient treatment
planning. Virtual patient
interactive audio-video
elements, also increase
the realism of the
simulation encounter.
USA; Canada
Quantitative
The two simulations may
be of similar efficacy for
educating students on
the physiology of shock;
however, the data
suggest improved
learning when webbased simulation
precedes manikin use.
USA
Strong
Quantitative
Two predictors of CPX
failure in patientphysician interaction skills
were identified: low
clerkship ratings; and
student progress review
for communication or
professionalism
concerns. No
assessments predicted
CPX failure in clinical
USA
Strong
Very weak
104
skills.
Chenot J-F, Simmenroth-Nayda A,
Koch A, Fischer T, Scherer M,
Emmert B, et al. Can student tutors
act as examiners in an objective
structured clinical examination?
Medical Education.
2007;41(11):1032-8.
To assess the reliability of
student tutors (STs) as
OSCE examiners and
their acceptance by
their peers.
Medical
students
OSCEs
Quantitative
Chou CL, Masters DE, Chang A,
Kruidering M, Hauer KE. Effects of
longitudinal small-group learning
on delivery and receipt of
communication skills feedback.
Medical Education.
2013;47(11):1073-9.
To study the effects of
prior shared learning
experiences among
medical students in the
delivery and receipt of
feedback on clinical
(communication) skills.
Medical
students
SPs;
OTHER(CPX)
Mixed methods
Christner JG, Stansfield RB, Schiller
JH, Madenci A, Keefer PM, Pituch
K. Use of simulated electronic mail
(e-mail) to assess medical student
knowledge, professionalism, and
communication skills. Academic
Medicine. 2010;85(10 Suppl):S1-4.
To examine the effect of
an instructive session on
effective e-mail
communication.
Medical
students
OTHER(e-mail)
Quantitative
Chumley HS, Dobbie A, Pollock M,
Delzell JE, Jr. Teaching medical
students to prioritize preventive
services. Fam Med.
2006;38(10):696-9.
To evaluate a workshop
that teach third-year
medical students to
prioritise preventive
services during an office
visit.
Medical
students
SPs
Quantitative
STs can act as examiners
in summative OSCEs to
assess basic medical
skills. Students accepted
assessment performed
by STs.
Year 3 medical student
peers can deliver
specific feedback on
clinical skills; prior peerlearning relationships in
pre-clerkship clinical skills
courses enrich the
provision of specific
corrective feedback
about communication
skills. Feedback between
peers with pre-existing
peer-learning
relationships represents
an additional and
potentially underutilised
method of helping
students improve clinical
skills in sensitive realms
such as interpersonal
communication.
Communicating
effectively with patients
via e-mail is not intuitive
but can be taught. It is
feasible to introduce
responses to a simulated
e-mail case in a clinical
clerkship as an
assessment tool.
The brief intervention
failed to increase
students' scores on an SP
case requiring
preventive services
prioritisation.
Germany
Weak
USA
Weak
USA
Very Weak
USA
Very Weak
105
Quantitative
These data
demonstrated that
experts and novices
asked essentially the
same questions and
spent similar amounts of
time with the patients,
yet the experts
consistently scored
higher and ordered
fewer diagnostic tests
and medications than
the novices.
USA
Weak
Quantitative
A remedial intervention
linked to poor
assessment performance
predicted improved
performance in later
examination.
UK
Weak
USA
Strong
USA
Strong
Clark GT, Suri A, Enciso R.
Autonomous virtual patients in
dentistry: system accuracy and
expert versus novice comparison.
J Dent Educ. 2012;76(10):1365-70.
To examine an
autonomous virtual
patient (AVP) system for
identifying differences
between novices and
experts in dentistry.
Cleland J, Mackenzie RK, Ross S,
Sinclair HK, Lee AJ. A remedial
intervention linked to a formative
assessment is effective in terms of
improving student performance in
subsequent degree examinations.
Medical Teacher. 2010;32(4):e18590.
To ask if remedial
intervention linked to a
formative assessment is
effective in terms of
improving student
performance in
subsequent degree
examinations.
Clever SL, Dudas RA, Solomon BS,
Yeh HC, Levine D, Bertram A, et al.
Medical student and faculty
perceptions of volunteer
outpatients versus simulated
patients in communication skills
training. Academic Medicine.
2011;86(11):1437-42.
To determine whether
medical students and
faculty perceive
differences in the
effectiveness of
interactions with real
patients (volunteer
outpatients - VOs) with
SPs in communication
skills training.
Medical
students
SPs
Quantitative
Colbert-Getz JM, Fleishman C,
Jung J, Shilkofski N. How do
gender and anxiety affect
students' self-assessment and
actual performance on a highstakes clinical skills examination?
Academic Medicine.
2013;88(1):44-8.
To determine the effect
of gender and anxiety
on accuracy of students'
self-assessment versus
actual performance in
the context of a highstakes assessment.
Medical
students
SPs;
OTHER(CPX)
Quantitative
Dental students
Medical
students
VPs
OSCEs
Students rated their
experiences with VOs
significantly higher than
those with SPs on several
criteria. Faculty
preceptors' ratings did
not differ significantly
between VOs and SPs.
Use of VOs was well
received by students
and faculty for teaching
communication skills.
Females with high
anxiety were more
accurate in selfassessment and
achieved higher actual
scores compared with
males with high anxiety.
No differences by
gender emerged for
students with moderate
or low anxiety. These
finding suggest that both
gender and the role of
106
emotion, in this case
anxiety, should be taken
into account when
planning interventions to
help improve accuracy
of students' selfassessment.
Collins LG, Schrimmer A, Diamond
J, Burke J. Evaluating verbal and
non-verbal communication skills,
in an ethnogeriatric OSCE. Patient
Educ Couns. 2011;83(2):158-62.
To assess the role of nonverbal and verbal
communication skills on
evaluations by SPs during
an ethno-geriatric OSCE.
Medical
students
SPs; OSCEs
Quantitative
Consoli A, Fraser K, Ma I, Sobczak
M, Wright B, McLaughlin K.
Diagnostic performance 1 h after
simulation training predicts
learning. Advances in Health
Sciences Education.
2013;18(5):893-900.
To assess if performance
in a one hour posttraining has a predictive
value of performance six
weeks later.
Medical
students
Not stated
Quantitative
Cooper S, Bulle B, Biro MA, Jones
J, Miles M, Gilmour C, et al.
Managing women with acute
physiological deterioration:
student midwives performance in
a simulated setting. Women Birth.
2012;25(3):e27-36.
To assess student
midwives' ability to
assess, and manage
maternal deterioration
using measures of
knowledge, situation
awareness and skill,
performance.
Midwifery
students
SPs
Quantitative
Non-verbal
communication skills
played a role in
perception of overall
interview quality as well
as perception of
culturally competent
communication.
Incorporating formative
and summative
evaluation of both
verbal and non-verbal
communication skills
may be a critical
component of curricular
innovations in ethnogeriatrics, such as the
OSCE.
Students who
successfully diagnosed a
cardiac murmur one
hour after simulation
training were very likely
to recognize the same
murmur six weeks later,
suggesting that
performance one hour
post-training can be
used a learning
outcome.
Whilst knowledge levels
were generally good,
skills were generally poor
and decreased as the
women deteriorated.
USA
Weak
Canada
Weak
Australia
Very weak
107
Cooper S, Kinsman L, Buykx P,
McConnell-Henry T, Endacott R,
Scholes J. Managing the
deteriorating patient in a
simulated environment: nursing
students' knowledge, skill and
situation awareness. J Clin Nurs.
2010;19(15-16):2309-18.
To examine, in a
simulated environment,
the ability of final-year
nursing students to
assess, identify and
respond to patients
either deteriorating or at
risk of deterioration.
Nursing
students
Manikin
Mixed methods
Corbo M, Patel J, Tawab R, Davies
J. Evaluating clinical skills of
undergraduate pharmacy
students using objective
structured clinical examinations
(OSCEs). Pharmacy Education: An
International Journal of
Pharmaceutical Education.
2006;6(1):53-8.
To evaluate the clinical
performance of 4th year
MPharm students,
through two academic
years.
Pharmacy
students
OSCE
Quantitative
Crary WM. A study of the prelicensure nursing students'
perception of the simulation
learning environment as helpful in
achieving clinical competencies
and their perception of the
impact of the level of fidelity.
Dissertation Abstracts
International: Section B: The
Sciences and Engineering.
2013;74(6-B(E)):No Pagination
Specified.
To explore and describe
the phenomena of
student perceptions of
learning in the simulation
environment and the
role of the level of reality.
Nursing
students
Manikin
Mixed methods
Creutzfeldt J, Hedman L,
Fellander-Tsai L. Effects of pretraining using serious game
technology on CPR performance-an exploratory quasiexperimental transfer study.
Scand J Trauma Resusc Emerg
Med. 2012;20:79.
To explore medical
students' retention of
knowledge and skills as
well as their proficiency
gain after pre-training
using a multiplayer virtual
world (MV) with avatars
for cardio-pulmonary
resuscitation (CPR) team
training.
Medical
students
VR; OTHER
(Avatar);
Manikin
Quantitative
Knowledge scores
suggest, on average, a
satisfactory academic
preparation, but this
study identified
significant deficits in
students' ability to
manage patient
deterioration.
This study demonstrates
that final year pharmacy
undergraduates perform
poorly in activities which
demand an element of
clinical problem
identification and
resolution or when
performing a clinical
calculation.
The more real the
student perceives the
simulation learning
environment to be, the
more helpful they will
find the environment in
achieving clinical
competencies. Students
also reported more
strongly that the level of
reality had an impact on
their ability to learn.
This study supports the
beneficial effects of
MVW-CPR team training
with avatars as a
method for pre-training,
or repetitive training, on
CPR-skills among
medical students.
Australia
Weak
UK
Weak
USA
Weak
Sweden
Strong
108
Creutzfeldt J, Hedman L, Medin C,
Heinrichs WL, Fellander-Tsai L.
Exploring virtual worlds for
scenario-based repeated team
training of cardiopulmonary
resuscitation in medical students. J
Med Internet Res. 2010;12(3):e38.
To find a feasible way to
implement CPR training
and to investigate how a
serious game setting in a
virtual world using
avatars would influence
medical students'
subjective experiences
as well as their retention
of knowledge.
Medical
students
VR; OTHER
(Avatars)
Quantitative
Cunningham NJ, Weiland TJ, van
Dijk J, Paddle P, Shilkofski N,
Cunningham NY. Telephone
referrals by junior doctors: a
randomised controlled trial
assessing the impact of SBAR in a
simulated setting. Postgrad Med J.
2012;88(1045):619-26.
To determine whether
exposing junior doctors
to Situation, Background,
Assessment,
Recommendation
(SBAR) improves their
telephone referrals.
Medical
students
OTHER(Simulate
d clinical
scenarios)
Mixed methods
Curran V, Heath O, Adey T,
Callahan T, Craig D, Hearn T, et al.
An approach to integrating
interprofessional education in
collaborative mental health care.
Acad Psychiatry. 2012;36(2):91-5.
To describe an
evaluation of a
curriculum approach to
integrating
interprofessional
education (IPE) in
collaborative mental
health practice across
the pre- to post-licensure
continuum of medical
education.
Medical
students
SPs
Mixed methods
Using scenario-based
virtual world team
training with avatars to
train medical students in
multi-person CPR was
feasible and showed
promising results.
Although no evidence of
stimulated recall of CPR
procedures in the testretest study was found,
the subjects were
enthusiastic and
reported increased
concentration during the
training. Subjects' selfefficacy had increased
after the training.
In this simulated setting
exposure to SBAR did not
improve telephone
referral performance by
increasing the amount of
critical information
presented, despite the
fact that it is a minimum
data element tool. SBAR
did improve the 'call
impact' of the telephone
referral as measured by
qualitative global rating
scores.
IPE in collaborative
mental health practice
was well received at
both the pre- and postlicensure levels.
Satisfaction scores were
very high, and all
welcomed the
opportunity to learn
about collaboration in
the context of mental
health. Medical student
satisfaction increased
significantly with the
Sweden
Weak
Australia
Strong
Canada
Strong
109
introduction of SPs as an
interprofessional learning
method. Medical
students and faculty
reported that
experiential learning in
practice-based settings
is a key component of
effective approaches to
IPE implementation.
Curran VR, Mugford J, Law RM,
MacDonald S. Influence of an
Interprofessional HIV/AIDS
Education Program on Role
Perception, Attitudes and
Teamwork Skills of Undergraduate
Health Sciences Students.
Education for Health: Change in
Learning & Practice. 2005;18(1):3244.
To assess changes in role
perception, attitudes
towards collaboration,
self-reported teamwork
skills and satisfaction with
a shared learning
experience in an
undergraduate HIV/AIDS
interprofessional
education program for
medical, nursing and
pharmacy students.
Curtin LB, Finn LA, Czosnowski QA,
Whitman CB, Cawley MJ.
Computer-based simulation
training to improve learning
outcomes in mannequin-based
simulation exercises. Am J Pharm
Educ. 2011;75(6):113.
To assess the impact of
computer-based
simulation on the
achievement of student
learning outcomes
during mannequinbased simulation.
Curtis J. Working together: a joint
initiative between academics and
clinicians to prepare
undergraduate nursing students to
work in mental health settings. Int
J Ment Health Nurs.
2007;16(4):285-93.
To describe the response
to preclinical
undergraduate
workshops that were
developed to address
problems related to the
recruitment of newly
graduated nurses to
mental health settings in
the Illawarra region of
New South Wales,
Australia.
Medical
students;
Nursing
students;
Pharmacy
students
SPs
Pharmacy
students
Manikin; OTHER
(Computerbased
simulation)
Nursing
students
Role-play
Quantitative
A problem-based
learning approach
combined with SPs was
effective in enhancing
HIV/AIDS
interprofessional role
perception, enhancing
attitudes towards
collaboration and
interprofessional
approaches to HIV/AIDS
care and fostering
confidence in teamwork
skills among pre-licensure
health sciences students.
Canada
Weak
Quantitative
The use of computerbased simulation prior to
mannequin-based
simulation improved the
achievement of learning
goals and outcomes.
USA
Strong
Mixed methods
Both students' and
clinicians' attitudes to the
workshops were
consistently positive and
indicated that the
workshops were
beneficial in preparing
students for their clinical
placement. Importantly,
since the
implementation of the
workshops and other
collaborative initiatives,
Australia
Weak
110
an increasing number of
newly graduated nurses
from the region are
choosing to work in
mental health.
Dadgar S-R, Saleh A, Bahador H,
Baradaran HR. OSCE as a tool for
evaluation of practical semiology
in comparison to MCQ & oral
examination. JPMA J Pak Med
Assoc. 2008;58(9):506-7.
To compare medical
students' perceptions
regarding Objectively
Structured Clinical
Examination (OSCE) with
Multiple Choice
Questions (MCQ) and
Oral exam in their
semiology course.
Daeppen J-B, Fortini C, Bertholet
N, Bonvin R, Berney A, Michaud PA, et al. Training medical students
to conduct motivational
interviewing: a randomized
controlled trial. Patient Educ
Couns. 2012;87(3):313-8.
To examine the
effectiveness of
motivational interviewing
(MI) training among
medical students.
Davies BR, Leung AN, Dunne SM.
Perceptions of a simulated
general dental practice facility reported experiences from past
students at the Maurice Wohl
General Dental Practice Centre
2001-2008. Br Dent J.
2009;207(8):371-6.
To assess the perceived
value of a simulated
general dental practice
centre as reported by
past undergraduates
over five years.
Medical
students
Medical
students
Dental students
OSCE
SPs
Not stated
Quantitative
The findings of this study
support OSCE as an
acceptable method to
assess essentials of
practical clinical skills of
medical students.
Iran
Mixed methods
An 8-hours training
workshop was
associated with
improved MI
performance.
Switzerland
Mixed methods
A simulated general
dental practice centre
was highly rated by past
dental students in terms
of the overall learning
experience received
and its relevance to later
vocational training. By
far the most consistently
reported attribute was
the opportunity to
practise close support
four handed dentistry
with a nurse. Training in
practice management
and organisational skills
were viewed as
important with effective
teamwork and a friendly
environment seen as
conducive to building up
knowledge and
confidence. The role of
experienced current
UK
Very weak
Strong
Very weak
111
primary care
practitioners as teachers
was seen to be very
effective in this setting.
Davies J, Nathan M, Clarke D. An
evaluation of a complex
simulated scenario with final year
undergraduate children's nursing
students. Collegian.
2012;19(3):131-8.
To evaluate a complex
simulated scenario with
final year undergraduate
children's nursing
students
Nursing
students
Role-play
Mixed methods
Dayal AK, Fisher N, Magrane D,
Goffman D, Bernstein PS, Katz NT.
Simulation training improves
medical students' learning
experiences when performing real
vaginal deliveries. Simul.
2009;4(3):155-9.
To (1) determine the
relationship between
simulation training for
vaginal delivery
manoeuvres and
subsequent participation
in live deliveries during
the clinical rotation and
(2) assess medical
students' performance
and confidence in
vaginal delivery
manoeuvres with and
without simulation
training.
Medical
students
Manikin
Quantitative
Overwhelmingly, the
results showed that this
was a positive
experience for the
students, demonstrating
a number of perceived
improvements in the
application of their
clinical skills. These
included: development
of specific management
skills; enhanced
confidence;
development of selfawareness; and the
transferability of skills to
practice. Students also
demonstrated strong
agreement in terms of
the realism of the
experience.
Students who receive
simulation training
participate more
actively in the clinical
environment during the
course of the clerkship.
Student simulation
training is beneficial to
learn obstetric skills in a
minimal risk environment,
demonstrate
competency with
manoeuvres, and
translate this
competence into
increased clinical
participation and
confidence.
Australia
USA
Very weak
Strong
112
de Giovanni D, Roberts T, Norman
G. Relative effectiveness of highversus low-fidelity simulation in
learning heart sounds. Medical
Education. 2009;43(7):661-8.
To compare the effects
of training using a highfidelity heart sound
simulator (Harvey) and a
low-fidelity simulator (a
CD) on recognition of
both simulated heart
sounds and those in
actual patients.
Medical
students
Manikin; OTHER
(CD)
Quantitative
de la Croix A, Skelton J. The reality
of role-play: interruptions and
amount of talk in simulated
consultations. Medical Education.
2009;43(7):695-703.
To resolve the following
questions: How are
interruptions and
numbers of words
distributed in simulated
consultations? Do they
correlate with set
variables (e.g. gender,
scenario) or outcome
variables (e.g. grade)?
Medical
students
SPs
Quantitative
de la Croix A, Skelton J. The
simulation game: an analysis of
interactions between students
and simulated patients. Medical
Education. 2013;47(1):49-58.
To find linguistic patterns
in predefined parts of
the conversations
(questions, topic
initiations, openings,
closings) that might
suggest conversational
dominance related to
conversations between
SPs and Year 3 students
Medical
students
SPs
Qualitative
The study found little
evidence that students
trained with a highfidelity simulator were
more able to transfer
skills to real patients than
a control group.
Although there was
some suggestion that the
Harvey-trained group
was better at
recognising heart
sounds, there was no
difference between
groups in diagnostic
accuracy or clinical skills.
SPs talked and
interrupted significantly
more than medical
students. Female SPs are
associated with more
words. The number of
words is significantly and
positively associated
with examination grade.
The number of student
interruptions is
significantly and
positively associated
with grade.
The SP is conversationally
more dominant, despite
performing the role of
the patient, in that he or
she asks more direct
questions, is more likely
to initiate topics, is more
likely not to follow topic
changes by students,
and closes the
consultation. The student
is likely to follow topics
initiated by the SP and to
seek permission to preclose the consultation.
UK
Strong
UK
Weak
UK
Very weak
113
de Leng BA, Dolmans DHJM,
Muijtjens AMM, van der Vleuten
CPM. Student perceptions of a
virtual learning environment for a
problem-based learning
undergraduate medical
curriculum. Medical Education.
2006;40(6):568-75.
To investigate the effects
of a virtual learning
environment (VLE) on
group interaction and
consultation of
information resources
during the preliminary
phase, self-study phase
and reporting phase of
the problem-based
learning process in an
undergraduate medical
curriculum.
Medical
students
VR
Quantitative
de Sousa Eskenazi E, de Arruda
Martins M, Ferreira M, Jr. Oral
health promotion through an
online training program for
medical students. J Dent Educ.
2011;75(5):672-8.
To compare the impact
on knowledge and
counselling skills of faceto-face and Internetbased oral health
training programs on
medical students.
Medical
students
OSCEs
Quantitative
Students indicated that
the use of a VLE in the
tutorial room and the
inclusion of multimedia in
case presentations
supported processes of
active learning in the
tutorial groups. However,
if we want to exploit the
full potential of
asynchronous computermediated
communication to
initiate in-depth
discussion during the selfstudy phase, its
application will have to
be selective and
deliberate. Students
indicated that the links in
the VLE to selected
information in library
repositories supported
their learning.
The Cybertutor + the
Contact Group (basic
intervention plus access
to an Internet-based
training program about
oral health themes plus
brief proactive contact
with a tutor) performed
significantly better than
the Control Group (basic
intervention) on both the
final assessment and the
OSCE and outperformed
all the other groups. The
Cybertutor + the
Contact Group also
showed the most
significant increase in
knowledge and the best
skills in asking and
counselling about oral
health.
Netherlands
Brazil
Very weak
Strong
114
Decara JM, Kirkpatrick JN,
Spencer KT, Ward RP, Kasza K,
Furlong K, et al. Use of handcarried ultrasound devices to
augment the accuracy of
medical student bedside cardiac
diagnoses. J Am Soc
Echocardiogr. 2005;18(3):257-63.
Deckers C. Designing high fidelity
simulation to maximize student
registered nursing decisionmaking ability. Dissertation
Abstracts International: Section B:
The Sciences and Engineering.
2011;72(6-B):3345.
To test the feasibility of
teaching medical
students to use handcarried ultrasound (HCU)
devices to make
bedside cardiac
diagnoses and to
compare the accuracy
of their HCU and
physical examinations.
To use design based
research to explore how
to structure high fidelity
simulation (HFS) training
to facilitate the
development of
decision-making in
second semester
Registered Nursing
learners.
Medical
students
Nursing
students
SPs
Manikin
Quantitative
Instruction of fourth-year
medical students on the
use of HCU device is
feasible and results in
significantly more
accurate bedside
diagnoses.
USA
Weak
Qualitative
Findings of this study
demonstrated that
design based research is
a powerful tool to create
a rich understanding of
the high fidelity
simulation learning
experience. The results
also supported the work
of Jeffries (2005)
reiterating that HFS
simulation design must
be created using strong
pedagogical principles
that support specific
learning outcomes.
Particular attention
should be focused on
maintenance of fidelity,
understanding
complexity and
scaffolding learning
opportunities through a
multi-phased approach
that minimally includes
debriefing. The briefing
stage of HFS learning
should be further
explored for its influence
on learning in HFS. The
influence of the
facilitator/faculty on the
HFS was emphasised in
this research.
USA
Very Weak
115
Degnan BA, Murray LJ, Dunling
CP, Whittlestone KD, Standley TDA,
Gupta AK, et al. The effect of
additional teaching on medical
students' drug administration skills
in a simulated emergency
scenario. Anaesthesia.
2006;61(12):1155-60.
To assess the benefit of
online teaching on
students' ability to
administer drugs in a
simulated critical
incident scenario, during
which they were scored
on their ability to
administer drugs in
solution presented as a
ratio (adrenaline) or
percentage (lidocaine).
Nursing
students
Not stated
Quantitative
Deladisma AM, Cohen M, Stevens
A, Wagner P, Lok B, Bernard T, et
al. Do medical students respond
empathetically to a virtual
patient? Am J Surg.
2007;193(6):756-60.
To determine whether
more complex
communication skills,
such as nonverbal
behaviours and
empathy, were similar
when students
interacted with a VP or
SP.
Medical
students
SPs; VPS
Quantitative
Denadai R, Toledo AP, Oshiiwa M,
Saad-Hossne R. Acquisition of
suture skills during medical
graduation by instructor-directed
training: a randomized controlled
study comparing senior medical
students and faculty surgeons.
Updates Surg. 2013;65(2):131-40.
To compare the
simulated teaching of
suture skills to novice
medical students by
senior medical students
and by experienced
faculty surgeons.
Medical
students
Task trainer
Quantitative
Deuster L, Christopher S, Donovan
J, Farrell M. A method to quantify
residents' jargon use during
counseling of standardized
patients about cancer screening.
Journal of General Internal
Medicine. 2008;23(12):1947-52.
To assess the amount of
jargon used and
explained during
discussions about
prostate or breast
cancer screening.
Medical
students
SPs
Quantitative
The online teaching
module significantly
improved the students'
ability to calculate the
correct volume of
lidocaine and
adrenaline, and
benefited each student's
overall performance.
Medical students
demonstrate nonverbal
communication
behaviours and respond
empathetically to a VP,
although the quantity
and quality of these
behaviours were less
than those exhibited in a
similar SP scenario.
Student empathy in
response to the VP was
less genuine and not as
sincere as compared to
the SP scenario.
The acquisition of suture
skills after studentdirected training was
similar to the training
supervised by faculty
surgeon, and the
increase in suture
performances of trainees
that received instructor
administered training
was superior to selfdirected learning.
The large number of
jargon words and low
number of explanations
suggest that many
patients may not
understand counselling
about cancer screening
UK
Strong
USA
Weak
Brazil
Strong
USA
Weak
116
tests.
Diez N, Rodriguez-Diez M-C,
Nagore D, Fernandez S, Ferrer M,
Beunza J-J. A randomized trial of
cardiopulmonary resuscitation
training for medical students:
voice advisory mannequin
compared to guidance provided
by an instructor. Simul.
2013;8(4):234-41.
To assess the quality of
CPR training among
second-year medical
students with a voice
advisory mannequin
(VAM) compared to
guidance provided by
an instructor.
DiFederico-Amicone Yates A. The
lived experience of associate
degree nursing students following
a pediatric simulation experience:
A phenomenological inquiry.
Dissertation Abstracts
International: Section B: The
Sciences and Engineering.
2014;74(9-B(E)):No Pagination
Specified.
To explore the lived
experience of the
associate degree nursing
student who has
completed a paediatric
clinical simulation; to
gain an understanding
of the meaning of this
engaged learning
experience so learning
approaches can be
employed to attain
positive outcomes that
will lead to competent
paediatric nursing care.
Medical
students
Nursing
students
Manikin
Not stated
Quantitative
In comparison to the
traditional training
method involving an
instructor, training
medical students in CPR
with VAM improves the
quality of chest
compressions in hand
position and in
compression rate
applied to mannequins.
Only among women was
VAM shown to be
superior in compression
depth training. This
technology reduces
costs in 14% in the setup
and might potentially
release instructors' time
for other activities.
Spain
Qualitative
This research study
primarily revealed the
desire and strength of
paediatric simulation for
these associate degree
nursing students. The
concept of self-efficacy
within simulation
influences students'
knowledge by increasing
their experience and
positively affecting their
performance.
USA
Strong
Very weak
117
Dillon PM, Noble KA, Kaplan L.
Simulation as a means to foster
collaborative interdisciplinary
education. Nurs Educ Perspect.
2009;30(2):87-90.
To initiate an
interdisciplinary
collaborative relationship
between nursing and
medical students; to
determine the usefulness
of an interdisciplinary
approach using
simulations as an
educational strategy;
and to analyse students'
perceptions of
collaboration.
Medical
students;
Nursing
students
Manikin
Mixed methods
Dobson R, Taylor J, Cassidy J,
Walker D, Proctor P, Perepelkin J.
Interprofessional and
intraprofessional teams in a
standardized patient assessment
lab. Pharmacy Education: An
International Journal of
Pharmaceutical Education.
2007;7(2):159-66.
To report on the relative
quality of patient care
plans produced by
students working in
interprofessional or
intraprofessional teams,
as well as student
expectations and
experiences working with
the different
collaborative models.
Pharmacy
students;
Nutrition
students;
Physical
therapy
students
SPs
Qualitative
Dubrowski A, MacRae H.
Randomised, controlled study
investigating the optimal
instructor: student ratios for
teaching suturing skills. Medical
Education. 2006;40(1):59-63.
To assess the optimal
ratio of teachers to
learners during the
teaching of a simulated
wound closure.
Medical
students
Task trainer
Quantitative
Statistically significant
differences were seen in
medical students' posttest scores for two
factors, collaboration
and nursing autonomy.
The narrative responses
revealed that nursing
students' perceptions of
the nurse-physician
relationship became
more collaborative after
the simulation
experience. Both
medical and nursing
students described the
experience as one that
should be continued.
Pharmacy students
working in teams with
other health disciplines
produce more complete
patient care plans than
pharmacy-only teams.
Assessment lab activities
also appear to increase
student support for
interprofessional teams
and appreciation for
contributions made by
other health care
professions.
The optimal instructorstudent ratio was 1
instructor for 4 students.
Higher ratios of
instructors to students
resulted in no
improvements in
learning, and lower ratios
of instructors to students
resulted in significantly
less learning. These
findings are in keeping
with current motor
learning theories.
USA
Very weak
Canada
Very weak
Canada
Strong
118
Duggan A, Bradshaw YS, Altman
W. How do I ask about your
disability? An examination of
interpersonal communication
processes between medical
students and patients with
disabilities. J Health Commun.
2010;15(3):334-50.
To examine interpersonal
communication
processes between
medical students and
patients with disabilities.
Medical
students
SPs
Qualitative
Duggan A, Bradshaw YS, Carroll
SE, Rattigan SH, Altman W. What
can I learn from this interaction? A
qualitative analysis of medical
student self-reflection and
learning in a standardized patient
exercise about disability. J Health
Commun. 2009;14(8):797-811.
To examine medical
students' learning about
disability in a project
using individuals with
disabilities as medical
educators.
Medical
students
SPs
Qualitative
Dunnington, R. M. (2013). The
nature and determinants of
presence among nursing students
participating in high fidelity
human patient simulation.
[Dissertation]. Dissertation
Abstracts International Section A:
Humanities and Social Sciences,
74(1-A(E)), No Pagination
Specified.
To examine the nature of
presence in
baccalaureate nursing
students participating in
high fidelity human
patient simulation (HFHPS) and to develop a
conceptual model that
could explain the
dimensions and
determinants of
presence as they may
impact learning
outcomes.
Nursing
students
Manikin
Qualitative
Results suggest that
some ways of asking
about disability may
inhibit patient disclosure
and restrict relationship
building. Students who
ignored disability
altogether often also
recognised they missed
disability cues, thus
providing a learning
experience of
considerable value.
The current investigation
provided evidence of
the ways examining
disability can serve as a
cornerstone for building
relationship-centred
patient care and
encouraging reflective
practice overall.
The nature of presence
was found to be a
dynamic state of being
with a centricity
between the simulation
and the natural
environment where
students perceived the
stimuli from one
environment as salient
over the other. The
results revealed that
presence was
experienced in the
domains of exocentricity,
endocentricity, or
bicentricity relative to
the perceived salience
of the simulation
environment. Further, the
presence of students in
scenario based HF-HPS
was impacted by
pedagogical factors,
USA
Very weak
USA
Very weak
USA
Weak
119
Duprey, M. D. (2011). Simulation
strategies in nursing education: An
experiential approach toward
student achievement.
[Dissertation]. Dissertation
Abstracts International Section A:
Humanities and Social Sciences,
71(9-A), 3154.
To test the hypothesis
that the incorporation of
simulated learning
activities into traditional
nursing pedagogy would
have a positive effect on
academic achievement
and students’
perceptions upon
transitioning to clinical
settings for students
enrolled in a nursing
associate-degree
program.
Nursing
students
Not stated
Quantitative
individual student
factors, and group
factors. Pedagogical
factors found in this study
included simulation
design, stream of stimuli,
and instructional
process. Individual
factors included
personality
characteristics,
referential experiences,
preconceptions,
emotional responses,
and entry
competencies. Group
dynamics and group
structure were also found
to be determinative of
the nature of presence
in HF-HPS.
Statistically significant
differences between the
groups in achievement
for both the
cardiovascular and the
high-risk obstetric
modules were observed.
Descriptive statistics
showed that 93% of
participants perceived
simulation to be useful in
preparing for actual
clinical experiences.
Findings suggest that the
incorporation of
simulated learning may
provide a studentcentred approach
toward enhancing
student achievement
and confidence among
nursing students.
USA
Strong
120
Durham, J. A., Brettell, S.,
Summerside, C., & McHanwell, S.
(2009). Evaluation of a virtual
anatomy course for clinical
undergraduates. [Evaluation
Studies
Research Support, Non-U.S. Gov't].
European Journal of Dental
Education, 13(2), 100-109. doi:
http://dx.doi.org/10.1111/j.16000579.2008.00549.x
To implement and
evaluate a series of
interactive clinically
applied anatomy
tutorials for final year
dental undergraduate
students.
Dental students
VR
Mixed methods
Duvivier, R. J., van Geel, K., van
Dalen, J., Scherpbier, A. J. J. A., &
van der Vleuten, C. P. M. (2012).
Learning physical examination
skills outside timetabled training
sessions: what happens and why?
Advances in Health Sciences
Education, 17(3), 339-355. doi:
http://dx.doi.org/10.1007/s10459011-9312-5
To investigate what
activities
medical students
undertake to improve
their skills and factors
influencing students’
practice behaviour of
physical examination
skills outside timetabled
training sessions.
Medical
students
OSCE, SPs
Qualitative
Overall perceptions of
the course were
favourable although a
number of modifications
were suggested. These
included a more concise
presentation of the
mainstream tutorial text
with hyperlinks to more
detailed content.
Students also indicated
a desire for more line
diagrams. These
changes, it was
suggested, would help
with the on-line
readability of the
tutorials. The primary
focus for the students’
learning appeared to be
provided by the preand post-tutorial tests
even though explicit
learning outcomes were
provided for each
tutorial.
Practice patterns shift
from just-in-time learning
to a longitudinal selfdirected approach.
Factors influencing this
change are assessment
methods and
simulated/real patients.
Simulated/real patients
stimulated students to
practise of physical
examination skills, initially
causing confusion and
anxiety about skill
performance but
leading to increased
feelings of competence.
Difficult or enjoyable skills
stimulate students to
practise. The strategies
students adopt to master
UK
Weak
Netherlands
Weak
121
Dyrbye, L. N., Starr, S. R.,
Thompson, G. B., & Lindor, K. D.
(2011). A model for integration of
formal knowledge and clinical
experience: the advanced
doctoring course at Mayo
Medical School. Academic
Medicine, 86(9), 1130-1136. doi:
http://dx.doi.org/10.1097/ACM.0b
013e31822519d4
To describe a year long
Advanced Doctoring
course, a
multidisciplinary clinical
skills course for secondyear students that was
implemented at Mayo
Medical School in 2006–
2007.
Medical
students
Task trainers
Quantitative
physical examination
skills outside timetabled
training sessions are selfdirected. OSCE
assessment does have
influence, but learning
takes place also when
there is no upcoming
assessment. Simulated
and real patients
provide strong incentives
to work on skills. Early
patient contacts make
students feel more
prepared for clinical
practice.
Student feedback on
course evaluation forms
is highly positive. Further,
on the 2009 Association
of American Medical
Colleges Graduation
Questionnaire,
graduating Mayo
medical students were
twice as likely as U.S.
medical students
nationally to strongly
agree that the basic
science content was
sufficiently integrated
and had sufficient
illustrations of clinical
relevance.
USA
Weak
122
Edelbring, S., Brostrom, O.,
Henriksson, P., Vassiliou, D., Spaak,
J., Dahlgren, L. O., . . . Zary, N.
(2012). Integrating virtual patients
into courses: follow-up seminars
and perceived benefit. [Research
Support, Non-U.S. Gov't]. Medical
Education, 46(4), 417-425. doi:
http://dx.doi.org/10.1111/j.13652923.2012.04219.x
To investigate how best
to use VPs in practice.
Medical
students
VPs
Quantitative
Edelbring, S., Dastmalchi, M., Hult,
H., Lundberg, I. E., & Dahlgren, L.
O. (2011). Experiencing virtual
patients in clinical learning: a
phenomenological study.
Advances in Health Sciences
Education, 16(3), 331-345. doi:
http://dx.doi.org/10.1007/s10459010-9265-0
To elicit the nature of
virtual
patients in a clinical
setting, from the
perspective of students’
experience.
Medical
students
VPs
Qualitative
The perceived benefit of
VPs and their usage
were higher in the two
intense-use settings
compared with the
moderate- and lowintensity settings. The
wish for more guidance
was high in the low- and
one of the high-intensity
settings. Students in all
settings displayed little
interest in more
assessment and
feedback regarding VPs.
High case processing
intensity was related to
positive perceptions of
the benefit of VPs.
However, the low interest
in more assessment and
feedback on the use of
VPs indicates the need
to clearly communicate
the added value of the
follow-up seminar. The
findings suggest that a
more intense follow-up
pays off in terms of the
benefit perceived by
students. This study
illustrates the need to
consider VPs from the
perspective of a holistic
course design and not as
isolated add-ons.
The VPs represented
typical clinical cases
which encouraged
clinical reasoning and
allowed for decision
making. The students
reported that the
activities integrated
biomedical knowledge
and clinical experience,
providing structure that
Sweden
Weak
Sweden
Weak
123
Ekmekci, O., Plack, M., Pintz, C.,
Bocchino, J., LeLacheur, S., &
Halvaksz, J. (2013). Integrating
executive coaching and
simulation to promote
interprofessional education of
health care students. Journal of
Allied Health, 42(1), 17-24.
To evaluate a program
that uses executive
coaching and simulation
to enhance
interprofessional
teamwork by promoting
collaboration and
leadership capacity in
health professional
undergraduate students.
Health
professional
students
Not stated
Mixed methods
prepared for the
unstructured clinical
environment and patient
encounters under
unstressful conditions.
However, the VPs were
reported as lacking the
emotional interactivity
and complexity of
actual patients. VP
activities during clinical
rotations provide
students with the
experiences of clinical
reality and allow them to
solve problems actively.
These features are
dependent on VP
technology but are also
contingent on the
surrounding
environment.
A statistically significant
increase was noted preand post-program on
the Team Assessment
Inventory. Qualitative
analysis of reflective
essays and focus group
interviews revealed that
students participated as
a career-building
opportunity and
because they wanted to
gain a better
appreciation for the roles
and contributions of
other health care
providers. The themes
that emerged related to
aspects of the process
students found helpful,
lessons learned about
professional roles, and
the meaning of
leadership in the context
of interprofessional
USA
Weak
124
teams. Findings suggest
that integrating
executive coaching and
simulation in
interprofessional
education may have the
potential to create
meaningful experiences
for health professional
students.
Ellison, S., Sullivan, C., Quaintance,
J., Arnold, L., & Godfrey, P. (2008).
Critical care recognition,
management and
communication skills during an
emergency medicine clerkship.
[Evaluation Studies]. Medical
Teacher, 30(9-10), e228-238. doi:
http://dx.doi.org/10.1080/0142159
0802334259
To evaluate a curriculum
that enable students to
recognise, manage, and
simultaneously
communicate with
critically ill patients.
Medical
students
SPs
Mixed methods
Ellman, M. S., Schulman-Green, D.,
Blatt, L., Asher, S., Viveiros, D.,
Clark, J., & Bia, M. (2012). Using
online learning and interactive
simulation to teach spiritual and
cultural aspects of palliative care
to interprofessional students.
[Research Support, Non-U.S.
Gov't]. Journal of Palliative
Medicine, 15(11), 1240-1247. doi:
http://dx.doi.org/10.1089/jpm.201
2.0038
To evaluate an
educational program
was that created with
five learning objectives
emphasised spiritual,
cultural, and
interprofessional aspects
of palliative care.
Health
professional
students
Not stated
Mixed methods
According to faculty
assessment, students as
a group performed
79.6% (SD 0.15) of the
critical care and 70.9%
(SD 11.5%) of the
communication skills.
Students most often
demonstrated basic
interpersonal skills and
least often
demonstrated empathy
skills. Students rated the
curriculum positively.
Students of all professions
recognised important
issues beyond their own
discipline, the roles of
other professionals, and
the value of team
collaboration.
Quantitative analysis
indicated that students
of all professions
perceived that the
program met its five
learning objectives, and
highly rated the program
and its two components
for both educational
quality and usefulness for
future professional work.
USA
Strong
USA
Strong
125
Endacott, R., Scholes, J., Buykx, P.,
Cooper, S., Kinsman, L., &
McConnell-Henry, T. (2010). Finalyear nursing students' ability to
assess, detect and act on clinical
cues of deterioration in a
simulated environment. [Research
Support, Non-U.S. Gov't]. Journal
of Advanced Nursing, 66(12),
2722-2731. doi:
http://dx.doi.org/10.1111/j.13652648.2010.05417.x
To investigate the
processes used by finalyear nursing students to
recognise and act on
clinical cues of
deterioration in a
simulated environment.
Nursing
students
Manikin
Qualitative
Falcone, J. L., & Watson, G. A.
(2011). Differential diagnosis in a 3station acute abdominal pain
objective structured clinical
examination (OSCE): a needs
assessment in third-year medical
student performance and
summative evaluation in the
surgical clerkship. [Comparative
Study]. Journal of Surgical
Education, 68(4), 266-269. doi:
http://dx.doi.org/10.1016/j.jsurg.20
11.02.012
To test the following
hypotheses: (1) thirdyear medical students in
the surgical clerkship will
be able to accurately
diagnose adult patients
with acute abdominal
pain after performing a
focused history and
physical examination in
a 3-station OSCE, (2)
service assessments of a
student's ability to
analyse data will not
correspond with OSCE
performance.
Medical
students
OSCE
Quantitative
Farra, S., Miller, E., Timm, N., &
Schafer, J. (2013). Improved
training for disasters using 3-D
virtual reality simulation.
[Randomized Controlled Trial
Research Support, Non-U.S. Gov't].
Western Journal of Nursing
Research, 35(5), 655-671. doi:
http://dx.doi.org/10.1177/0193945
912471735
To examine the effects
of virtual reality
simulation (VRS) on
learning outcomes and
retention of disaster
training.
Nursing
students
VR
Quantitative
Thematic analysis of
video data and
reflective interviews
identified considerable
differences in processes
used by students to
identify cues. Four
aspects of cue
recognition were
evident: initial response,
differential recognition of
cues, accumulation of
signs and diversionary
activity.
For 2 stations, more than
half of the medical
students had the correct
diagnosis on the
differential diagnosis list.
For 1 station, less than
half of the medical
students had the correct
diagnosis on the
differential diagnosis list.
There were no
differences in the service
evaluation scores and
the number of correct
differential diagnosis lists
for the students.
The main effect of the
virtual simulation was
strongly statistically
significant. The VRS
effect demonstrated
stability over time. In this
preliminary examination,
VRS is an instructional
method that reinforces
learning and improves
learning retention.
Australia
Weak
USA
Strong
USA
Strong
126
Feddock, C. A., Hoellein, A. R.,
Griffith, C. H., Wilson, J. F.,
Lineberry, M. J., & Haist, S. A.
(2009). Enhancing knowledge and
clinical skills through an
adolescent medicine workshop.
[Randomized Controlled Trial
Research Support, U.S. Gov't,
P.H.S.]. Archives of Pediatrics &
Adolescent Medicine, 163(3), 256260. doi:
http://dx.doi.org/10.1001/archpe
diatrics.2008.559
To determine the effect
of a medical school
adolescent medicine
workshop on knowledge
and clinical skills using
SPs.
Medical
students
SPs
Mixed methods
Feeley, T. H., Anker, A. E., Soriano,
R., & Friedman, E. (2010). Using
standardized patients to educate
medical students about organ
donation. Communication
Education, 59(3), 249-262. doi:
http://dx.doi.org/10.1080/0363452
1003628289
To investigate students’
accuracy and missed
opportunities for
educating patients on
cadaveric organ
donation. The focus of
the intervention is to
promote knowledge and
improved
communication skills
related to cadaveric
organ donation.
Medical
students
SPs
Quantitative
Medical students in the
intervention group
scored significantly
higher on both measures
of clinical skills, the SP
stations during the endof-clerkship examination
and the Clinical
Performance
Examination. Intervention
medical students also
scored significantly
higher on both measures
of knowledge, the openended post-encounter
written exercise and the
written examination. A
brief adolescent
medicine workshop using
SPs improved medical
students' knowledge and
skills at the end of a 4week clerkship, and the
improvement in clinical
skills persisted at the end
of the third year of
medical school.
The results indicate
several areas of
students’ missed
opportunities for patient
education including: (1)
logistics of the state
health care proxy, (2)
timing of funeral
arrangements, and (3)
ability to choose organs
for transplantation. The
value of using SP for
communication training
and health
education/promotion is
discussed.
USA
Very strong
USA
Strong
127
Feeley, T. H., Tamburlin, J., &
Vincent, D. E. (2008). An
educational intervention on organ
and tissue donation for first-year
medical students. [Research
Support, U.S. Gov't, P.H.S.].
Progress in Transplantation, 18(2),
103-108.
To implement and
evaluate a medical
education intervention
on organ and tissue
donation designed for
first-year medical
students.
Medical
students
SPs
Quantitative
Fenik, Y., Celebi, N., Wagner, R.,
Nikendei, C., Lund, F., Zipfel, S., . . .
Weyrich, P. (2013). Prepackaged
central line kits reduce procedural
mistakes during central line
insertion: a randomized controlled
prospective trial. [Randomized
Controlled Trial]. BMC Medical
Education, 13, 60. doi:
http://dx.doi.org/10.1186/14726920-13-60
To assess whether the
use of prepackaged allinclusive central line
insertion kits reduces
procedural mistakes
during central line
catheter insertion by
novices.
Medical
students
Task trainers;
Manikin
Quantitative
Significant increases
from pretest to posttest
in medical students'
knowledge, self-efficacy,
and family notification of
donation intentions were
found. The intervention
was successful in
increasing students'
knowledge and
awareness about organ
and tissue donation.
The prepackaged kit
group outperformed the
standard kit group in four
of the five quality
indicators: procedure
duration; major
technical mistakes; minor
technical mistakes; and
correct steps. These
differences were
statistically significant.
The difference for
breaches of aseptic
technique was not
statistically significant.
Prepackaged allinclusive kits for novices
improved the procedure
quality and saved staff
time resources in a
controlled simulation
environment.
USA
Strong
Germany
Strong
128
Fernandez, R., Parker, D., Kalus, J.
S., Miller, D., & Compton, S. (2007).
Using a human patient simulation
mannequin to teach
interdisciplinary team skills to
pharmacy students. American
Journal of Pharmaceutical
Education, 71(3), 51.
To determine the
effectiveness and
student acceptance of
using a human patient
simulation (HPS) training
module focused on
interdisciplinary
teamwork skills.
Pharmacy
students
Manikin
Quantitative
Fernandez, R., Pearce, M., Grand,
J. A., Rench, T. A., Jones, K. A.,
Chao, G. T., & Kozlowski, S. W. J.
(2013). Evaluation of a computerbased educational intervention to
improve medical teamwork and
performance during simulated
patient resuscitations. [Research
Support, Non-U.S. Gov't
Research Support, U.S. Gov't,
P.H.S.]. Critical Care Medicine,
41(11), 2551-2562. doi:
http://dx.doi.org/10.1097/CCM.0b
013e31829828f7
To determine the impact
of a low-resourcedemand, easily
disseminated computerbased teamwork
process training
intervention on
teamwork behaviors and
patient care
performance in code
teams.
Medical
students
Computer
simulation
Quantitative
Over 98% of students
agreed or strongly
agreed that they
learned material
relevant to their current
studies. When compared
to student lectures, 90%
of students felt that they
learned clinical patient
care better when using a
HPS mannequin in
simulated patient
scenarios. HPS-based
learning offers a realistic
training experience
through which clinical
knowledge and
interpersonal teamwork
skills can be taught.
Students enjoy the
experience and find it
relevant to their future
practice. Simulationbased training may
teach certain topics
better than traditional
lecture formats and as
such could help to fill
gaps in the current
pharmacy curriculum.
When controlling for
team members’
medically relevant
experience, teams in the
training condition
demonstrated better
teamwork and patient
care than did teams in
the placebo condition.
Computer-based team
training positively
impacts teamwork and
patient care during
simulated patient
resuscitations.
USA
Weak
USA
Strong
129
Fisher, M. J., Taylor, E. A., & High, P.
L. (2012). Parent-nursing student
communication practice: roleplay and learning outcomes.
[Research Support, Non-U.S.
Gov't]. Journal of Nursing
Education, 51(2), 115-119. doi:
http://dx.doi.org/10.3928/0148483
4-20111216-04
To investigate students'
opinions before and
after an intervention
where an innovative
method of teaching
nursing students about
communicating with
parents of sick children.
Nursing
students
Role-play
Not stated
Foley, K. L., George, G., Crandall,
S. J., Walker, K. H., Marion, G. S., &
Spangler, J. G. (2006). Training
and evaluating tobacco-specific
standardized patient instructors.
[Comparative Study
Research Support, N.I.H.,
Extramural]. Family Medicine,
38(1), 28-37.
To assess the experience
of simulated patient
instructors (SPI) with a
tabacco-specific SPI
training program. The
perceptions of medical
students on the
interaction with the SPI
are also evaluated.
Medical
students
SPs
Quantitative
Feedback provided by
students before and
after the parent session
included requests for
additional parents’
experiences,
appreciation and
exceeded expectations
of hands-on experience,
recognised value of
information provided,
and the
recommendation that all
students attend. It is
demonstrate that
empathy is a teachable
skill, nursing students are
apprehensive about
communicating with
parents, and nursing
students do not
understand how much
families rely on nurses.
SPIs highly rated the
content, organisation,
and presenters of the
training program.
Medical students
positively evaluated their
experience with the SPIs.
The Tobacco
Intervention Risk Factor
Interview Scale (TIRFIS)
and Tobacco Beliefs
Management ScaleTobacco Cultural
Concerns Scale (TBMSTCCS) subscales
demonstrated good
internal reliability, and
inconsistencies in ratings
by different SPIs were
minimal. In addition, a
range of scores on both
measures attest to the
sensitivity of the
instruments to assess
USA
Weak
USA
Strong
130
variations in student
performance. Significant
start-up costs are
associated with
developing this training
program, although costs
decline when SPIs are
retained long term.
Franc-Law, J. M., Ingrassia, P. L.,
Ragazzoni, L., & Della Corte, F.
(2010). The effectiveness of
training with an emergency
department simulator on medical
student performance in a
simulated disaster. [Comparative
Study
Randomized Controlled Trial].
CJEM Canadian Journal of
Emergency Medical Care, 12(1),
27-32.
To determine whether
exposure to an
electronic simulation tool
would improve the ability
of medical students to
manage a simulated
disaster.
Medical
students
Manikin
Quantitative
Fraser, K., Ma, I., Teteris, E., Baxter,
H., Wright, B., & McLaughlin, K.
(2012). Emotion, cognitive load
and learning outcomes during
simulation training. Medical
Education, 46(11), 1055-1062. doi:
http://dx.doi.org/10.1111/j.13652923.2012.04355.x
To assess emotion during
simulation training and to
explore the relationships
between emotion and
cognitive load, and
diagnostic performance.
Medical
students
Task trainer
Quantitative
Participants in the
intervention group
triaged their patients
more quickly than
participants in the
control group. The score
of performance
indicators on a
standardised scale was
also significantly higher in
the intervention group
when compared with
the control group. All
students indicated that
they preferred the
simulation-based
curriculum to a lecturebased curriculum. When
asked to rate the
exercise overall, both
groups gave a median
score of 8 on a 10-point
modified Likert scale.
Two principal
components of emotion
which represented
invigoration and
tranquility were
identified. Both of these
were associated with
cognitive load. A
significant negative
association between
cognitive load and the
odds of subsequently
identifying the trained
murmur was found.
Increased invigoration
Canada
Very strong
Canada
Strong
131
and reduced tranquility
during simulation training
were associated with
increased cognitive
load, and that the
likelihood of correctly
identifying a trained
murmur declined with
increasing cognitive
load.
Fraser, K., Wright, B., Girard, L.,
Tworek, J., Paget, M., Welikovich,
L., & McLaughlin, K. (2011).
Simulation training improves
diagnostic performance on a real
patient with similar clinical
findings. [Randomized Controlled
Trial
Research Support, Non-U.S. Gov't].
Chest, 139(2), 376-381. doi:
http://dx.doi.org/10.1378/chest.10
-1107
To determine whether
training on a
cardiorespiratory
simulator improves
diagnostic performance
on a real patient.
Medical
students
Task trainer
Quantitative
Students trained on
mitral regurgitation were
more likely to identify
and diagnose these
findings on a real patient
with mitral regurgitation
than those who had
trained on aortic stenosis
or a scenario with no
cardiac murmur. The
differences in result of
performance of the
three groups in
accuracy (SD) of
identifying clinical
features of and
diagnosing mitral
regurgitation were
statistically significant.
Simulator training on
mitral regurgitation
increases the likelihood
of diagnosing this
abnormality on a real
patient
Canada
Very strong
132
Galal, S., Carr-Lopez, S., Seal, C.
R., Scott, A. N., & Lopez, C. (2012).
Development and assessment of
social and emotional
competence through simulated
patient consultations. American
Journal of Pharmaceutical
Education, 76(7), 132. doi:
http://dx.doi.org/10.5688/ajpe767
132
To determine whether a
quantitative tool could
be used to measure
social emotional
competence and
whether the
development of social
emotional competence
through a pharmacy
practicum course is
possible.
Pharmacy
students
Role-play
Not stated
Gallimore, C., George, A. K., &
Brown, M. C. (2008). Pharmacy
students' preferences for various
types of simulated patients.
American Journal of
Pharmaceutical Education, 72(1),
04.
To evaluate pharmacy
students' preferences for
various types of
simulated patients.
Pharmacy
students
SPs
Quantitative
Evaluation of students’
performance in the
clinical cases using a
patient counselling
assessment form showed
that students’ social
emotional
competencies
significantly improved.
Observer ratings for
“influence” and
“connection” on the
assessment form
predicted student
performance in the
clinical cases. Role-play
exercises in which
students engage in
patient consultations
can be used to develop
social emotional
competence in
pharmacy students, and
the Social Emotional
Development Inventory
(SED-I) and a patient
counselling assessment
form can be used to
assess learning and
improvement in this
area.
Students preferred
community volunteers as
simulated patients,
followed by peers,
instructors, and staff
members. Greater than
89% agreed or strongly
agreed that their work
with simulated patients
prepared them for
actual patients, with
community volunteers
receiving the highest
ratings.
USA
Weak
USA
Weak
133
Gantt, L. T., & Webb-Corbett, R.
(2010). Using simulation to teach
patient safety behaviors in
undergraduate nursing
education. [Evaluation Studies].
Journal of Nursing Education,
49(1), 48-51. doi:
http://dx.doi.org/10.3928/0148483
4-20090918-10
To describe how a
college of nursing began
to integrate patient
safety instruction into
simulation experiences
for undergraduate
nursing students.
Nursing
students
Not stated
Quantitative
Garbee, D. D., Paige, J., Barrier, K.,
Kozmenko, V., Kozmenko, L.,
Zamjahn, J., . . . Cefalu, J. (2013).
Interprofessional teamwork
among students in simulated
codes: a quasi-experimental
study. [Research Support, Non-U.S.
Gov't]. Nursing Education
Perspectives, 34(5), 339-344.
To evaluate the efficacy
of using crisis resource
management (CRM)
principles and highfidelity human patient
simulation (HFHPS) for
interprofessional (IP)
team training of students
from undergraduate
nursing, nurse
anaesthesia, medical,
and respiratory therapy.
Nursing
students;
Medical
students
Manikin
Quantitative
Garrett, B., MacPhee, M., &
Jackson, C. (2010). High-fidelity
patient simulation: considerations
for effective learning. Nursing
Education Perspectives, 31(5),
309-313.
To explore a case of the
implementation of highfidelity simulation (HFS) in
an undergraduate
preregistration nursing
program in a Canadian
school of nursing.
Nursing
students
Manikin
Not stated
In the first semester in
which data were
collected, students did
not demonstrate
satisfactory performance
of either hand hygiene
or patient identification
61% of the time. After
instruction, students still
did not perform these
procedures consistently
38% of the time.
Mean scores increased
after training, and skills
were retained fairly well.
Any loss was regained
with repeat training in
the spring. The results
suggest that using CRM
and HFHPS is an effective
pedagogy for teaching
communication and
teamwork skills to IP
student teams.
Students identified
positive learning
experiences and
indicated that real-time
patient status changes
proved valuable to
them. Also, using these
techniques offered a
safe environment for
improving competence.
The use of reflective
debriefing appeared to
be a focal area for
learning that requires
emphasis in the planning
of HFS experiences. This
template, team-focused
learning approach also
appeared to offer a
cost-efficient strategy for
HFS.
USA
Very weak
USA
Strong
Canada
Very weak
134
Gesundheit, N., Brutlag, P.,
Youngblood, P., Gunning, W. T.,
Zary, N., & Fors, U. (2009). The use
of virtual patients to assess the
clinical skills and reasoning of
medical students: initial insights on
student acceptance. Medical
Teacher, 31(8), 739-742.
To examine student
acceptance of a webbased VP system, WebSP, developed for
teaching and
assessment purposes.
Medical
students
VPs
Not stated
Student acceptance of
this web-based method
was high, with greater
acceptance in preclinical (second-year)
compared with clinical
(fourth-year) medical
students. Students rated
VPs as realistic and
appropriately
challenging; they
particularly liked the
ability of VPs to show
physical abnormalities
(such as abnormal heart
and lung sounds, skin
lesions, and neurological
findings), a feature that is
absent in SPs. These
results document high
acceptance of webbased instruction and
assessment by medical
students. VPs of the
complexity used in this
study appear to be
particularly well suited for
learning and assessment
purposes in early
medical students who
have not yet had
significant clinical
contact.
USA
Very weak
135
Gilligan, C., Outram, S., Rasiah, R.,
& Cooper, J. (2011). Exploring the
attitudes of pharmacy students to
clinical communications training.
Focus on Health Professional
Education: A Multi-disciplinary
Journal, 13(2), 25-36.
To: (1) explore the
students' attitudes
towards communication
skills sessions and their
confidence in
participating in role-play
scenarios with simulated
patients; (2) assess the
extent to which students
perceive that the skills
practised during these
sessions are
implemented during
placement; (3) assess
whether an association
exists between attitude,
confidence and
outcomes in terms of
assessment marks
relating to
communication skills;
and (4) identify students'
needs in relation to
communication skills
training.
Pharmacy
students
Role-play, SPs
Mixed methods
Gilliland, I., Frei, B. L., McNeill, J., &
Stovall, J. (2012). Use of highfidelity simulation to teach end-oflife care to pharmacy students in
an interdisciplinary course.
American Journal of
Pharmaceutical Education, 76(4),
66. doi:
http://dx.doi.org/10.5688/ajpe764
66
To assess the effect of
high-fidelity simulation on
pharmacy students’
attitudes and perceived
competencies in
providing end-of-life
care in an
interdisciplinary palliative
care course.
Pharmacy
students
Manikin
Mixed methods
Most students reported
that they valued and
benefited from the
communications skills
sessions in terms of
confidence and an
awareness of
communication skills.
Recognition of the
importance of learning
communication skills
increased after tutorials,
and students indicated
that the tutorials had
helped in equipping
them with skills which
they used in clinical
placement situations. No
association could be
demonstrated between
students' attitudes or
confidence and their
results in oral exams.
Large tutorial groups
were reported as a key
limitation to the
effectiveness, and
students' enjoyment of,
communications skills
sessions.
Students’ post-simulation
attitudes toward death
significantly improved
compared to presimulation attitudes and
they felt significantly
more competent to take
care of dying patients.
Students were satisfied
with this teaching
method.
High-fidelity simulation is
an innovative way to
challenge pharmacy
students’ attitudes and
help them with
knowledge acquisition
Australia/NSW
Strong
Not stated
Strong
136
about end-of-life care.
Glass, C. C., Acton, R. D., Blair, P.
G., Campbell, A. R., Deutsch, E. S.,
Jones, D. B., . . . Yang, S. C. (2014).
American College of
Surgeons/Association for Surgical
Education medical student
simulation-based surgical skills
curriculum needs assessment.
[Research Support, U.S. Gov't,
Non-P.H.S.]. American Journal of
Surgery, 207(2), 165-169. doi:
http://dx.doi.org/10.1016/j.amjsur
g.2013.07.032
To survey surgical
clerkship directors
nationally and medical
students at 5 medical
schools to rank and
stratify simulation-based
educational topics.
Surgical
clerkship
directors;
Medical
students
Not stated
Quantitative
Goodstone, L., Goodstone, M. S.,
Cino, K., Glaser, C. A., Kupferman,
K., & Dember-Neal, T. (2013).
Effect of simulation on the
development of critical thinking in
associate degree nursing
students. Nursing Education
Perspectives, 34(3), 159-162.
To explore the
development of critical
thinking for students who
received instruction
using high-fidelity patient
simulation (HFPS) versus
low-fidelity simulation
(instructor-written case
studies).
Nursing
students
Manikin
Quantitative
Clerkship directors and
students generally
agreed on the
importance and timing
of specific educational
topics. Clerkship
directors tended to rank
basic skills, such as
examination skills, higher
than medical students.
Students ranked
procedural skills, such as
lumbar puncture, more
highly than clerkship
directors. Surgery
clerkship directors and
4th-year medical
students agree
substantially about the
content of a simulationbased curriculum,
although 4th-year
medical students
recommended that
some topics be taught
earlier than the clerkship
directors recommended.
Students planning to
apply to surgical
residencies did not differ
significantly in their
scoring from students
pursuing nonsurgical
specialties.
Both groups showed an
increase in critical
thinking skills; however,
there was no statistically
significant difference
between the HFPS and
case study groups.
Results suggest that highand low-fidelity
simulations are both
USA
Weak
USA
Very strong
137
associated with
increases in critical
thinking scores.
Goolsby, C., & Deering, S. (2013).
Hybrid simulation during military
medical student field training-A
novel curriculum. Military
Medicine, 178(7), 742-745. doi:
http://dx.doi.org/10.7205/MILMEDD-12-00541
To determine if highfidelity hybrid simulation
could be successfully
implemented in a field
environment. The
secondary goals were to
enhance the medical
realism of training, allow
students to practice
crucial combat
emergency medical skills
and management in
stressful field conditions,
and develop medical
team leadership.
Medical
students
Manikin hybrid
Not stated
Gordon, C. J., & Buckley, T. (2009).
The effect of high-fidelity
simulation training on medicalsurgical graduate nurses'
perceived ability to respond to
patient clinical emergencies.
[Evaluation Studies]. Journal of
Continuing Education in Nursing,
40(11), 491-498; quiz 499-500. doi:
http://dx.doi.org/10.3928/0022012
4-20091023-06
To examine the effect of
simulation on medicalsurgical graduate nurses’
perceived ability and
confidence in
responding to patient
clinical emergencies.
Nursing
students
Manikin
Quantitative
Gormley, G. J., McGlade, K.,
Thomson, C., McGill, M., & Sun, J.
(2011). A virtual surgery in general
practice: evaluation of a novel
undergraduate virtual patient
learning package. [Evaluation
Studies]. Medical Teacher, 33(10),
e522-527. doi:
http://dx.doi.org/10.3109/0142159
X.2011.599889
To evaluate the
usefulness and usability
of a set of online virtual
patients in an
undergraduate general
practice clerkship.
Medical
students
VPs
Quantitative
High-fidelity simulation
can be successfully
implemented in combatsimulated field
conditions, and
feedback indicated very
positive perceptions from
students.
After simulation,
participants reported
increased confidence in
their ability to perform
both technical and
nontechnical aspects of
responding to patient
clinical emergencies.
Ninety-four percent of
participants identified
formal debriefing as the
most useful aspect of the
simulation experience.
Ninety-five per cent of
students agreed that the
online package was a
useful learning tool and
ranked virtual patients
third out of six learning
modalities. Questions
and answers and the use
of images and videos
were all rated highly by
students as useful
learning methods. The
package was perceived
to have a high level of
USA
Very weak
Australia/NSW
Strong
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138
usability among
respondents.
Gottlieb, R., Lanning, S. K.,
Gunsolley, J. C., & Buchanan, J. A.
(2011). Faculty impressions of
dental students' performance with
and without virtual reality
simulation. [Comparative Study].
Journal of Dental Education,
75(11), 1443-1451.
To compare faculty
perceptions and
expectations of dental
students’ abilities using
VR simulation to those
who did not use VR in an
operative dentistry preclinical course.
Dental students
VR
Mixed methods
Gough, J. K., Frydenberg, A. R.,
Donath, S. K., & Marks, M. M.
(2009). Simulated parents:
Developing paediatric trainees'
skills in giving bad news. Journal of
Paediatrics and Child Health,
45(3), 133-138. doi:
http://dx.doi.org/10.1111/j.14401754.2009.01440.x
To obtain a better
understanding of the
trainees' experiences of
a program that involves
simulated parents
supporting junior
medical staff to refine
their skills in
communication,
particularly in giving
parents bad news.
Junior doctors
SPs
Qualitative
Faculty perceptions of
VR simulation students’
abilities were higher than
for non-VR simulation
students for most abilities
examined. However, the
faculty members’
expectations of VR
simulations training were
higher than their
perceptions of the
students’ abilities after
VR simulation training for
most abilities examined.
Since ergonomic
development and
technical performance
were positively impacted
by VR simulation training,
these results support the
use of VR simulation in a
preclinical dental
curriculum.
Five themes emerged
from the qualitative
data: timeliness,
emotional safety, the
complexity of
communication,
practical usefulness and
the challenge of
effecting change. In
addition, the ratings of
the videos helped to
clarify those ‘parentcentred’ communication
skills that trainees may
neglect in difficult
conversations: ‘ask
about support’,
‘encourage the parent
to ask questions’ and
USA
Strong
Australia/VIC
Strong
139
‘repeat key messages’.
Green, A. R., Miller, E., Krupat, E.,
White, A., Taylor, W. C., Hirsh, D.
A., . . . Betancourt, J. R. (2007).
Designing and implementing a
cultural competence OSCE:
lessons learned from interviews
with medical students. [Research
Support, Non-U.S. Gov't]. Ethnicity
& Disease, 17(2), 344-350.
To evaluate an OSCEbased curriculum that
emphasises cross-cultural
communication skills
(ccOSCE).
Medical
students
OSCE
Qualitative
Themes that emerged
pertinent to design and
implementation of the
station were grouped
into four categories:
learning goals, logistical
issues, faculty feedback,
and SPs. Students were
positive about the
overall experience. They
appreciated the
practical focus on nonadherence. Some found
the learning goals
complex, and others felt
the format promoted
stereotypes. Logistical
issues included concerns
about marginalizing
cross-cultural care by
creating a separate
station. Faculty
feedback was helpful
when specific about
sociocultural issues
students did or did not
explore well. Students
found SPs realistic but
inconsistent in how easily
they revealed
information. Learning
goals should be clear,
concise, and effectively
communicated to
faculty and SPs so their
feedback can be
standardized and
specific.
USA
Strong
140
Grice, G. R., Wenger, P., Brooks,
N., & Berry, T. M. (2013).
Comparison of patient simulation
methods used in a physical
assessment course. [Comparative
Study
Research Support, Non-U.S. Gov't].
American Journal of
Pharmaceutical Education, 77(4),
77. doi:
http://dx.doi.org/10.5688/ajpe774
77
To determine whether
there is a difference in
student pharmacists’
learning or satisfaction
when SPs or manikins are
used to teach physical
assessment.
Pharmacy
students
SPs; Manikin
Quantitative
Griswold-Theodorson, S., Hannan,
H., Handly, N., Pugh, B., Fojtik, J.,
Saks, M., . . . Wagner, D. (2009).
Improving patient safety with
ultrasonography guidance during
internal jugular central venous
catheter placement by novice
practitioners. [Randomized
Controlled Trial]. Simulation in
Healthcare: The Journal of The
Society for Medical Simulation,
4(4), 212-216. doi:
http://dx.doi.org/10.1097/SIH.0b01
3e3181b1b837
To compare
ultrasonography-guided
(USG) placement with
anatomic placement
during internal jugular (IJ)
central venous catheter
(CVC) insertion by
novice practitioners
using a simulation model.
Medical
students
Task trainer
Quantitative
There was no difference
in performance scores
between student
pharmacists who were
trained using manikins vs
SPs. Student pharmacists
who were trained using
manikins indicated that
they would have
probably learned to
perform cardiac and
pulmonary examinations
better had they been
taught using SPs and
that they were less
satisfied with their
method of learning.
Training using SPs and
manikins are equally
effective methods of
learning physical
assessment, but student
pharmacists preferred
using SPs.
Fifty-four percent of
participants had at least
one arterial stick without
USG compared with 0%
when using USG.
Significant differences
were shown in the USG
versus no-USG groups in
number of needle
advances until
successful cannulation of
the vein; time to
successful cannulation;
and success rates. The
number needed to treat
to avoid an arterial stick
by using USG during IJ
insertion by novice
practitioners is ∼2. The
USG during IJ CVC
placement by novice
practitioners is essential
to improve patient
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141
safety.
Haak, R., Rosenbohm, J., Koerfer,
A., Obliers, R., & Wicht, M. J.
(2008). The effect of
undergraduate education in
communication skills: a
randomised controlled clinical
trial. [Comparative Study
Randomized Controlled Trial].
European Journal of Dental
Education, 12(4), 213-218. doi:
http://dx.doi.org/10.1111/j.16000579.2008.00521.x
To determine whether
students improve their
communication skills as a
result of supervised
patient care and
whether a newly
implemented
communication course
could further improve
these skills.
Dental students
Role-play
Quantitative
Haeseler, F., Fortin, A. H., Pfeiffer,
C., Walters, C., & Martino, S.
(2011). Assessment of a
motivational interviewing
curriculum for year 3 medical
students using a standardized
patient case. Patient Education
and Counseling, 84(1), 27-30. doi:
http://dx.doi.org/10.1016/j.pec.20
10.10.029
To evaluate a year 3
motivational interviewing
(MI) curriculum using a
SP case.
Medical
students
SPs
Quantitative
A statistically significant
difference of the sum
scores of the ratings
between test and
control group were
observed. The
participants educated in
communication skills
improved significantly,
whereas in the control
group no accretion of
practical
communication
competence was
observed.
The SP reliably rated the
students on their
performance of 8 items.
Students who had
participated in the MI
curriculum were
significantly more
proficient than
nonparticipating
students in the
performance of 2
strategic MI skills,
importance and
confidence rulers. The
groups did not differ in
their use of patientcentered counseling skills
or collaborative change
planning commonly
used in MI.
Germany
Very strong
USA
Very weak
142
Haist, S. A., Lineberry, M. J., Griffith,
C. H., Hoellein, A. R., Talente, G.
M., & Wilson, J. F. (2008). Sexual
history inquiry and HIV counseling:
improving clinical skills and
medical knowledge through an
interactive workshop utilizing
standardized patients. [Research
Support, U.S. Gov't, P.H.S.].
Advances in Health Sciences
Education, 13(4), 427-434.
To evaluate a SP
educational intervention
teaching third-year
medical students SHHIVC
(Sexual history and HIV
counselling).
Medical
students
SPs
Quantitative
Halaas, G. W., Zink, T., Brooks, K.
D., & Miller, J. (2007). Clinical skills
day: preparing third year medical
students for their rural rotation.
Rural & Remote Health, 7(4), 788.
To evaluate a clinical
skills day that featured
human patient simulators
and SPs.
Medical
students
SPs; Manikin
Mixed methods
Workshop participants
scored higher than nonparticipants on SHHIVC
items on the SP station,
written exam, and openended written exercise
after the SP encounter.
The differences were
statistically significant.
The curriculum was
associated with students
demonstrating better
clinical skills on a SP
examination station and
more SHHIVC knowledge
on two measures of
medical knowledge
than students not
participating in the
educational intervention.
Evaluations were
overwhelmingly positive
with means well above
four on a five-point Likert
scale. Feedback from
both immediate and
delayed evaluations
were and continue to be
used to improve the
session for the following
year. Both students and
faculty were enthusiastic
about this 'hands on'
team learning format,
which provided students
with opportunities to
begin to understand the
complex skills that they
will need before they
learn them step-by-step.
USA
Not stated
Very weak
Weak
143
Halbach, J. L., & Sullivan, L. L.
(2005). Teaching medical students
about medical errors and patient
safety: evaluation of a required
curriculum. [Evaluation Studies].
Academic Medicine, 80(6), 600606.
To assess the
effectiveness of a brief
curriculum about patient
safety and medical
errors with third-year
medical students.
Medical
students
SPs
Quantitative
Hamilton, N. A., Kieninger, A. N.,
Woodhouse, J., Freeman, B. D.,
Murray, D., & Klingensmith, M. E.
(2012). Video review using a
reliable evaluation metric
improves team function in highfidelity simulated trauma
resuscitation. [Comparative
Study]. Journal of Surgical
Education, 69(3), 428-431. doi:
http://dx.doi.org/10.1016/j.jsurg.20
11.09.009
To demonstrate that
instruction of proper
team function can occur
using high-fidelity
simulated trauma
resuscitation with videoassisted debriefing and
that this process can be
integrated rapidly into a
standard general surgery
curriculum.
Junior doctors
Manikin
Quantitative
Five hundred eleven
(89%) students reported
that the opportunity to
present an error to a
patient increased their
confidence about
discussing this issue with
patients, and 537 (94%)
students reported that
they strongly agreed or
agreed that the SP and
feedback exercise was a
useful learning
experience. A
comparison of before
and after questionnaire
data revealed
statistically significant
increases in the selfreported awareness of
students' strengths and
weaknesses in
communicating medical
errors to patients.
Ninety percent of
residents found the
video debriefing very to
extremely helpful in
improving team function
and clinical
competency. All
participants felt more
competent as both
team leaders and team
members because of
the video debriefing. The
mean team function
score improved
significantly after video
debriefing pre-video vs.
post-video review.
USA
Strong
USA
Very weak
144
Hanna, M. N., Donnelly, M. B.,
Montgomery, C. L., & Sloan, P. A.
(2005). Perioperative pain
management education: a short
structured regional anesthesia
course compared with traditional
teaching among medical
students. [Randomized Controlled
Trial]. Regional Anesthesia & Pain
Medicine, 30(6), 523-528.
Hansel, M., Winkelmann, A. M.,
Hardt, F., Gijselaers, W., Hacker,
W., Stiehl, M., . . . Muller, M. P.
(2012). Impact of simulator
training and crew resource
management training on finalyear medical students'
performance in sepsis
resuscitation: a randomized trial.
[Randomized Controlled Trial
Research Support, Non-U.S. Gov't].
Minerva Anestesiologica, 78(8),
901-909.
Haq, I., Fuller, J., & Dacre, J.
(2006). The use of patient partners
with back pain to teach
undergraduate medical students.
[Research Support, Non-U.S.
Gov't]. Rheumatology, 45(4), 430434.
To compare a structured
clinical instruction course
on regional anaesthesia
techniques for
perioperative pain
management with
traditional teaching
given to senior medical
students.
To evaluate the
influence of the CRM
course on situational
awareness and medical
performance in crisis
scenarios and to
compare the results with
the effects of a purely
clinical simulator training.
To assess the impact of
teaching about back
pain to medical students
using trained patient
partners (PP).
Medical
students
Medical
students
Medical
students
Structured
Clinical
Instruction
Module (SCIM)
- Similar to
OSCE
Manikin
SPs
Quantitative
The study group
performed better on
each of the 11 items of
the OSCE and on the
total performance scores
of the study and control
groups. The differences
were statistically
significant. All students
rated the clinical course
highly valuable.
USA
Very strong
Quantitative
The SAGAT score rose in
the SIM group, whereas
no significant changes
could be shown in the
CRM group and the
control group,
respectively. The clinical
performance scores in
the post-intervention test
did not differ from those
in the pre-intervention
test.
Germany
Very strong
Mixed methods
Students receiving the PP
teaching performed
significantly better in a
summative OSCE, but no
difference was seen in
analysis of a single
station assessing historytaking skills in a patient
with back pain. Students
felt that the PP teaching
improved their ability to
elicit information from a
patient during the
consultation. PPs
enjoyed the experience
of teaching and felt
empowered to selfmanage their medical
conditions, and were
better able to seek
medical advice when
needed.
UK
Strong
145
Harder, B. N. (2013). Nursing
students' learning in high fidelity
simulation: An ethnographic
study. [Dissertation]. Dissertation
Abstracts International: Section B:
The Sciences and Engineering,
74(4-B(E)), No Pagination
Specified.
To look at the culture of
learning in HFS in
undergraduate nursing
education.
Nursing
students;
Instructors
Manikin
Qualitative
Harris, D. M., Ryan, K., & Rabuck,
C. (2012). Using a high-fidelity
patient simulator with first-year
medical students to facilitate
learning of cardiovascular
function curves. Advances in
Physiology Education, 36(3), 213219. doi:
http://dx.doi.org/10.1152/advan.0
0058.2012
To implement a HFPS
activity into a problembased curriculum to
enhance the learning of
basic sciences.
Medical
students
Manikin
Quantitative
Students believed that
the level of instructor
involvement at critical
points during HFS was
important and instructors
believed that their
comfort level in teaching
with HFS had an
important influence on
teaching and
subsequently learning in
HFS. Other factors that
enhanced or impaired
the simulated clinical
experience included
realism, the ability to
make mistakes in HFS
and the specific roles
assigned to students
during HFS. An important
limitation of the study
was the possible bias
that might have resulted
from the researcher’s
extensive experience
with HFS. A major
implication for practice
pertains to the
preparation of faculty
and students for HFS.
There was an increase in
the percentage of
students achieving
correct answers on a
posttest compared with
their pretest score.
Student survey data
showed agreement that
the activity aided in
learning. This study
suggests that a HFPS
activity can be
implemented during the
preclinical years of
medical education to
address basic science
concepts. Additionally, it
Canada
Strong
USA
Strong
146
suggests that student
learning of
cardiovascular function
curves and heart failure
strategies are facilitated.
Harris, M. A. (2011). Simulationenhanced pediatric clinical
orientation. [Controlled Clinical
Trial
Research Support, Non-U.S. Gov't].
Journal of Nursing Education,
50(8), 461-465. doi:
http://dx.doi.org/10.3928/0148483
4-20110429-05
Hastings, J. K., et al. (2010). "An
Objective Standardized Clinical
Examination (OSCE) in an
advanced nonprescription
medicines course." American
Journal of Pharmaceutical
Education 74(6): 98.
Hauer, K. E., et al. (2009). "Impact
of an in-person versus web-based
practice standardized patient
examination on student
performance on a subsequent
high-stakes standardized patient
examination." Teaching and
Learning in Medicine 21(4): 284290.
Hauer, K. E., et al. (2011).
"Assessment of medical students'
shared decision-making in
standardized patient encounters."
Journal of General Internal
Medicine 26(4): 367-372.
To determine the effect
of simulation-enhanced
orientation on paediatric
acute care examination
scores and paediatric
clinical course grades
among junior-level
baccalaureate nursing
students.
To add an objective
standardized clinical
examination (OSCE) to a
non-prescription
medication elective and
assess the impact on
students' knowledge,
skills, and satisfaction.
To compare the impact
of two formats of a
formative SP
examination (Webbased vs. in-person) on
scores on a subsequent
high-stakes SP
examination and to
compare students'
satisfaction with each
formative examination
format.
To characterize medical
students' shared
decision-making with SPs
and determine if
students' use of shared
decision-making
correlates with SP ratings
of their communication.
Nursing
students
Not stated
Quantitative
Health
professional
students
SPs
Qualitative
Medical
students
Medical
students
SPs, Web-based
vs. in-person
SP's
No significant difference
between groups was
detected for the
students’ examination
scores. Clinical grades of
the intervention group
were statistically
significantly higher than
those of the control
group.
The addition of the OSCE
to the elective course
provided students with
an enhanced
mechanism for
evaluation of their selfcare education and skill
development
USA
Very strong
USA
Very weak
Mixed methods
Two formats of a
formative SP
examination led to
equivalent improvement
in scores on a
subsequent high-stakes
examination. Students
preferred an in-person
formative examination to
online but were satisfied
with both
USA
Strong
Quantitative
No correlation between
shared decision-making
and overall
communication
competence rated by
the SPs. These findings
suggest that SP ratings of
students' communication
USA
Strong
147
skill cannot be used to
infer students' use of
shared decision-making.
Hayden, E. M., et al. (2012). "Webconferenced simulation sessions: a
satisfaction survey of clinical
simulation encounters via remote
supervision." Telemedicine Journal
& E-Health 18(7): 525-529.
To compared the impact
of simulation sessions
facilitated by in-person
(IP) faculty versus those
supervised remotely
using Web-conferencing
software (WebEx(), Cisco
Medical
students
OTHER (sim
scenario participants vs
faculty)
Quantitative
Hearn, J. A. (2009). "Human
Patient Simulators: Evaluation with
beginning undergraduate nursing
students." Dissertation Abstracts
International Section A:
Humanities and Social Sciences
69(12-A): 4695.
To investigate the
perceived relationship
between using Human
Patient Simulators
learning basic nursing
skills and to examine the
influences of faculty and
environment on the
nursing curriculum.
Nursing
students
Manikin (HPS)
Qualitative
Hedrick, T. L. and J. S. Young
(2008). "The use of "war games" to
enhance high-risk clinical
decision-making in students and
residents." American Journal of
Surgery 195(6): 843-849.
To see if repeated
simulations in the "war
games" format would
improve performance.
Junior doctors
Manikin (HPS)
Quantitative
Hein, C., et al. (2010). "A training
program for novice paramedics
provides initial laryngeal mask
airway insertion skill and improves
skill retention at 6 months."
Simulation in Healthcare: The
Journal of The Society for Medical
Simulation 5(1): 33-39.
To develop a training
program that provides
student paramedics with
initial knowledge and
experience in laryngeal
mask airway (LMA)
insertion skills but equally
important to provide
ongoing skill retention.
Paramedic
students
Task trainer /
(manikin)
Quantitative
Telecommunication can
successfully enhance
access to simulationbased instruction. In this
study, a Web interface
downgraded the quality
of student-faculty
communication.
The respondents
reported having a high
degree of satisfaction
with the use of human
patient simulation and,
had a better than
average level of trust in
using the simulator for
incorporation of
knowledge, cognitive
and psychomotor skills.
The results supported the
use of simulator
technology in
undergraduate nursing
education,
demonstrated the
effectiveness of the use
of simulation.
Subjects with the least
amount of clinical
experience
demonstrated the most
improvement from this
educational system
A short intervention
based on a training
program using a video
and practice in part task
trainers. In an assessment
using high-fidelity
simulation, we
demonstrated significant
improvements in
USA
Weak
USA
Very weak
USA
Strong
Australia
Strong
148
Heitz, C., et al. (2009). "Large
group high-fidelity simulation
enhances medical student
learning." Medical Teacher 31(5):
e206-210.
This project studies
whether large group
simulation leads to
enhanced basic science
learning.
Medical
students
Not stated
Quantitative
Hendrickx, K., et al. (2009).
"Learning intimate examinations
with simulated patients: the
evaluation of medical students'
performance." Medical Teacher
31(4): e139-147.
This study assessed the
effect of learning
intimate examinations
with the use of simulated
patients.
Medical
students
SPs, OSCE,
global rating
scales
Quantitative
Herge, E., et al. (2013). "The
standardized patient encounter:
A dynamic educational
approach to enhance students'
clinical healthcare skills." Journal
of Allied Health 42(4): 229-235.
To describe the process
for integrating SP
encounters in a
professional healthcare
curriculum for
occupational therapy
graduate students
Occupational
therapy
students
SPs
Descriptive
Hernandez, C., et al. (2013).
"Assessing students' ability to
detect melanomas using
standardized patients and
moulage." Journal of the
American Academy of
Dermatology 68(3): e83-88.
To examined the
proficiency of fourthyear University of Illinois
at Chicago medical
students at detecting
melanomas.
Medical
students
SPs
Quantitative
maintenance of LMA
insertion skills in student
paramedics at 6 months.
The model of just-in-time
assessment and
reinforcement of training
prevents skill decay and
has implications for
healthcare skills training
in general.
Simulation is an effective
teaching method for
preclinical basic science
education. Students
demonstrated significant
improvements after
participating in a live
interactive simulation
scenario
Learning intimate
examinations with
simulated patients has a
positive effect on the
performance of medical
students.
The authors believe the
SP experience is a viable
teaching method in
preparing competent,
reflective practitioners
for tomorrow's
healthcare environment.
The low detection rate
and failure of students
who noticed the
moulage to identify the
lesion as atypical
represents a lost
opportunity to provide a
patient intervention. Use
of SP examinations may
help physicians in
training build confidence
and competence in
cutaneous malignancy
screening.
USA
Weak
Belgium
Strong
USA
Very weak
USA
Weak
149
Hobgood, C. D., et al. (2009).
"Griev_Ing: death notification skills
and applications for fourth-year
medical students." Teaching &
Learning in Medicine 21(3): 207219.
To examine whether
GRIEV_ING improved
death notification skills of
medical students,
whether pretesting with
simulated survivors
primed learners and
improved results of the
intervention, and
whether feedback on
the simulated encounter
improved student
performance.
Medical
students
SPs
Quantitative
Hobgood, C., et al. (2010).
"Teamwork training with nursing
and medical students: does the
method matter? Results of an
interinstitutional, interdisciplinary
collaboration." Quality & Safety in
Health Care 19(6): e25.
To evaluate four
pedagogical methods
commonly used to
deliver teamwork
training and measured
the effects of each
method on the
acquisition of student
teamwork knowledge,
skills, and attitudes.
Medical
students;
Nursing
students
Manikin , Roleplay
Quantitative
Hoellein, A. R., et al. (2009). "A
complementary and alternative
medicine workshop using
standardized patients improves
knowledge and clinical skills of
medical students." Alternative
Therapies in Health & Medicine
15(6): 30-34.
To determine the impact
of a complementary
and alternative
medicine (CAM)
workshop using SPs on
knowledge and clinical
skills of third-year
medical students.
Medical
students
SPs
Quantitative
GRIEV_ING provides an
effective model medical
educators can use to
train medical students to
provide competent
death notifications.
Senior medical students
are primed to learn
death notification and
do not require a preexposure.
Each of the four
modalities demonstrated
significantly improved
teamwork knowledge
and attitudes, but no
modality was
demonstrated to be
superior. Institutions
should feel free to utilise
educational modalities,
which are best
supported by their
resources to deliver
interdisciplinary
teamwork training.
Participating in a 4-hour
SP workshop exhibit
superior CAM
knowledge as assessed
by SP checklist, openended exercises, and
multiple-choice items. It
appears that practice
with SPs assists in
acquisition and
application of CAM
knowledge and
deferential counselling
skills.
USA
Weak
USA
Strong
USA
Strong
150
Hoffmann, R. L., et al. (2007). "The
effects of human patient
simulators on basic knowledge in
critical care nursing with
undergraduate senior
baccalaureate nursing students."
Simulation in Healthcare: The
Journal of The Society for Medical
Simulation 2(2): 110-114.
To report on a study that
investigates whether
participation in
instruction involving
human patient
simulators, in conjunction
with a traditional clinical
experience, improves
professional
competence in seniorlevel undergraduate
nursing students related
to basic knowledge of
critical care nursing
Nursing
students
Manikin
Quantitative
Horan, K. M. (2009). "Using the
human patient simulator to foster
critical thinking in critical
situations." Nursing Education
Perspectives 30(1): 28-30.
To give an example of
mini-scenario, using an
oncology patient with
hypercalcaemia and
ventricular tachycardia
Nursing
students
Manikin
Descriptive
Horton, N., et al. (2013). "A
standardized patient counseling
rubric for a pharmaceutical care
and communications course."
American Journal of
Pharmaceutical Education 77(7):
152.
To restructure a required
pharmaceutical care
and communications
course to place greater
emphasis on
communication skills and
include a high-stakes
assessment.
Pharmacy
students
OSCE
Quantitative
Howard, V. M. (2007). "A
comparison of educational
strategies for the acquisition of
medical-surgical nursing
knowledge and critical thinking
skills: Human patient simulator vs.
the interactive case study
approach." Dissertation Abstracts
International Section A:
Humanities and Social Sciences
68(6-A): 2259.
To determine whether
the use of the human
patient simulator (HPS) as
an educational
intervention with nursing
students was more
effective than the use of
interactive case studies
(ICS) with respect to
knowledge gain and
critical thinking abilities
Nursing
students
Manikin
Mixed methods
Instruction involving highfidelity human simulation
is a viable teaching
strategy to improve
basic knowledge
acquisition as one
essential attribute
needed for professional
competence.
Using mini-scenarios on
the human patient
simulator, faculty
members can foster
critical thinking and
expose students to
critical situations in a
nonthreatening
environment.
The 2010 course revision
improved students'
medication counseling
abilities and readiness to
practice. Major course
revisions should be
undertaken only after
input from all
stakeholders and with
data to support the
need for change.
The use of simulation
technology in
undergraduate nursing
education,
demonstrated the
effectiveness of the use
of simulation as an
innovative teaching
strategy, validated the
nursing students' positive
experience with respect
to simulation, and
USA
Weak
USA
Very weak
USA
Weak
USA
Strong
151
confirmed the costbenefit ratio with respect
to the resources needed
to integrate simulation
into an undergraduate
nursing curriculum.
Howard, V. M., et al. (2010).
"Human patient simulators and
interactive case studies: a
comparative analysis of learning
outcomes and student
perceptions." CIN: Computers,
Informatics, Nursing 28(1): 42-48.
To investigate the value
of human patient
simulators as an
innovative teaching
method for nursing
students.
Nursing
students
Manikin
Mixed methods
Hoyer, C. B., et al. (2009). "Junior
physician skill and behaviour in
resuscitation: a simulation study."
Resuscitation 80(2): 244-248.
To describe physician
behaviour as team
leaders in a simulated
cardiac arrest during
inter-hospital transfer.
The goal was to pinpoint
deficits in knowledge
and skill integration and
make recommendations
for improvements in
education.
Junior doctors
Manikin
Quantitative
Hravnak, M., et al. (2005).
"Expanding acute care nurse
practitioner and clinical nurse
specialist education: invasive
procedure training and human
simulation in critical care." AACN
Clinical Issues 16(1): 89-104.
To describe the critical
care technical skills
training mechanisms and
use of a High-Fidelity
Human Simulation (HFHS)
Laboratory in the acute
care nurse practitioners
and clinical nurse
specialists programs at
the University of
Nursing
students
Manikin
Descriptive
No significant difference
was found in student
scores among the three
types of nursing
programs that
participated in the study.
Data obtained from a
questionnaire
administered to
participants indicated
that students responded
favorably to the use of
human patient simulators
as a teaching method
Junior physicians
performed well with
respect to the treatment
given and the
delegation of tasks.
However, variations in
the time of initiation it
took for each treatment
indicated lack of
leadership skills. It is
imperative that the
education of physicians
includes training in
leadership
Critical care technical
skills training and the use
of simulation in the
curriculum have had a
favourable response
from students and
preceptors at the
University of Pittsburgh
School of Nursing, and
have enhanced faculty's
USA
Strong
Denmark
Strong
USA
Very weak
152
Pittsburgh School of
Nursing
Hudson, J. N. and A. L. Tonkin
(2008). "Clinical skills education:
outcomes of relationships
between junior medical students,
senior peers and simulated
patients." Medical Education
42(9): 901-908.
To explored whether
senior medical students
are effective tutors for
their junior peers in
clinical skills education,
and how the
participants in the
learning triad (tutors,
learners and SPs)
perceive the learning
environment created in
peer-assisted learning
(PAL).
ability to prepare
advanced practice
nurses.
Medical
students
SPs
Quantitative
Hunziker, S., et al. (2010). "Brief
leadership instructions improve
cardiopulmonary resuscitation in a
high-fidelity simulation: a
randomized controlled
trial.[Erratum appears in Crit Care
Med. 2010 Jun;38(6):1510]."
Critical Care Medicine 38(4): 10861091.
To compare leadership
instruction with a general
technical instruction in a
high-fidelity simulated
cardiopulmonary
resuscitation scenario.
Medical
students
Manikin
Quantitative
Husebo, S. E., et al. (2011).
"Educating for teamwork--nursing
students' coordination in
simulated cardiac arrest
situations." Journal of Advanced
Nursing 67(10): 2239-2255.
To explore and describe
the communicative
modes students employ
to coordinate the team
in a simulation-based
environment designed
for resuscitation team
training.
Nursing
students
Manikin
Descriptive
With appropriate
support, volunteer Year 6
student tutors are as
effective as graduate
doctors for small-group
structured tutorials in
clinical skills. Educational
relationships were forged
between all participants
in the learning triad
Video-assisted
leadership and technical
instructions after a
simulated
cardiopulmonary
resuscitation scenario
showed sustained
efficacy after a 4-months
duration. Leadership
instructions were superior
to technical instructions,
with more leadership
utterances and better
overall cardiopulmonary
resuscitation
performance
Simulation-based
environments offer a
promising solution in
nursing education for
training the coordination
necessary in resuscitation
teams as they give the
opportunity to practice
the complex interplay of
verbal and non-verbal
communication modes
that would otherwise not
be possible.
Australia
Strong
Switzerland
Strong
Norway
Weak
153
Hussainy, S. Y., et al. (2012). "A
virtual practice environment to
develop communication skills in
pharmacy students." American
Journal of Pharmaceutical
Education 76(10): 202.
To develop
communication skills in
second-year pharmacy
students using a virtual
practice environment
(VPE) and to assess
students' and tutors'
(instructors') experiences.
Pharmacy
students
Role-play
Descriptive
The VPE provided an
effective context for
communication skills
development classes.
Australia
Descriptive
Classroom didactic
content, followed by a
simulated learning
experience, was found
to be an effective
teaching strategy for
preparing
undergraduate nursing
students in disaster
preparedness.
USA
Qualitative
Students perceived the
design principles
identified as being
conducive to their
learning.
Germany
Weak
South Korea
Weak
USA
Weak
Hutchinson, S. W., et al. (2011).
"Implementing a multidisciplinary
disaster simulation for
undergraduate nursing students."
Nursing Education Perspectives
32(4): 240-243.
To describe curriculum
enhancement activities
that led to the
implementation of a
disaster simulation
Huwendiek, S., et al. (2009).
"Design principles for virtual
patients: a focus group study
among students." Medical
Education 43(6): 580-588.
To examine what
students perceive as the
ideal features of virtual
patient (VP) design in
order to foster learning
with a special focus on
clinical reasoning.
Hwang, J. Y. (2013). "Checklist
maker, standardised patient and
rater." Medical Education 47(5):
529.
To presents the results
from a program aimed
at developing checklists
and utilisation of SPs to
enhance clinical
performance
Medical
students
Role-play
Descriptive
Ironside, P. M., et al. (2009).
"Fostering patient safety
competencies using multiplepatient simulation experiences."
Nursing Outlook 57(6): 332-337.
To examined the impact
of multiple-patient
simulation experiences
on the development of
nursing students' patient
safety competencies in
the final semester of their
baccalaureate or
associate degree nursing
program
Nursing
students
Not stated
Quantitative
Nursing
students
Medical
students
Not stated
VPs
The results showed that
students were able to
learn more about the
doctor's responsibilities
by role-playing as
patients than by roleplaying as doctors.
The findings of this study
contribute to the
science of nursing
education by providing
evidence for nursing
educators related to the
impact of multiplepatient simulations on
improving and
documenting students'
patient safety
competencies before
their entry into the
workforce.
Weak
Very weak
154
Isherwood, J., et al. (2013).
"Teaching digital rectal
examination to medical students
using a structured workshop-a
point in the right direction?"
Journal of Surgical Education
70(2): 254-257.
To examine a program
teaching Digital rectal
examination (DRE)
Medical
students
Task trainer,
OSCE
Quantitative
Jabeen, D. (2013). "Use of
simulated patients for assessment
of communication skills in
undergraduate medical
education in obstetrics and
gynaecology." Jcpsp, Journal of
the College of Physicians &
Surgeons - Pakistan 23(1): 16-19.
To compare the
effectiveness of
simulated patients with
real patients through
undergraduate students'
results of Mini-CEX
encounters and their
opinions.
Medical
students
SPs, Mini-CEX
Mixed methods
Jane Cook, M. (2012). "Design and
initial evaluation of a virtual
pediatric primary care clinic in
Second Life()." Journal of the
American Academy of Nurse
Practitioners 24(9): 521-527.
To present an example
of an innovative
educational strategy
using a theoretical
framework for the design
and evaluation of a
virtual world simulation
for family nurse
practitioner (FNP)
students.
Nursing
students
VR
Descriptive
Jeffries, P. R., et al. (2011). "Multicenter development and testing
of a simulation-based
cardiovascular assessment
curriculum for advanced practice
nurses." Nursing Education
Perspectives 32(5): 316-322.
To develop, implement,
and evaluate outcomes
of a cardiovascular
assessment curriculum
for advanced practice
nurses at four institutions
Nursing
students
Manikin; OSCE
Quantitative
The overwhelming
feedback to the
program is extremely
favorable and
demonstrates that
medical students clearly
benefit from a
structured, interactive,
and hands-on
educational workshop in
DRE
Undergraduate students
were more in favour of
using simulated patients
encounters for
evaluation of
communication skills.
There were no significant
differences between
students’ performance
on real and simulated
patients.
Virtual-world simulations
have the potential to
provide a safe
environment for students
to practice clinical
decision making for
paediatric patients.
However, attention to
the context, pedagogy,
learner, and the
capabilities of the
technology is essential to
provide a quality
educational experience.
Students who received
the simulation-based
training showed
statistically significant
pre-to-post-test
improvement in
cognitive knowledge
and cardiovascular
assessment skills.
UK
Weak
Pakistan
Strong
USA
Very weak
USA
Weak
155
Jensen, R. (2013). "Clinical
reasoning during simulation:
comparison of student and
faculty ratings." Nurse Education in
Practice 13(1): 23-28.
To examine the Lasater
Clinical Judgment Rubric
(LCJR), when used to
evaluate nursing
students' clinical
reasoning during
simulated patient care
scenarios.
Nursing
students
SPs
Quantitative
Jenson, C. E. and D. M. Forsyth
(2012). "Virtual reality simulation:
using three-dimensional
technology to teach nursing
students." CIN: Computers,
Informatics, Nursing 30(6): 312-318;
quiz 319-320.
To review the
importance of virtual
reality simulation as a
computerized teaching
strategy.
Nursing
students
VR
Descriptive
Johannesson, E., et al. (2013).
"Students' experiences of learning
manual clinical skills through
simulation." Advances in Health
Sciences Education 18(1): 99-114.
To investigate the
students' experiences
and thoughts about their
learning through
simulation skills training.
Nursing
students
Task trainer
Qualitative
Johnson, E. A., et al. (2012).
"Geriatrics in simulation: role
modeling and clinical judgment
effect." Nursing Education
Perspectives 33(3): 176-180.
To determine the effect
of expert role modelling
on nursing students'
clinical judgment in the
care of a simulated
geriatric hip fracture
client.
Nursing
students
SPs
Mixed methods
To promote more
realistic self-appraisals,
students may need more
opportunities to selfassess clinical reasoning
behaviours in
conjunction with
feedback on
performance from
faculty throughout the
nursing program.
Innovative teaching
strategies, such as virtual
reality simulation,
address barriers of
increasing patient
acuity, high student-tofaculty ratio, patient
safety concerns from
faculty, and student
anxiety and can offer
rapid feedback to
students.
The simulator was seen
as a facilitator to
learning the manual skills.
The study design, with
students working in pairs
combined with video
recording, was found to
enhance opportunities
for reflection.
Findings provide support
for combining expert role
modelling with clinical
simulation to improve
students' clinical
judgment in the care of
older adults.
USA
Weak
USA
Very weak
Sweden
Very weak
USA
Weak
156
Johnsson, A. C. E., et al. (2006).
"Evaluation of nursing students'
work technique after proficiency
training in patient transfer
methods during undergraduate
education." Nurse Education
Today 26(4): 322-331.
To investigate (1) if
nursing students
improved their work
technique when assisting
a SP from bed to
wheelchair after
proficiency training, and
(2) whether there was a
correlation between the
nursing students' work
technique and the SPs’
perceptions of the
transfer.
Josefyk, M. E. (2014). "High-fidelity
simulation and the nurse
educator's perception."
Dissertation Abstracts
International: Section B: The
Sciences and Engineering 74(8B(E)): No Pagination Specified.
To evaluate the students'
and nurse educator's
perceptions and
satisfaction with the use
of HFS.
Joud, A., et al. (2010). "Feasibility
of a computerized male urethral
catheterization simulator." Nurse
Education in Practice 10(2): 70-75.
Jude, D. C., et al. (2006).
"Simulation training in the
obstetrics and gynecology
clerkship." American Journal of
Obstetrics & Gynecology 195(5):
1489-1492.
Junger, J., et al. (2005). "Effects of
basic clinical skills training on
objective structured clinical
examination performance."
Medical Education 39(10): 1015-
To study the feasibility of
a new portable
computer-based male
urethral catheterization
simulator, Urecath
(Melerit Urecath Vision).
To determine the
effectiveness of
obstetrics simulator
training for medical
students by comparing
measures of confidence
in normal obstetrics skills
of students with and
without training.
To evaluate curriculum
reform in medical
education in improving
students' clinical and
communication skills.
Nursing
students
Nursing
students
Registered
nurses; Nurse
assistants;
Nursing
students
SPs
Manikin (HPS)
Task trainer
Medical
students
Task trainer
Medical
students
Skill training,
bedside, test
with OSCE,
MCQ
Mixed methods
Nursing students
improved their work
technique after training
in patient transfer
methods, and the work
technique affected the
simulated patients'
perceptions of the
transfer.
Sweden
Weak
Quantitative
Educators viewed the
use of HFS as an
appropriate and useful
tool in the education of
the nursing student
USA
Weak
Mixed methods
The male urethral
catheterization simulator
prototype Urecath has
advantages in its present
shape but to be an
alternative to existing
training options for
practicing male urethral
catheterization, it should
be complemented with
a tactile mode and
degrees of difficulty
Sweden
Weak
Quantitative
Students who practiced
deliveries on an
obstetrics simulator
report higher levels of
confidence in their skills
to perform vaginal
deliveries
USA
Weak
Quantitative
Curriculum reform
promoting
communication and
basic clinical skills are
effective and lead to an
Germany
Strong
157
1020.
Kamdar, G., et al. (2013).
"Qualitative evaluation of just-intime simulation-based learning:
the learners' perspective."
Simulation in Healthcare: The
Journal of The Society for Medical
Simulation 8(1): 43-48.
To evaluated the impact
of simulation-based Justin-time training (JITT) on
interns' infant lumbar
puncture (LP) success
rates.
Junior doctors
Task trainer
Qualitative
Kameg, K., et al. (2010). "The
impact of high fidelity human
simulation on self-efficacy of
communication skills." Issues in
Mental Health Nursing 31(5): 315323.
To compare the
effectiveness of two
educational delivery
methods, traditional
lecture and high fidelity
human simulation (HFHS)
Nursing
students
Manikin
Not stated
Kaplan, A. G., et al. (2012).
"Genitourinary exam skills training
curriculum for medical students: a
follow-up study of comfort and skill
utilization." Journal of Endourology
26(10): 1350-1355.
To evaluate a
genitourinary skills
training (GUST)
curriculum for incoming
third year medical
students (MS3).
Medical
students
Task trainer
Quantitative
Kaplan, B. and D. Ura (2010). "Use
of multiple patient simulators to
enhance prioritizing and
delegating skills for senior nursing
students." Journal of Nursing
Education 49(7): 371-377.
To evaluate a simulation
based learning
experience that sought
to increase student
confidence and
enhance student ability
to safely and effectively
prioritize, delegate, and
implement care for
numerous patients.
Nursing
students
Manikin
Quantitative
improved performance
in history taking and
physical examination
skills.
Just-in-time training
improved procedural
confidence with infant
LP, but work place
busyness and instructor
lack of support or
unawareness were
barriers to JITT
performance. Optimal LP
JITT would occur with
improved contextual
fidelity.
The results of this study
support the use of HFHS
to assist in enhancing
undergraduate students'
self-efficacy in
communicating with
patients who are
experiencing mental
illness.
MS3 described improved
comfort with the GU skills
at all time points during
follow-up. This was
particularly important
because both MS3 and
MS4 reported using their
skills infrequently during
their clinical training
years.
Students reported
through Likert surveys to
either "agree" or "strongly
agree" that the SBL was
well organized (87%, n =
84), prompted realistic
expectations (59%, n =
57), the scenarios were
believable (73%, n = 71),
case studies increased
understanding (66%, n =
USA
Weak
USA
Weak
USA
Strong
USA
Weak
158
Kaplan, B. G., et al. (2011). "Design
and implementation of an
interdisciplinary pediatric mock
code for undergraduate and
graduate nursing students." CIN:
Computers, Informatics, Nursing
29(9): 531-538.
To discuss and evaluate
an interdisciplinary
course that used
pediatric mock code
simulation.
Nursing
students
Manikin
Descriptive
Kaplan, B. G., et al. (2012). "Use of
an emergency preparedness
disaster simulation with
undergraduate nursing students."
Public Health Nursing 29(1): 44-51.
To report of an
educational strategy to
prepare nursing students
to respond to disasters.
Nursing
students
Not stated
Descriptive
Karabilgin, O. S., et al. (2012).
"Assessing medical student
competency in communication in
the pre-clinical phase: objective
structured video exam and SP
exam." Patient Education &
Counseling 87(3): 293-299.
To present the structure,
process and results of the
objective structured
video exam and OneStation SP exam that
have been used to
assess second year
medical students'
communication skills.
Kardong-Edgren, S., et al. (2012).
"Findings from a nursing student
CPR study: implications for staff
development educators." Journal
for Nurses in Staff Development JNSD 28(1): 9-15.
To report a secondary
data analysis of a yearlong study with 606
nursing students involving
brief monthly CPR
practice with voiceactivated manikins
versus no practice.
Medical
students
Nursing
students
SPs; OTHER
(Video based
exam)
Task trainer
64), and that the SBL
experience increased
understanding of
prioritizing and
delegating care (69%, n
= 67). Seventy-eight
percent (n = 76)
reported "more
confidence in ability to
work as a team" and 55%
(n = 52) reported "more
confidence in prioritizing
and delegating care."
The simulation was rated
very highly for realism,
enjoyment, concept
clarification in
debriefing, increasing
knowledge base, ability
to function in the clinical
setting, and increasing
confidence in caring for
a critically ill infant.
Effective outcome and
the intervention has
been incorporated into
the undergraduate
curriculum.
USA
Weak
USA
Not applicable
Quantitative
Both exams need
measures to improve
them, such as increasing
the number of video
cases or stations, and
further standardisation of
raters.
Turkey
Strong
Quantitative
Findings indicate that
even with monthly
practice and accurate
voice-activated manikin
feedback, some
students could not
perform CPR correctly.
Implications of these
findings for staff
USA
Strong
159
educators are discussed.
Kelly, L. P., et al. (2013). "Teaching
ophthalmoscopy to medical
students (the TOTeMS study)."
American Journal of
Ophthalmology 156(5): 10561061.e1010.
To determine medical
student preferences for
learning the ocular
fundus examination and
to assess their accuracy
using different
examination modalities.
Kern, D. H., et al. (2011).
"Simulation-based teaching to
improve cardiovascular exam skills
performance among third-year
medical students." Teaching &
Learning in Medicine 23(1): 15-20.
To evaluate whether the
addition of simulation
offers added benefit
over training utilising SPs
only.
Medical
students
Medical
students
Manikin; SP
SP; Manikin
Quantitative
Students preferred
fundus photographs for
both learning and
examining the ocular
fundus. Identification of
ocular fundus features
was more accurate on
photographs compared
to examination by direct
ophthalmoscopy.
USA
Strong
Quantitative
The use of simulation in
addition to SP teaching
can improve students'
performance of cardiac
examination skills.
USA
Strong
USA
Weak
USA
Weak
Kesten, K. S. (2011). "Role-play
using SBAR technique to improve
observed communication skills in
senior nursing students." Journal of
Nursing Education 50(2): 79-87.
To evaluate data from
undergraduate nursing
students (N = 115) on
their performance using
a standardized
communication tool
SBAR (Situation,
Background, Assessment,
and Recommendation).
Nursing
students
Role-play
Quantitative
Kidd, L. I., et al. (2012).
"Effectiveness of a second life()
simulation as a teaching strategy
for undergraduate mental health
nursing students." Journal of
Psychosocial Nursing & Mental
Health Services 50(7): 28-37.
To assess the
effectiveness of a
Second Life (SL) virtual
simulation as a teaching
strategy for
undergraduate mental
health nursing students.
Nursing
students
VR
Descriptive
Findings suggest roleplay may have a place
in teaching
communication skills in
nursing schools as well as
continuing education
and training in hospitals
and other health care
settings. Interdisciplinary
communication training
may provide even more
effective learning.
Positive aspects included
client assessment in an
environment where
mistakes were without
consequence, working
from home, and novelty.
Drawbacks were
dressing and
manoeuvring the avatar
and lack of realism.
160
Kiegaldie, D. and G. White (2006).
"The virtual patient-Development,
implementation and evaluation of
an innovative computer
simulation for postgraduate
nursing students." Journal of
Educational Multimedia and
Hypermedia 15(1): 31-47.
To evaluate The Virtual
Patient, an interactive
multimedia learning
resource using a critical
care clinical scenario for
postgraduate nursing
students, was developed
to enhance flexible
access to learning
experiences and
improve learning
outcomes in the
management of critically
ill patients.
Kiersma, M. E., et al. (2009).
"Laboratory session to improve
first-year pharmacy students'
knowledge and confidence
concerning the prevention of
medication errors." American
Journal of Pharmaceutical
Education 73(6): 99.
To implement a
laboratory session into
the first-year pharmacy
curriculum that would
provide active-learning
experiences in the
recognition, resolution,
and prevention of
medication errors.
King, A. E. A., et al. (2013).
"Improving collaboration among
medical, nursing and respiratory
therapy students through
interprofessional simulation."
Journal of Interprofessional Care
27(3): 269-271.
Kirkman, T. R. (2013). "High fidelity
simulation effectiveness in nursing
students' transfer of learning."
International Journal of Nursing
Education Scholarship 10: 1-6.
To evaluate the
implementation of
simulation-based
scenarios to train
students within nursing,
respiratory therapy and
medical fields in
interprofessional
practice
To determine whether
undergraduate nursing
students were able to
transfer knowledge and
skills learned from
classroom lecture and a
HFS clinical to the
traditional clinical
setting.
Nursing
students
Pharmacy
students
Medical
students;
Nursing
students;
Respiratory
therapy
students
Nursing
students
VR; VPs
Role-play
Not stated
Manikin (HFS)
Descriptive
The article reports the
project's development,
design features, and
user-evaluation data,
concluding with design
recommendations.
Australia
Descriptive
Students' awareness of
the pharmacist's role in
medication error
reduction improved and
confidence in their
ability to recognize,
prevent, and
communicate
medication errors
increased
USA
Weak
Descriptive
The study suggests that
simulated scenarios can
help interprofessional
collaboration.
USA
Weak
Quantitative
Transfer of learning was
demonstrated and the
use of HFS was found to
be an effective learning
and teaching method.
USA
Strong
Not applicable
161
Kirkpatrick, J. M. (2008). "Relation
of nursing students' motivational
state and learning effort to
motivational appeal and learning
outcomes in the use of an
interactive computer-based
multimedia program." Dissertation
Abstracts International Section A:
Humanities and Social Sciences
69(1-A): 190.
To investigate
relationships between
learners' motivational
state, the amount of
learning effort
expended, the
perceived motivational
appeal, and the learning
outcomes in a
computer-based
learning (CBL) program
designed with
embedded motivational
strategies.
Kirwin, J. L., et al. (2013). "A
simulated hospital pharmacy
module using an electronic
medical record in a
pharmaceutical care skills
laboratory course." American
Journal of Pharmaceutical
Education 77(3): 62.
To implement and
evaluate the effects of a
simulated hospital
pharmacy module using
an electronic medical
record on student
confidence and abilities
to perform hospital
pharmacist duties.
Pharmacy
students
Not stated
Quantitative
Kleinert, H. L., et al. (2007).
"Improving student dentist
competencies and perception of
difficulty in delivering care to
children with developmental
disabilities using a virtual patient
module." Journal of Dental
Education 71(2): 279-286.
To evaluate an
interactive, multimedia,
virtual patient module
was designed and
developed on compact
disc (CD-ROM) student
dentists.
Dentist students
VPs
Descriptive
Kneebone, R. L., et al. (2005).
"Blurring the boundaries: scenariobased simulation in a clinical
setting." Medical Education 39(6):
580-587.
To explore the potential
of locating quasi-clinical
scenarios, where
inanimate models
attached to simulated
patients within a real
clinical setting, allowing
participants to
experience the
challenges of the
workplace while ensuring
patient safety. An
innovative portable
digital recording device
Medical
students
SPs; Task
trainers
Qualitative
Nursing
students
E-learning
Descriptive
This study provided
support for the use of the
ARCS (Attention,
Relevance, Confidence
and Satisfaction) model
as a framework for the
design of motivational
strategies in a computerbased learning program
A simulated hospital
pharmacy module
improved pharmacy
students' hospital
practice skills and their
perceived comfort and
confidence in
completing the typical
duties of a hospital
pharmacist.
This study demonstrated
that an interactive,
multimedia (CD-ROM),
virtual patient learning
module for student
dentists is potentially an
effective tool in meeting
this need.
Scenario-based
teaching within an
authentic clinical
environment is feasible
and perceived by
participants to be
educationally useful. This
approach blurs
traditional boundaries
between skills laboratory
teaching and clinical
practice and may offer
considerable
advantages in training
USA
Weak
USA
Weak
USA
Weak
UK
Strong
162
(the 'Virtual Chaperone')
is evaluated for use in
clinical settings.
for clinical procedures.
Knobe, M., et al. (2012).
"Arthroscopy or ultrasound in
undergraduate anatomy
education: a randomized crossover controlled trial." BMC
Medical Education 12: 85.
To investigate whether
musculoskeletal
ultrasound (MSUS) or
arthroscopic methods
can increase the
anatomical knowledge
uptake.
Medical
students
Task trainer;
OSCE
Quantitative
Knudson, M. M., et al. (2008).
"Trauma training in simulation:
translating skills from SIM time to
real time." Journal of Trauma-Injury
Infection & Critical Care 64(2):
255-263; discussion 263-254.
To evaluate training of
surgical residents to
manage critically injured
patients in a timely
fashion.
Junior doctors
Manikin
Quantitative
Kuiper, R., et al. (2008). "Debriefing
with the OPT model of clinical
reasoning during high fidelity
patient simulation." International
Journal of Nursing Education
Scholarship 5: Article17.
To describe a project
that uses a structured
debriefing activity, the
Outcome Present StateTest Model of clinical
reasoning following high
fidelity patient
simulation,
Nursing
students
Manikin (HPS)
Descriptive
The additional
implementation of
arthroscopy tutorials to
the dissection course
during the
undergraduate anatomy
training is profitable and
attractive to students
with respect to complex
joint anatomy.
Simultaneous teaching
of basic-skills in
musculoskeletal
ultrasound should be
performed by medical
experts, but seems to be
inferior to the
arthroscopic 2D-3Dtransformation, and is
regarded by students as
more difficult to learn.
A trauma curriculum
incorporating simulation
shows promise in
developing crisis
management skills that
are essential for
evaluation of critically
injured patients.
The arguments for using
high fidelity patient
simulation in the current
educational
environment has obvious
short-term benefits,
however, the long term
benefit of developing
clinical expertise remains
to be discovered.
Germany
Strong
USA
Strong
USA
Very weak
163
Kumalasari, C. D., et al. (2011).
"Simulation followed by a
reflection and feedback session in
medical education." International
Journal of Information and
Communication Technology
Education 7(2): 46-56.
Kuznar, K. A. (2010). "Effects of
high-fidelity human patient
simulation experience on selfefficacy, motivation and learning
of first semester associate degree
nursing students." Dissertation
Abstracts International Section A:
Humanities and Social Sciences
70(7-A): 2356.
L. Kinsman, P. B., R. Cant, R.
Champion, S. Cooper, R.
Endacott, T. McConnell, Henry, K.
Missen, J. Porter and J. Scholes
(2012). "The FIRST 2ACT simulation
program improves nursing
practice in a rural Australian
hospital." Australian Journal of
Rural Health 20(5): 270-274.
La Rochelle, J. S., et al. (2011).
"Authenticity of instruction and
student performance: a
prospective randomised trial."
Medical Education 45(8): 807-817.
To examine surgical
residents' perception of
their learning after
participation in a
simulation followed by a
reflection and feedback
session.
To determine how
associate degree nursing
students' self-efficacy,
motivation, and learning
in the simulated
environment compare to
nursing educational
experiences without
simulation.
To measure the impact
of the Feedback
Incorporating Review
and Simulation
Techniques to Act on
Clinical Trends (FIRST 2
ACT) simulation program
on nursing observations
and practice relevant to
patient deterioration in a
rural Australian hospital.
To investigate the
relationship between the
authenticity of
instructional formats and
outcome measures
within a pre-clerkship
clinical reasoning course
Junior doctors
Nursing
students
Nurses
Medical
students
Not stated
Manikin (HPS)
Not stated
SPs; E-learning
Mixed methods
Three areas of perceived
learning were identified:
(1) dealing with
complexity; (2) dealing
with distractions; and, (3)
improvement of
teamwork skills.
USA
Strong
Mixed methods
Simulation was found to
be an acceptable
learning strategy for
novice associate degree
nursing students.
USA
Strong
Quantitative
FIRST(2) ACT was
associated with
measurable
improvements in nursing
practice
Australia
Strong
Quantitative
Increasing the
authenticity of
instructional formats
does not appear to
significantly improve
clinical reasoning
performance in a preclerkship course. Medical
educators should
balance increases in
authenticity with factors
such as cognitive load,
subject area and learner
experience when
designing new
instructional formats
USA
Strong
164
Laack, T. A., et al. (2010). "A 1week simulated internship course
helps prepare medical students
for transition to residency."
Simulation in Healthcare: The
Journal of The Society for Medical
Simulation 5(3): 127-132.
To describe Internship
Boot Camp, an
innovative course
specifically designed to
prepare fourth-year
medical students for the
transition from medical
school to internship.
Medical
students
SPs; Manikin;
Task trainers
Mixed methods
Lai, N. M., et al. (2012). "Teaching
medical students neonatal
resuscitation: knowledge gained
and retained from a brief
simulation-based training
workshop." Education for Health
25(2): 105-110.
To assess the
effectiveness of a
workshop in improving
knowledge immediately
post-training and at the
end of the year.
Medical
students
Manikin
Quantitative
Laiou, E., et al. (2011). "The effects
of laryngeal mask airway passage
simulation training on the
acquisition of undergraduate
clinical skills: a randomised
controlled trial." BMC Medical
Education 11: 57.
To compare the
effectiveness in vivo of
two LMA placement
simulation courses of
different durations.
Medical
students
Manikin
Quantitative
Lang, V. J., et al. (2013). "The
evolving role of online virtual
patients in internal medicine
clerkship education nationally."
Academic Medicine 88(11): 17131718.
To understand needs
and implementation
strategies for virtual
patients for effective
curriculum planning.
Medical
students
VPs
Descriptive
Internship Boot Camp is
a unique learning
environment that is
recalled by participants
as the most helpful, of all
components of their
medical school
education, in
preparation for
internship.
The workshop produced
a modest gain in student
knowledge on neonatal
resuscitation at the end
of their medical course.
The students' overall gain
in knowledge was below
expectation, and
evaluation appeared to
be their weakest domain
The results suggest that
the value of extended
mannequin simulation
training in the case of
LMA placement is
limited. Educators
considering simulation
for the training of
practical skills should
reflect on the extent to
which the in vitro
simulation mimics the skill
required and the degree
of difficulty of the
procedure.
Meeting cognitive
learning objectives
remained an important
reason for adopting VPs,
whereas meeting
regulatory requirements
decreased significantly
in importance.
Opportunities remain for
more systematically
integrating VPs into
USA
Weak
UK
Weak
UK
Strong
USA
Weak
165
clerkship curricula.
Lapkin, S. and T. Levett-Jones
(2011). "A cost-utility analysis of
medium vs. high-fidelity human
patient simulation manikins in
nursing education." Journal of
Clinical Nursing 20(23-24): 35433552.
To conduct a cost–utility
analysis that of medium
and high fidelity manikins
in nursing education. The
analysis sought to
determine whether the
extra costs associated
with high-fidelity manikins
can justify the
differences, if any, in the
outcomes of clinical
reasoning, knowledge
acquisition and student
satisfaction.
Nursing
students
Manikin
Quantitative
LaRochelle, J. S., et al. (2012).
"Impact of increased authenticity
in instructional format on
preclerkship students'
performance: a two-year,
prospective, randomized study."
Academic Medicine 87(10): 13411347.
To address whether
increasingly authentic
instructional formats are
more effective in
improving pre-clerkship
medical students'
performance.
Medical
students
SPs; OSCE
Quantitative
Lasater, K. (2007). "High-fidelity
simulation and the development
of clinical judgment: students'
experiences." Journal of Nursing
Education 46(6): 269-276.
To examine the
experiences of students
in one nursing program's
first term of using highfidelity simulation as part
of its regular curriculum.
Nursing
students
Manikin
Qualitative
The cost analysis
indicated that to obtain
equivalent clinical
reasoning, knowledge
acquisition and student
satisfaction scores, it
required $AU1Æ21
(US$ 1Æ14; €0Æ85) using
medium-fidelity as
compared with
$AU6Æ28 (US$6Æ17;
€4Æ40) for high-fidelity
manikins per student.
Based on the results of
the cost-utility analysis,
medium-fidelity manikins
are more cost effective
requiring one-fifth of the
cost of high-fidelity
manikins to obtain the
same effect on clinical
reasoning, knowledge
acquisition and student
satisfaction.
The authors could not
demonstrate that
increased authenticity of
the instructional format
resulted in improved
learner performance.
However, they believe
that there may be some
benefit to tailoring
preclerkship clinical
education based on
students' ability.
On the basis of these
experiences, it seems
that high-fidelity
simulation has potential
to support and affect
the development of
clinical judgment in
nursing students and to
serve as a value-added
Australia
Strong
USA
Strong
USA
Weak
166
adjunct to their clinical
practice.
Leach, J. L. (2010). "Traditional
versus high-fidelity simulationbased learning to teach vital sign
assessment." Dissertation Abstracts
International: Section B: The
Sciences and Engineering 70(9-B):
5433.
To determine the
differential effect of a
simulated learning
experience and
traditional instruction to
improve competency on
the assessment of vital
signs among sophomore
nursing students.
Nursing
students
Manikin
Qualitative
Lee, C. A., et al. (2011).
"Standardized patient-narrated
web-based learning modules
improve students' communication
skills on a high-stakes clinical skills
examination." Journal of General
Internal Medicine 26(11): 13741377.
To describe an
innovative web-based
SP module using detailed
SP and faculty
commentary to teach
communication skills.
Medical
students
SPs; E-learning
Quantitative
Lee, J. D., et al. (2008). "Working
with patients with alcohol
problems: a controlled trial of the
impact of a rich media web
module on medical student
performance." Journal of General
Internal Medicine 23(7): 1006-1009.
To assess the impact on
performance with an SP
vs. traditional lecture.
Medical
students
SPs; E-learning
Quantitative
This study extends the
literature on simulation
by providing evidence
for the importance of
measuring clinical
learning outcomes and
the usefulness of high
fidelity manikins and
clinical scenarios to
collect outcome data
on competence. This
study used a
Competency Validation
Tool to measure
competence in the
assessment of vital signs.
Students who watched
an optional web-based
SP module prior to the
CPX performed higher
than those who did not
on communication skills.
The web-based module
appears to be an
effective CPX
preparatory activity to
enhance
communication
performance.
A web module for
alcohol use interview
skills reached a greater
proportion of voluntary
learners and was
associated with
equivalent overall
performance scores and
higher brief intervention
skills scores on a SP
encounter.
USA
Strong
USA
Weak
USA
Weak
167
Leeper, H., et al. (2007). "A
student-designed and student-led
sexual-history-taking module for
second-year medical students."
Teaching & Learning in Medicine
19(3): 293-301.
To describe a sexualhistory-taking module
that was initiated,
designed, and
presented by 2nd-year
medical students for their
peers as part of the
required Introduction to
Clinical Medicine (ICM)
course.
LeFlore, J. L., et al. (2012). "Can a
virtual patient trainer teach
student nurses how to save lives-teaching nursing students about
pediatric respiratory diseases."
Simulation in Healthcare: The
Journal of The Society for Medical
Simulation 7(1): 10-17.
To compare the
achievement of learning
outcomes of
undergraduate nursing
students when a virtual
patient trainer or a
traditional lecture was
used to teach paediatric
respiratory content.
Lefroy, J., et al. (2011). "Some like it
hot: medical student views on
choosing the emotional level of a
simulation." Medical Education
45(4): 354-361.
To determine the impact
of giving junior medical
students control over the
level of emotion
expressed by a
simulated patient (SP) in
a teaching session
designed to prepare
students to handle
emotions when
interviewing real patients
on placements.
Lehmann, R., et al. (2013). "An
innovative blended learning
approach using virtual patients as
preparation for skills laboratory
training: perceptions of students
and tutors." BMC Medical
Education 13: 23.
To investigate how
students and tutors
perceive a blended
learning approach using
virtual patients (VPs) as
preparation for skills
training.
Medical
students
Nursing
students
Medical
students
Medical
students
Role-play
VR
SPs
VPs
Descriptive
Medical students can
successfully create and
implement a curriculum
module for their peers in
a sensitive area such as
sexual history taking.
USA
Weak
Quantitative
Although the virtual
patient trainer
experience produced
statistically better
outcomes, the
differences may not be
clinically significant. The
results suggest that a
virtual patient trainer
may be an effective
substitute for the
achievement of learning
outcomes that are
typically met using a
traditional lecture
format.
USA
Strong
Qualitative
The emotional level
control was a useful
innovation for most
students and may
potentially be used in
any first encounter with
challenging simulation.
UK
Weak
Mixed methods
The overall acceptance
of the blended learning
approach was high
among students and
tutors. VPs proved to be
a convenient cognitive
preparation tool for skills
training.
Germany
Strong
168
Leonard, B., et al. (2010). "Nursing
student perceptions of
intraprofessional team education
using high-fidelity simulation."
Journal of Nursing Education
49(11): 628-631.
To evaluate an
intraprofessional team
learning program that
used clinical simulation
scenarios.
Nursing
students
Manikin
Quantitative
Levett-Jones, T., et al. (2011).
"Examining the impact of high
and medium fidelity simulation
experiences on nursing students'
knowledge acquisition." Nurse
Education in Practice 11(6): 380383.
To measure and
compare knowledge
acquisition in nursing
students exposed to
medium or high fidelity
human patient
simulation manikins.
Nursing
students
Manikin
Quantitative
Levett-Jones, T., et al. (2011). "The
development and psychometric
testing of the Satisfaction with
Simulation Experience Scale."
Nurse Education Today 31(7): 705710.
To report the
development and
psychometric testing of
the Satisfaction with
Simulation Experience
Scale, an instrument
designed to measure
and compare
differences in satisfaction
levels between nursing
students exposed to
medium and high fidelity
human patient
simulation manikins.
Nursing
students
Manikin
Mixed methods
Intraprofessional
educational experiences
provide rich learning
opportunities for both
third-year and fourthyear nursing students. In
addition, simulation
provides a context within
which to support
intraprofessional nursing
student education.
The results of this study
raise questions about the
value of investing in
expensive simulation
modalities when the
increased costs
associated with high
fidelity manikins may not
be justified by a
concomitant increase
learning outcomes. This
study also suggests that
multiple-choice
questions may not be
the most appropriate
measure of simulation
effectiveness.
The results of this study
indicate that simulation is
highly valued by
students, irrespective of
the level of fidelity. This
raises questions about
the value of investing in
expensive simulation
modalities. The
Satisfaction with
Simulation Experience
Scale was reliable and
valid for this cohort.
Canada
Weak
Australia
Strong
Australia
Strong
169
Lewis, R. A. (2010). "The effect of
virtual clinical gaming simulations
on student learning outcomes in
medical-surgical nursing
education courses." Dissertation
Abstracts International: Section B:
The Sciences and Engineering
71(2-B): 924.
To determine what the
effects of virtual clinical
simulation instruction
were on the learning
outcomes of students in
higher education
medical-surgical nursing
education courses.
Liachopoulou, A. P., et al. (2008).
"Nurses' training and confidence
on deep venous catheterization."
Technology & Health Care 16(3):
159-169.
To evaluate the change
in self-confidence of one
team of students who
were trained with a
simulator on deep
venous catheterization
and the correlation of
their self-confidence with
their performance
recorded by the
simulator.
Nursing
students
Nurses; Nursing
students
VR
Task trainer
Quantitative
Findings revealed that
students who received
virtual clinical simulation
instruction significantly
demonstrated (p = .000)
for medical-surgical
content mastery and
100% of students’
demonstrated positive
growth (p = .000) in
perceived competency.
USA
Strong
Quantitative
Educational courses and
simulators are useful
educational tools that
are likely to shorten but
in no case can efface
the early phase of the
learning curve in clinical
setting, substituting the
clinical training of
inexperienced users.
Greece
Strong
Singapore
Strong
Singapore
Weak
Liaw, S. Y., et al. (2012).
"Recognizing, responding to and
reporting patient deterioration:
transferring simulation learning to
patient care settings."
Resuscitation 83(3): 395-398.
To explore nursing
students' experiences of
how a simulation
program has prepared
them to transfer their
performance to clinical
practice, in their
encounters with
deteriorating patients in
ward.
Nursing
students
SPs
Qualitative
Liaw, S., et al. (2010). "Developing
clinical competency in crisis event
management: An integrated
simulation problem-based
learning activity." Advances in
Health Sciences Education 15(3):
403-413.
To evaluate the
integration of a
simulation based
learning activity on
nursing students' clinical
crisis management
performance in a
problem-based learning
(PBL) curriculum.
Nursing
students
SPs
Descriptive
The findings provide an
understanding of how a
simulation program may
impact on the nursing
students' performances
in clinical practice,
which is useful
information for future
improvement of
programs to optimise
learning and transfer
effective care to patient
care settings.
Incorporation of
simulation learning
activities into problembased discussion
appeared to be an
effective educational
strategy for teaching
nursing students to assess
and manage crisis
events.
170
Lie, D., et al. (2010). "Longitudinal
development of medical students'
communication skills in interpreted
encounters." Education for Health:
Change in Learning & Practice
23(3): 1-12.
To describe longitudinal
skill development of
medical students for the
interpreted encounter.
Medical
students
SPs
Quantitative
Lin, J. Y., et al. (2009). "Training
medical students in bag-valvemask technique as an alternative
to mechanical ventilation in a
disaster surge setting." Prehospital
& Disaster Medicine 24(5): 402-406.
To evaluate the rapid
training of medical
students and their ability
to provide effective
manual ventilation using
the bag-valve-mask
technique.
Medical
students
Not stated
Descriptive
Linden, L. L. (2008). "The effect of
clinical simulation and traditional
teaching versus traditional
teaching alone on critical thinking
of nursing students." Dissertation
Abstracts International: Section B:
The Sciences and Engineering
69(6-B): 3513.
To compare the effect of
clinical simulation in
addition to traditional
teaching versus
traditional teaching
methodologies alone on
the cognitive aspects of
critical thinking of nursing
students during their first
clinical course.
Nursing
students
Not stated
Quantitative
Lindquist, L. A., et al. (2008).
"Teaching medication
reconciliation through simulation:
a patient safety initiative for
second year medical students."
Journal of General Internal
Medicine 23(7): 998-1001.
To discuss the design
and implementation of
an interactive learning
exercise to teach
second year medical
students about
medication
reconciliation
Medical
students
Not stated
Descriptive
Over time students
showed a pattern of
overrating their own skills
compared with trained
observers. Faculty who
teach students should
focus on specific
behaviours that are most
likely to decay without
reinforcement and
practice.
Medical students can be
rapidly trained and be
utilized as a potential
resource to carry out the
potentially lifesaving task
of manual ventilation
using the BVM technique
in a disaster situation
Demonstration of the
effectiveness of clinical
simulation transforms the
signature pedagogy of
nursing education from
the two-step process of
theory and clinical
learning to theory,
simulation and clinical
application
The Medication
Reconciliation Simulation
is the first to specifically
target medication
reconciliation as a
curriculum topic for
medical students.
Students praised the
entertaining simulation
and felt it provided a
very meaningful
experience on the
patient safety topic.
USA
Strong
USA
Weak
USA
Strong
USA
Very weak
171
Linssen, T., et al. (2007). "Simulating
the longitudinal doctor-patient
relationship: Experiences of
simulated patients in successive
consultations." Medical Education
41(9): 873-878.
Littlewood, K. E., et al. (2013).
"High-fidelity simulation is superior
to case-based discussion in
teaching the management of
shock." Medical Teacher 35(3):
e1003-1010.
Liu, L., et al. (2010). "Tracheal
intubation of a difficult airway
using Airway Scope, Airtraq, and
Macintosh laryngoscope: a
comparative manikin study of
inexperienced personnel."
Anesthesia & Analgesia 110(4):
1049-1055.
To explore the
experiences of SPs in a
new, longitudinal SP
program in which SPs
met the same Year 3
students ('GP') in 4
consecutive
consultations during the
year.
To compare the
effectiveness of highfidelity medical
simulation with Casebased discussion (CBD)
in an undergraduate
medical curriculum for
shock.
To evaluate ease of use
of the Airway Scope
(AWS) (Pentax-AWS,
Hoya Corp., Tokyo,
Japan) and the Airtraq
(ATQ) (Prodol, Vizcaya,
Spain) compared with
the Macintosh
laryngoscope (ML) by
inexperienced personnel
in a simulated manikin
difficult airway.
Medical
students
Medical
students
Medical
students
SPs
Manikin
Manikin
Qualitative
Longitudinal feedback is
now possible; it may be
of higher quality and of
benefit to SPs as well.
These findings suggest
new possibilities for SPbased education and
research.
Netherlands
Strong
Quantitative
Better understanding of
shock following
simulation than after
CBD was found.
USA
Strong
Quantitative
Both the AWS and ATQ
may be suitable devices
for difficult intubation by
inexperienced personnel
in this manikin simulated
scenario
Japan
Weak
USA
Weak
Greece
Weak
Lofaso, D. P., et al. (2011). "Design
and effectiveness of a required
pre-clinical simulation-based
curriculum for fundamental
clinical skills and procedures."
Medical Education Online 16.
To evaluate the
replacement its
traditional Introduction in
to Clinical Medicine
(ICM) course with the
Science and Practice of
Medicine (SPM) course.
Medical
students
Task trainers
Quantitative
Loukas, C., et al. (2010). "A virtual
reality simulation curriculum for
intravenous cannulation training."
Academic Emergency Medicine
17(10): 1142-1145.
To evaluate the learning
curves of novice and
intermediate users during
a VR simulation-based
curriculum for
intravenous (IV)
cannulation.
Medical
students and
recent
graduates
VR
Quantitative
The CSL design is not to
replace real clinical
patient experiences. It's
to provide early
exposure, medial
knowledge,
professionalism and
opportunity to practice
skills in a patient free
environment.
Significant learning
curves for novice and
intermediate students
were demonstrated after
following the VR
simulation-based
curriculum.
172
Competencies acquired
during this educational
course may provide an
important advantage for
training prior to actual
clinical practice.
Lucisano, K. E. (2013). "Use of
human patient simulation to
teach difficult airway
management and improve
patient safety in the nurse
anesthesia student." Dissertation
Abstracts International Section A:
Humanities and Social Sciences
74(1-A(E)): No Pagination
Specified.
To determine if scenariobased training (SB) was
more effective than taskbased (TB) training in
teaching a difficult
airway algorithm to nurse
anaesthesia student
Nursing
students
Manikin
Quantitative
Luctkar-Flude, M., et al. (2012).
"Evaluating high-fidelity human
simulators and standardized
patients in an undergraduate
nursing health assessment course."
Nurse Education Today 32(4): 448452.
To evaluate three
experiential modalities
for practicing health
assessment skills: highfidelity human simulators
(HFS), SPs (SP) and
community volunteers
(CV)
Nursing
students
Manikin; SPs
Quantitative
Lumley, S. (2013). "An hour on call:
Simulation for medical students."
Medical Education 47(11): 1125.
To describe the 'hour on
call' simulation program
where medical students
are given a hands-on
experience on being a
junior doctor.
Medical
students
SPs
Descriptive
MacDowall, J. (2006). "The
assessment and treatment of the
acutely ill patient--the role of the
patient simulator as a teaching
tool in the undergraduate
programme." Medical Teacher
28(4): 326-329.
To evaluate a protocol
for the assessment and
treatment of the acutely
ill patient in a
reproducible and
controlled environment.
Medical
students
Manikin
Mixed methods
Mixed evidence showed
that scenario-based
training may offer
specific advantages,
including improved
didactic knowledge and
compliance with a
complex algorithm
compared to task-based
training, in teaching
management of the
patient with a difficult
airway to novice
anaesthesia providers.
Significantly lower
satisfaction with HFS may
reflect learners'
perceived lack of
realism. However, HFS
may provide a low-stress
opportunity for novice
learners to practice skills
The 'hour on call'
simulation addresses this
problem by providing
students with realistic oncall scenarios, allowing
them to practice this full
skill set and build
confidence in their
decision making in a
safe environment.
The SimMan allows
students to gain
knowledge and skills in a
vital area of clinical
practice, which had
been poorly covered
within the curriculum.
USA
Strong
Canada
Weak
UK
Not applicable
UK
Weak
173
MacLaren, J. E., et al. (2008).
"Training nursing students in
evidence-based techniques for
cognitive-behavioral pediatric
pain management." Journal of
Nursing Education 47(8): 351-358.
To evaluate the effects
of a didactic training
program for nursing
students involving
developmentally
appropriate strategies
for cognitive-behavioural
pain management in
children.
Nursing
students
Role-play
Qualitative
Maloney, S., et al. (2013). "The
effect of student self-video of
performance on clinical skill
competency: a randomised
controlled trial." Advances in
Health Sciences Education 18(1):
81-89.
To examine the impact
of student self-video on
the attainment of clinical
skills.
Physiotherapy
students
Self-video
Quantitative
Marken, P. A., et al. (2010).
"Human simulators and
standardized patients to teach
difficult conversations to
interprofessional health care
teams." American Journal of
Pharmaceutical Education 74(7):
120.
Marriott, J. (2007). "Use and
evaluation of "virtual" patients for
assessment of clinical pharmacy
undergraduates." Pharmacy
Education: An International
Journal of Pharmaceutical
Education 7(4): 341-349.
Marriott, J., et al. (2012). "The
Pharmville community: a
curriculum resource platform
integrating context and theory."
American Journal of
Pharmaceutical Education 76(9):
178.
To design and
implement a
demonstration project to
teach interprofessional
teams how to recognize
and engage in difficult
conversations with
patients.
To evaluate an
assessment task, where
pharmacy students
choose their own
individual "virtual" patient
using a purposedesigned computer
program and respond to
a clinical scenario.
To develop and
implement a resource
platform consisting of a
fictional community of
people to augment
learning in an
undergraduate
pharmacy program and
to refine patient contact
skills.
Pharmacy
students;
Nursing
students; Junior
doctors
Pharmacy
students
Pharmacy
students
SPs; Manikin
VPs
VPs
These results suggest that
a brief training program
in cognitive-behavioural
pain management can
improve nursing students'
knowledge of cognitivebehavioural pain
management strategies
and ability to implement
them.
The results of this study
demonstrate that
greater clinical skill
competency is achieved
when traditional tutoring
methods are
supplemented with
student self-video of
performance tasks.
USA
Weak
Australia
Strong
Qualitative
Simulation is an effective
technique to teach
interprofessional teams
how to engage in
difficult conversations
with patients.
USA
Weak
Descriptive
Students reported that
the assignment was
relevant to the subject
and the assessment
improved their learning.
Australia
Very weak
Descriptive
Pharmville is an
instructional resource
that links professionalism
and academic study,
and provides context for
student learning.
Australia
Very weak
174
Marshall, S. D., et al. (2012).
"Telephone referral education,
and evidence of retention and
transfer after six-months." BMC
Medical Education 12: 38.
Marshall, S., et al. (2009). "The
teaching of a structured tool
improves the clarity and content
of interprofessional clinical
communication." Quality & Safety
in Health Care 18(2): 137-140.
Massias, L. A. (2010). "Influencing
critical thinking in nursing
education: Comparing highfidelity simulations and traditional
clinical training." Dissertation
Abstracts International: Section B:
The Sciences and Engineering
70(8-B): 4764.
To determine the longerterm effectiveness of an
education session
employing a structured
method to teach
referral-making skills to
medical students.
To determine if the
teaching of a
communication tool,
ISBAR (Identify, Situation,
Background, Assessment,
Recommendation), a
modification of SBAR
(Situation, Background,
Assessment,
Recommendation),
improved the content
and clarity of a
telephone referral in an
immersive simulated
clinical scenario
conducted in real time.
To compare the
effectiveness of a
simulated hospital
experience and a
traditional hospital
experience on the
critical thinking skills of
second year nursing
students enrolled in the
Maternal-Child course of
a pre-licensure
associate-degree
program.
Medical
students
Medical
students
Nursing
students
Manikin
Manikin
Manikin
Quantitative
A brief education session
improved telephone
communication in a
simulated environment
above baseline for over
six months, achieved
functional retention of
the acronym over a
seven to eight month
period and resulted in
self-reports of transfer of
the learning into
practice.
Australia
Strong
Quantitative
The teaching of a
structured method of
communication
improved the
communication during
telephone referral in a
simulated clinical setting.
This research has
implications for how
healthcare professionals
are taught to
communicate with each
other.
Australia
Strong
Quantitative
Implications for nursing
education and the
nursing profession
include expanded use of
simulations in nursing
curriculum and a
cautious increase in the
number of hours that
can be used as a
substitution for clinical
experience.
USA
Weak
175
Mathews, J. L., et al. (2011). "Rolereversal exercise with Deaf Strong
Hospital to teach communication
competency and cultural
awareness." American Journal of
Pharmaceutical Education 75(3):
53.
To implement a rolereversal exercise to
increase first-year
pharmacy students'
awareness of
communication barriers
in the health care
setting, especially for
deaf and hard-ofhearing patients
Pharmacy
students
Role-play
Descriptive
Mavis, B., et al. (2006). "Faculty,
students, and actors as
standardized patients: expanding
opportunities for performance
assessment." Teaching & Learning
in Medicine 18(2): 130-136.
To evaluate the
expanded preclinical
formative assessments,
our medical school has
implemented additional
simulated encounters
using faculty members
and students in addition
to actors to portray SPs
(SP). This report focuses
on the implementation
of this strategy.
Medical
students
SPs
Descriptive
McCallum, J., et al. (2011).
"Exploring nursing students'
decision-making skills whilst in a
Second Life clinical simulation
laboratory." Nurse Education
Today 31(7): 699-704.
To explore nursing
students' decisionmaking skills through the
use of a 3D virtual
environment such as
Second Life.
Nursing
students
VR
Qualitative
The role-reversal exercise
was an effective method
of teaching students that
the delivery of health
care is dependent on
adequate
communication
between health care
providers and the
patient.
Students and faculty
benefited from their SP
experience. A
combination of SP types
can provide a broad
range of cost-effective
preclinical learning
experiences. Students,
faculty, and actors as
SPs each have specific
strengths and
weaknesses related to
cost, training needs,
feedback quality, and
simulation fidelity. The
goals of the encounter
should guide the choice
of SP type.
Further work is required
for students to practice
decision-making skills.
With further
development the
innovative 3D virtual
worlds such as Second
Life could provide this
experience.
USA
Weak
USA
Strong
UK
Very weak
176
McConville, S. A. and A. M. Lane
(2006). "Using on-line video clips to
enhance self-efficacy toward
dealing with difficult situations
among nursing students." Nurse
Education Today 26(3): 200-208.
McCoy, C. E., et al. (2011).
"Prospective randomized
crossover study of simulation vs.
didactics for teaching medical
students the assessment and
management of critically ill
patients." Journal of Emergency
Medicine 40(4): 448-455.
McEvoy, M., et al. (2012).
"Teaching professionalism through
virtual means." The clinical
teacher 9(1): 32-36.
McGlynn, M. C., et al. (2012).
"How we equip undergraduates
with prioritisation skills using
simulated teaching scenarios."
Medical Teacher 34(7): 526-529.
To evaluate the
effectiveness of video
clip materials that
showed examples of
nurses dealing with
potentially difficult and
delicate patient groups
for enhancing nursing
student's self-efficacy to
effectively communicate
with the abovementioned patient
groups.
To compare SIM-based
training to traditional
didactic lecture (LEC) for
teaching medical
students to assess and
manage critically ill
patients with myocardial
infarction (MI) and
anaphylaxis
To evaluate students'
perceived effectiveness
of an online interactive
virtual patient
developed to augment
a personal professional
development curriculum,
and to identify factors
that would maximise the
associated educational
benefits
To equip
undergraduates about
to become Foundation
year one doctors with
the prioritisation skills.
Nursing
students
Medical
students
Health
professional
students
Medical
students
VPs; E-learning
Manikin
VPs
Role-play
Quantitative
Using video clips that
show students effectively
coping with adverse
situations provide an
effective teaching
approach for enhancing
self-efficacy.
UK
Strong
Quantitative
SIM training is superior to
didactic lecture for
teaching fourth-year
medical students to
assess and manage
simulated critically ill MI
and anaphylaxis
patients.
USA
Strong
Qualitative
It is possible to improve
approaches to teaching
and learning
professionalism by
exploring students' views
on innovative teaching
developments designed
to augment personal
professional
development curricula.
Ireland
Weak
Descriptive
Simulated teaching is a
relatively easy yet
effective way to teach
prioritisation and other
skills. The authors believe
that their methods could
be adapted for other
teaching groups or
material.
UK
Weak
177
McGovern, M. M., et al. (2006).
"Use of standardized patients in,
undergraduate medical genetics
education." Teaching & Learning
in Medicine 18(3): 203-207.
To study the
effectiveness of a SP
program in increasing
the competence of
medical students in
assessing genetic risks
and communicating
genetic information to
patients.
Medical
students
SPs
Descriptive
McIlvried, D. E., et al. (2008). "The
use of role-play to enhance
medical student understanding of
genetic counseling." Genetics in
Medicine 10(10): 739-744.
To discuss a project that
sought to enhance
understanding of
genetic counselling.
Medical
students
Role-play
Quantitative
Meechan, R., et al. (2011). "Do
medicines OSCEs improve drug
administration ability?" British
Journal of Nursing 20(13): 817-822.
To examine the efficacy
of the early introduction
of a medicines
management 'objective
structured clinical
examination' (OSCE) into
an undergraduate adult
nursing students'
programme of
education and to
determine if the
acquisition of applied
drug/pharmacology
knowledge and drug
administration of
medicines had improved
prior to qualification.
Mehta, N., Boynton, C., Boss, L.,
Morris, H., & Tatla, T. (2013).
Multidisciplinary difficult airway
simulation training: two year
evaluation and validation of a
novel training approach at a
District General Hospital based in
the UK. [Validation Studies].
European Archives of Oto-RhinoLaryngology, 270(1), 211-217. doi:
http://dx.doi.org/10.1007/s00405-
To devise and assess a
multidisciplinary
simulated course in
training junior doctors for
possible difficult airway
scenarios.
Nursing
students
Junior doctors
OSCE
Manikin
The use of SPs in
undergraduate medical
genetics education may
be one means for
increasing the
confidence of medical
students in skills that are
related to genetic
encounters.
The project proved
overall valuable in
improving medical
student understanding of
genetic counselling and
may be applied to a
variety of medical
education settings to
improve patient care.
USA
Weak
USA
Weak
Quantitative
The authors of this study
conclude that early
introduction of clinical
examinations, namely
OSCEs with an
integrated approach to
pharmacology and
medicines management
teaching, does facilitate
and improve students
drug administration and
applied pharmacology
ability.
UK
Weak
Quantitative
Participants felt an
improvement in clinical
knowledge, teamwork,
leadership and nontechnical skills, as well as
the mutual
understanding and
respect between related
medical and nonmedical team members.
In addition, audit of
UK
Weak
178
012-2131-3
airway mortality showed
a reduction in inpatient
airway related mortality
following the course.
Meier, A. H., Boehler, M. L.,
McDowell, C. M., Schwind, C.,
Markwell, S., Roberts, N. K., &
Sanfey, H. (2012). A surgical
simulation curriculum for senior
medical students based on
TeamSTEPPS. [Research Support,
Non-U.S. Gov't]. Archives of
Surgery, 147(8), 761-766. doi:
http://dx.doi.org/10.1001/archsurg
.2012.1340
To investigate whether
the existing Team
Strategies and Tools to
Enhance Performance
and Patient Safety
(TeamSTEPPS) curriculum
can effectively teach
senior medical students
team skills.
Medical
students
Role-play;
Manikin
Quantitative
Meyer, M. N., Connors, H., Hou, Q.,
& Gajewski, B. (2011). The effect of
simulation on clinical
performance: a junior nursing
student clinical comparison study.
[Comparative Study
Multicenter Study
Research Support, Non-U.S. Gov't].
Simulation in Healthcare: The
Journal of The Society for Medical
Simulation, 6(5), 269-277. doi:
http://dx.doi.org/10.1097/SIH.0b01
3e318223a048
To evaluate the effects
of a theory-driven
paediatric simulation
curriculum on nursing
students' clinical
performance.
Nursing
students
Not stated
Quantitative
Mikkelsen, J., Reime, M. H., &
Harris, A. K. (2008). Nursing
students' learning of managing
cross-infections--scenario-based
simulation training versus study
groups. [Comparative Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't].
Nurse Education Today, 28(6), 664671. doi:
http://dx.doi.org/10.1016/j.nedt.20
To determine the most
efficient teaching
strategies for managing
cross-infections and
determining the
teachers’ role by
comparing three
different teaching
methods; scenariobased study groups with
and without teacher and
Nursing
students
Manikin
Qualitative
Self-evaluation scores
improved and the
increase was significant
for all of the TeamSTEPPS
competencies and
highest for leadership
skills. The curriculum led
to improved selfevaluation and multiplechoice scores as well as
improved team skills
during simulated
immersive patient
encounters.
Faculty rated students
with patient simulation
experience higher than
those who had not yet
attended simulation. On
item-level analysis,
therapeutic skills were
positively impacted by
simulation. Students who
had time in simulation
achieved higher scores
more quickly than those
without simulation and
maintained high
performance levels.
The findings indicated
that scenario-based
simulation training made
the students more aware
of how complex each
scenario was. Events
occurred that they had
not expected, and this
lead to a better
recollection of details.
USA
Weak
USA
Strong
Norway
Strong
179
07.11.003
simulation training.
Mittal, M. K., Morris, J. B., & Kelz, R.
R. (2011). Germ simulation: a novel
approach for raising medical
students awareness toward
asepsis. [Comparative Study
Research Support, Non-U.S. Gov't].
Simulation in Healthcare: The
Journal of The Society for Medical
Simulation, 6(2), 65-70. doi:
http://dx.doi.org/10.1097/SIH.0b01
3e318206953a
To test the hypothesis
that students would
demonstrate proficiency
comparable to surgery
residents after training
with germ simulation,
which was developed
for teaching hand
hygiene principles and
aseptic technique in
urinary catheterization
(UC).
Mollo, E. A., Reinke, C. E., Nelson,
C., Holena, D. N., Kann, B.,
Williams, N., . . . Kelz, R. R. (2012).
The simulated ward: ideal for
training clinical clerks in an era of
patient safety. Journal of Surgical
Research, 177(1), e1-6. doi:
http://dx.doi.org/10.1016/j.jss.2012.
03.050
To investigate feasibility
of and clinical clerk
opinions regarding a
novel simulated floor
management course to
teach patient care
concepts required on
the surgical wards.
Medical
students
Manikin
Quantitative
Moreno-Ger, P., Torrente, J.,
Bustamante, J., Fernandez-Galaz,
C., Fernandez-Manjon, B., &
Comas-Rengifo, M. D. (2010).
Application of a low-cost webbased simulation to improve
students' practical skills in medical
education. [Comparative Study
Research Support, Non-U.S. Gov't].
International Journal of Medical
Informatics, 79(6), 459-467. doi:
http://dx.doi.org/10.1016/j.ijmedin
f.2010.01.017
To investigate the
employment of low-cost
simulation (practical
exercises through a webbased e-learning
environment) and study
the effects of such a
simulation in terms of
impact on the laboratory
session, learning
outcomes and student
satisfaction.
Medical
students
E-learning
environment
Quantitative
Medical
students
Not stated
Quantitative
Students reported a
heightened awareness
of the importance of
hand hygiene and
aseptic precautions
during UC.
Most clinical clerks
thought that the
simulated floor
management course
improved their
understanding of
medical management
of surgical issues and
their documentation
skills.
The simulation was well
received by students in
the experimental group
(EG), who felt more
comfortable during the
laboratory session, and it
helped them to perform
the exercise better,
obtaining more
accurate results, which
indicates more effective
training. EG students
perceived the
procedure as easier to
perform, but did not
report an improvement
in the perceived
difficulty in using the
equipment. The
increased reliability
demonstrates that lowcost simulations are a
USA
Weak
USA
Weak
Spain
Strong
180
good complement to
the laboratory sessions.
Morgan, P. J., Cleave-Hogg, D.,
Desousa, S., & Lam-McCulloch, J.
(2006). Applying theory to
practice in undergraduate
education using high fidelity
simulation. [Evaluation Studies].
Medical Teacher, 28(1), e10-15.
To determine if
experiential education
using high-fidelity
simulation improves
undergraduate
performance scores on
simulation-based and
written examinations.
Medical
students
Manikin
Quantitative
Morrison, A. M., & Catanzaro, A.
M. (2010). High-fidelity simulation
and emergency preparedness.
[Evaluation Studies
Research Support, Non-U.S. Gov't].
Public Health Nursing, 27(2), 164173. doi:
http://dx.doi.org/10.1111/j.15251446.2010.00838.x
To describe a public
health emergency
simulation exercise with
undergraduate senior
nursing students enrolled
in a public health clinical
course.
Nursing
students
Not stated
Mixed methods
There was a statistically
significant improvement
in performance on the
pharmacology written
test. Simulation team
performance also
statistically improved
and a good correlation
between checklist and
global rating scores were
demonstrated in all but
one scenario. Student
evaluation of the
experience was
extremely positive. Highfidelity simulation can be
used to allow students to
apply theoretical
knowledge to practice in
a safe and realistic
environment.
The students'
quantitative evaluation
of the experience
indicated that 90.36%
thought the purpose of
the experience was
clear, 91.5% thought the
importance of delivering
safe care during a public
health emergency was
stressed, and 79.5%
thought the presimulation briefing and
post-simulation
debriefing helped them
understand and
participate in the drill.
Qualitatively, the
students' reflections of
the exercise indicated
that although they
initially felt overwhelmed
Canada
Strong
USA
Weak
181
and anxious, they
realised the importance
of participating in
emergency
preparedness and
recognised their ability to
apply nursing skills
learned in previous
courses.
Mortsiefer, A., Rotthoff, T.,
Schmelzer, R., Immecke, J.,
Ortmanns, B., in der Schmitten,
J., . . . Karger, A. (2012).
Implementation of the
interdisciplinary curriculum
Teaching and Assessing
Communicative Competence in
the fourth academic year of
medical studies (CoMeD).
[Research Support, Non-U.S.
Gov't]. GMS Zeitschrift Fur
Medizinische Ausbildung, 29(1),
Doc06. doi:
http://dx.doi.org/10.3205/zma000
776
To describe the
development of the
CoMeD project
(communication in
medical education
Düsseldorf) project and
report results of its
evaluation by medical
students.
Medical
students
SPs
Quantitative
Mould, J., White, H., & Gallagher,
R. (2011). Evaluation of a critical
care simulation series for
undergraduate nursing students.
[Clinical Trial]. Contemporary
Nurse, 38(1-2), 180-190. doi:
http://dx.doi.org/10.5172/conu.20
11.38.1-2.180
To assess self-reported
confidence and
competence using
scenario-based
simulations.
Nursing
students
Manikin; SPs:
OTHER
(Moulage)
Not stated
Moule, P., Wilford, A., Sales, R., &
Lockyer, L. (2008). Student
experiences and mentor views of
the use of simulation for learning.
[Evaluation Studies]. Nurse
Education Today, 28(7), 790-797.
doi:
http://dx.doi.org/10.1016/j.nedt.20
08.03.007
Phase 1 investigated
whether simulation could
support the
development of a range
of clinical skills amongst
pre-registration adult
and children’s nursing
students. The second
phase of the study
gathered mentors’ views
and experiences of the
Nursing
students
Not stated
Mixed methods
Introducing
interdisciplinary
communication training
and a corresponding
OSCE into the 4th year
medical curriculum is
feasible. Embedding
communication
teaching in a clinical
context and involvement
of clinicians, as lecturers
seem to be important
factors for ensuring
practical relevance and
achieving high
acceptance by medical
students.
Multiple scenario
simulations are effective
in improving BN students'
confidence and
competence related to
critical care practice
and is an enjoyable
experience for students.
Both students and
mentors positively
received simulation, as it
was apparent that it
offered scope for
interdisciplinary learning
that could be
broadened to interprofessional
applications. The study
also identified that the
Germany
Very weak
Australia/WA
Very weak
UK
Strong
182
use of simulation in the
preparation of students
for practice.
Moulton, C.-a., Tabak, D.,
Kneebone, R., Nestel, D., MacRae,
H., & LeBlanc, V. R. (2009).
Teaching communication skills
using the integrated procedural
performance instrument (IPPI): a
randomized controlled trial.
[Randomized Controlled Trial
Research Support, Non-U.S. Gov't].
American Journal of Surgery,
197(1), 113-118. doi:
http://dx.doi.org/10.1016/j.amjsur
g.2008.09.006
Mounsey, A. L., Bovbjerg, V.,
White, L., & Gazewood, J. (2006).
Do students develop better
motivational interviewing skills
through role-play with
standardised patients or with
student colleagues? [Randomized
Controlled Trial
Research Support, U.S. Gov't,
P.H.S.]. Medical Education, 40(8),
775-780.
Myden, C. A., Anglin, C., Kopp, G.
D., & Hutchison, C. R. (2012).
Computer-assisted surgery
simulations and directed practice
of total knee arthroplasty:
educational benefits to the
trainee. [Research Support, NonU.S. Gov't]. Computer Aided
Surgery, 17(3), 113-127. doi:
http://dx.doi.org/10.3109/1092908
8.2012.671365
To assess the
effectiveness of using
Integrated Procedural
Performance Instrument
(IPPI) format as a
teaching tool for
communication skills.
To determine whether
using standardised
patients to teach
motivational interviewing
(in smoking cessation
counselling) to Year 3
medical students would
be more effective than
using student role-plays.
To compared the
following surgical skill
courses: a conventional
tibiofemoral total knee
arthroplasty (TKA)
station, two different
tibiofemoral computerassisted surgery (CAS)
stations, and a CAS and
conventional patellar
resection station.
use of simulation could
provide scope for
collaborative working
between education
providers and clinical
staff.
Medical
students
Medical
students
Medical
students
SPs Hybrid
SPs; Role-play
VR
Quantitative
The experimental group
performed significantly
better on the
communication scores
following feedback
compared with the
control group. No
differences in scores for
technical skills postintervention were
demonstrated.
Canada
Very strong
Quantitative
There was no significant
difference between the
control and intervention
groups in the final
analyses of the
interviews.
USA
Very strong
Mixed methods
Four themes emerged:
confidence, awareness,
deepening knowledge
and changed
perspectives. The
residents’ attitudes to
CAS changed from
negative before the
course to neutral or
positive afterwards. The
junior resident group
completed 23% of tasks
in the pre-course skills
test and 75% of tasks on
the post-test (p < 0.01),
Canada
Strong
183
compared to 45% of
tasks completed by the
senior resident group.
Naeve-Velguth, S., Christensen, S.
A., & Woods, S. (2013). Simulated
patients in audiology education:
student reports. [Comparative
Study]. Journal of the American
Academy of Audiology, 24(8),
740-746. doi:
http://dx.doi.org/10.3766/jaaa.24.
8.10
Nau, J., Halfens, R., Needham, I.,
& Dassen, T. (2010). Student nurses'
de-escalation of patient
aggression: a pretest-posttest
intervention study. [Evaluation
Studies]. International Journal of
Nursing Studies, 47(6), 699-708. doi:
http://dx.doi.org/10.1016/j.ijnurstu.
2009.11.011
Naylor, R. A., Hollett, L. A.,
Valentine, R. J., Mitchell, I. C.,
Bowling, M. W., Ma, A. M., . . .
Scott, D. J. (2009). Can medical
students achieve skills proficiency
through simulation training?
American Journal of Surgery,
198(2), 277-282. doi:
http://dx.doi.org/10.1016/j.amjsur
g.2008.11.036
To survey audiology
students who had
completed a simulated
patient counselling
experience as part of
their graduate
coursework at Central
Michigan University, to
learn about their
experiences and views
of this instructional
format.
To examine the influence
of an aggression
management training
program for nursing
students on their
performance in deescalating aggressive
patients.
To determine whether
third-year medical
students can become
proficient in open
technical skills through
simulation laboratory
training.
Audiology
students
Nursing
students
Medical
students
SPs
SPs
Task trainers
Quantitative
Students reported
positive perceptions of
simulated patient
experiences. These data
support the continued
use of simulated patients
as a method of
instruction for audiology
counselling education
for breaking difficult
news, and suggest a
potential value of using
simulated patient
interactions for training
counselling skills in other
clinical situations and
scenarios.
USA
Quantitative
The trained students
managed scenario A
significantly better than
the untrained students.
Similar results were found
for scenario B.
Germany
Strong
Quantitative
Objective scores and
trainee self-ratings
suggest that this
structured curriculum
using simulator training
allows junior medical
students to achieve
proficiency in basic
surgical skills.
USA
Strong
Very weak
184
Nesbitt, J. C., St Julien, J., Absi, T.
S., Ahmad, R. M., Grogan, E. L.,
Balaguer, J. M., . . . Putnam, J. B.
(2013). Tissue-based coronary
surgery simulation: medical
student deliberate practice can
achieve equivalency to senior
surgery residents. [Comparative
Study
Randomized Controlled Trial].
Journal of Thoracic &
Cardiovascular Surgery, 145(6),
1453-1458; discussion 1458-1459.
doi:
http://dx.doi.org/10.1016/j.jtcvs.20
13.02.048
To assess the impact of
dedicated instruction
and deliberate practice
on fourth-year medical
students’ proficiency in
performing a coronary
anastomosis using a
porcine heart model,
compared with
nonsimulator-trained
senior general surgery
residents.
Medical
students
Task trainers
Quantitative
Nestel D, Campbell D. (In press)
Transferring procedural skills from
simulation to clinical practice: A
mixed methods evaluation.
International Jounral of Clinical
Skills.
To compare approaches
to supporting students in
the development of
intravenous infusion skills
using a stepwise model.
Medical
students
Task trainers;
SPs; Hybrid
simulation
Mixed methods
Nestel, D., & Kidd, J. (2005). Peer
assisted learning in patientcentred interviewing: the impact
on student tutors. [Research
Support, Non-U.S. Gov't]. Medical
Teacher, 27(5), 439-444.
To report the evaluation
of a peer assisted
learning (PAL) project on
student tutors.
Medical
students
SPs
Mixed methods
Dedicated instruction of
fourth-year medical
students with deliberate
and distributed practice
of microvascular
techniques using a
porcine end-to-side
coronary artery
anastomosis simulation
model results in
performance
comparable to that of
senior general surgery
residents.
STEPS supported the
transfer of learning from
simulation to clinical
practice. Teaching
technical and
professional skills relevant
for procedural skills in
one program was highly
valued. The DOPS rating
form provided a link
between learning in
simulation and
performing in clinical
settings
The self-report
evaluations strongly
suggest that
participating in a PAL
project has substantial
benefits for student tutors
that included both
interviewing and
facilitation skills.
Objective measures
revealed no change in
patient-centred
interviewing skills after
participating in the
project.
USA
Strong
Australia
Strong
UK
Strong
185
Nestel, D., & Tierney, T. (2007).
Role-play for medical students
learning about communication:
guidelines for maximising benefits.
[Evaluation Studies]. BMC Medical
Education, 7, 3.
To explore students'
experiences with the aim
of producing guidelines
for maximising the
benefits of role-play
within this learning
context.
Medical
students
Role play
Mixed methods
Newby, J. P., Keast, J., & Adam,
W. R. (2010). Simulation of medical
emergencies in dental practice:
development and evaluation of
an undergraduate training
programme. Australian Dental
Journal, 55(4), 399-404. doi:
http://dx.doi.org/10.1111/j.18347819.2010.01260.x
To discuss a
comprehensive
simulation based training
program for final year
undergraduate dental
students and assessed
student attitudes
towards training.
Dentistry
students
Scenario based
simulation
Quantitative
Nicholas, L., Toren, K., Bingham, J.,
& Marquart, J. (2013). Simulation in
dermatologic surgery: a new
paradigm in training.
Dermatologic Surgery, 39(1 Pt 1),
76-81. doi:
http://dx.doi.org/10.1111/dsu.1203
2
To evaluate the
perceived efficacy of
obtaining dermatologic
procedural skills using
simulators
Junior doctors;
Dermatology
staff
Manikin;
Cadaveric
Quantitative
Students reported the
key aspects of helpful
role-play were
opportunities for
observation, rehearsal
and discussion, realistic
roles and alignment of
roles with other aspects
of the curriculum.
Unhelpful aspects were
those that evoked strong
negative emotional
responses and factors
that contributed to a
lack of realism.
Student responses
supported simulation
training, evidenced by
the following selected
questionnaire responses:
achieved greater
confidence in managing
emergencies; prefer
lecture to simulation;
simulation training is
important in
undergraduate
teaching.
Overall, 93.9% strongly
agreed that simulators
are helpful in acquiring
procedural skills. More
than three-quarters of
participants agreed that
simulators are useful in
acquiring, refining,
assessing, and learning
these skills. Many
participants further
thought that simulator
use would be beneficial
in learning anatomy and
trouble-shooting
techniques. An
overwhelming majority
of those surveyed
UK
Strong
Australia/VIC
Very weak
USA
Very weak
186
Nikendei, C., Kraus, B., Schrauth,
M., Weyrich, P., Zipfel, S., Herzog,
W., & Junger, J. (2007). Integration
of role-playing into technical skills
training: a randomized controlled
trial. [Evaluation Studies
Randomized Controlled Trial
Research Support, Non-U.S. Gov't].
Medical Teacher, 29(9), 956-960.
To investigate the effects
of role-playing with
respect to the realism of
a training situation and
students’ objective
performance.
Medical
students
Role-play
Quantitative
Nilsson, T. A., Hedman, L. R., &
Ahlqvist, J. B. (2007). A
randomized trial of simulationbased versus conventional
training of dental student skill at
interpreting spatial information in
radiographs. [Clinical Trial
Comparative Study Randomized
Controlled Trial Research Support,
Non-U.S. Gov't]. Simulation in
Healthcare: The Journal of The
Society for Medical Simulation,
2(3), 164-169. doi:
http://dx.doi.org/10.1097/SIH.0b01
To compare learning
outcome regarding
interpretative skill after
training in the simulator
vs. after conventional
training.
Dentistry
students
VR
Quantitative
believed that training on
simulators would be
helpful in learning various
dermatologic
procedures; 90.9% of
participants thought that
training using simulators
should be, at least in
part, a mandatory
component of
residency. It was felt that
this training should be
conducted at the
beginning of residency,
with additional with
sessions held throughout
training.
The physician's role was
regarded to be
significantly more
realistic when performing
role-plays. Assessment of
videotaped sessions
showed that practising
technical skills by
performing role-plays
resulted in significantly
better patient-physician
communication whereas
students’ technical
performance did not
differ between groups.
The proficiency test
results were significantly
higher after training for
the experimental group,
but not for the control
group. Univariate
variance analysis of
difference in proficiency
test score revealed a
significant interaction
effect between training
group and (Mental
Rotations Test) MRT-A
category; in the
Germany
Sweden
Very strong
Strong
187
3e31811ec254
experimental group
there was a stronger
training effect among
students with low level of
MRT-A.
Ohtake, P. J., Lazarus, M., Schillo,
R., & Rosen, M. (2013). Simulation
experience enhances physical
therapist student confidence in
managing a patient in the critical
care environment. Physical
Therapy, 93(2), 216-228. doi:
http://dx.doi.org/10.2522/ptj.2011
0463
To examine the effect of
participation in
simulation-based
management of a
patient with critical illness
in an ICU setting on
levels of confidence and
satisfaction in physical
therapist students.
Physiotherapy
students
Not stated
Quantitative
Onovo, G. N. (2014). Human
patient simulations: Evaluation of
self-efficacy and anxiety in clinical
skills performance. [Dissertation].
Dissertation Abstracts International
Section A: Humanities and Social
Sciences, 74(7-A(E)), No
Pagination Specified.
To evaluate the selfefficacy/self-confidence
and anxiety levels in
clinical skills
performance of
undergraduate nursing
students, pre use and
post use of Human
Patients Simulations
(HPS), as a teaching and
learning strategy in
maternity nursing.
Nursing
students
Manikin
Quantitative
Students' confidence in
their technical,
behavioural, and
cognitive skill
performance increased
from “somewhat
confident” to
“confident” following the
critical care simulation
experience. Student
satisfaction was highly
positive, with strong
agreement the
simulation experience
was valuable, reinforced
course content, and was
a useful educational
tool.
The findings concluded
that HPS reduced
anxiety and increased
self-efficacy/selfconfidence in clinical
skills performance and
decision-making of the
participants. In addition,
the study found that the
participants had
difficulties in tasks
performance with the
following action verbs
associated with the
cognitive domain of
Bloom's taxonomy. The
verbs were Identify,
Apply, and Analyze.
USA
Weak
USA
Weak
188
Osbourne, A. (2012). Improving
the standardized patient
experience. [Comparative Study].
Journal of the American Podiatric
Medical Association, 102(6), 477484.
To seek the views of
podiatric medical
students at KSUCPM who
have completed the SP
rotation to see how they
felt their time in the
course was used and
whether they felt that
the course was useful to
them in terms of
advancing their
podiatric medical
education.
Medical
students
SPs
Quantitative
Paige, J. T., Garbee, D. D.,
Kozmenko, V., Yu, Q., Kozmenko,
L., Yang, T., . . . Swartz, W. (2014).
Getting a head start: high-fidelity,
simulation-based operating room
team training of interprofessional
students. [Clinical Trial
Research Support, Non-U.S. Gov't].
Journal of the American College
of Surgeons, 218(1), 140-149. doi:
http://dx.doi.org/10.1016/j.jamcoll
surg.2013.09.006
To investigate the
immediate impact of
conducting
interprofessional student
OR team training using
high-fidelity simulation
(HFS) on students' teamrelated attitudes and
behaviours.
Nursing, nurse
anaesthetist
and medical
students
Manikin
Quantitative
The students answered
positively that the SP
rotation was important in
terms of improving
interviewing skills and
worthwhile for future
professional
development. The
students agreed that
there likely was
underused time in the
course and even
suggested ways in which
they would make the
course run more
efficiently.
Statistically significant
gains from mean pre- to
post-training scores
occurred on 11 of the 15
self-efficacy items.
Statistically significant
gains in mean observer
performance scores
were present on all 3
subscales of the
teamwork scale from the
first scenario to the
second. A statistically
significant difference
was found in
comparisons of mean
observer scores with
mean participant scores
for the team-based
behaviours subscale.
USA
Very weak
USA
Strong
189
Palaganas, J. C. (2013). Exploring
healthcare simulation as a
platform for interprofessional
education. [Dissertation].
Dissertation Abstracts International
Section A: Humanities and Social
Sciences, 74(5-A(E)), No
Pagination Specified.
Park, J., MacRae, H., Musselman,
L. J., Rossos, P., Hamstra, S. J.,
Wolman, S., & Reznick, R. K. (2007).
Randomized controlled trial of
virtual reality simulator training:
transfer to live patients.
[Randomized Controlled Trial
Research Support, Non-U.S. Gov't].
American Journal of Surgery,
194(2), 205-211.
Parsh, B. (2010). Characteristics of
effective simulated clinical
experience instructors: interviews
with undergraduate nursing
students. Journal of Nursing
Education, 49(10), 569-572. doi:
http://dx.doi.org/10.3928/0148483
4-20100730-04
To examine how the
most commonly used
simulation modalities
and IPE teaching
methods (lowtechnology versus hightechnology;
multiprofessional versus
collaborative teambased activities;
observational versus
active methods; SPs
versus mannequins)
affect participants' posttest scores in perceived
teamwork and
collaboration in prelicensure students while
controlling for factors
shown previously to
affect these perceptions.
To assess a computerbased colonoscopy
simulator for effective
transfer of skills to live
patients.
To examine nursing
student perceptions of
the characteristics of an
effective instructor in the
simulated clinical
experience.
Health
professional
students
Medical
students
Nursing
students
SPs; Manikin
VR
Manikin
Quantitative
Perceptions of teamwork
and collaboration did
not improve significantly
for high-technology
methods over lowtechnology methods;
however, the difference
in means between posttest surveys differed
significantly, suggesting
that there was an
intervention effect.
Enhanced mannequinbased simulation
significantly increased
students' perceptions of
teamwork and
collaboration compared
to enhanced SP based
simulation.
USA
Strong
Quantitative
Residents trained on a
colonoscopy simulator
prior to their first patientbased colonoscopy
performed significantly
better in the clinical
setting than controls,
demonstrating skill
transfer to live patients.
USA
Very strong
Qualitative
Students identified six
themes for SCE
instructors: Personality,
Teaching Ability,
Evaluation, Nursing
Competence,
Interpersonal
Relationships, and
Realism.
USA
Strong
190
Paskins, Z., & Peile, E. (2010). Final
year medical students' views on
simulation-based teaching: a
comparison with the Best
Evidence Medical Education
Systematic Review. [Comparative
Study]. Medical Teacher, 32(7),
569-577. doi:
http://dx.doi.org/10.3109/0142159
0903544710
To explore in more depth
the features of
simulation-based
teaching that
undergraduate medical
students value using the
Best Evidence Medical
Education (BEME)
Systematic Review
features that lead to
effective learning as a
framework.
Medical
students
Manikin
Qualitative
Patel, V., Aggarwal, R., Osinibi, E.,
Taylor, D., Arora, S., & Darzi, A.
(2012). Operating room
introduction for the novice.
[Randomized Controlled Trial
Research Support, Non-U.S. Gov't].
American Journal of Surgery,
203(2), 266-275. doi:
http://dx.doi.org/10.1016/j.amjsur
g.2011.03.003
To assess the
implementation of a
theatre induction
curriculum through a
didactic lecture, an
online Second Life
operating room, and a
simulated operating
suite.
Medical
students
VR; game
Quantitative
Pauly-O'Neill, S., & Prion, S. (2013).
Using integrated simulation in a
nursing program to improve
medication administration skills in
the pediatric population. Nursing
Education Perspectives, 34(3),
148-153.
To determine the overall
influence of a mixed
educational approach
on student knowledge
and self-confidence with
paediatric intravenous
medication
administration.
Nursing
students
Manikin
Quantitative
Petersson, H., Sinkvist, D., Wang,
C., & Smedby, O. (2009). Webbased interactive 3D visualization
as a tool for improved anatomy
learning. Anatomical Sciences
Education, 2(2), 61-68. doi:
http://dx.doi.org/10.1002/ase.76
To assess whether
students value a new
three-dimensional (3D)
visualization method as a
learning tool and what
value they gain from its
use in reaching their
anatomical learning
objectives.
Medical
students
VR
Not stated
Twelve key themes were
identified, namely,
feedback, integration
into curriculum, learning
style, learning
environment, realism,
teamwork,
communication skills,
confidence/increased
self-efficacy, anxiety,
performance,
perceptions of
foundation year 1 (FY1)
and SimMan® as a
resource.
The lecture, Second Life,
and simulated operating
suite groups
demonstrated significant
improvements in all
outcome measures.
After the intervention,
these 3 groups had
significantly higher
behaviour, self-report,
and knowledge scores
than the control group.
Results revealed a rise in
knowledge and student
self-reporting of
confidence of essential
medication
administration skills for
the paediatric
population.
In general, students'
attitudes towards the
EVA-program were
positive when compared
with anatomy textbooks,
but results were not the
same with dissections.
Additionally, knowledge
tests suggest a
potentially beneficial
effect on learning.
UK
Strong
UK
Very strong
USA
Very weak
Sweden
Weak
191
Phillippi, J. C., Bull, A., & Holley, S.
L. (2013). Expanding primary care
opportunities: simulation for
clinical reasoning. Journal of
Nursing Education, 52(5), 299-302.
doi:
http://dx.doi.org/10.3928/0148483
4-20130412-02
To discuss the use of
simulated clinical visits to
guide the students
through the clinical
reasoning process in a
Family Nurse Practitioner
(FNP) faculty as primary
care experts program.
Nursing
students
Low fidelity
simulation
Not stated
Pierce, V. C. (2012).
Baccalaureate nursing students'
perceptions of clinical judgment
and self-efficacy following highfidelity simulation. [Dissertation].
Dissertation Abstracts International
Section A: Humanities and Social
Sciences, 73(4-A), 1295.
To explore the
effectiveness of using
multiple high-fidelity
simulation experiences
to increase perceptions
of clinical judgment and
self-efficacy in
baccalaureate nursing
students
Nursing
students
Manikin
Quantitative
Piper, L., & Czekanski, K. (2012).
Use of a simulated administrative
decision-making exercise in an
online master's Nursing
Administration course. Journal of
Nursing Education, 51(6), 343-344.
doi:
http://dx.doi.org/10.3928/0148483
4-20120323-05
To describe a unique
role-playing exercise was
developed in a
graduate Nursing
Administration course
focusing on ethical and
informed decisionmaking.
Nursing
students
Role-play
Not stated
Low-fidelity simulation
allowed students time to
take a systematic
approach to patient
assessment, planning,
and charting. The FNP
“experts” were used to
critique student chart
notes prior to grading.
This collaborative
approach to the primary
care clinical conference
was well received by
students, faculty, and
preceptors and was
quick and inexpensive to
implement.
Data analysis revealed a
statistically significant
increase in students'
perceptions of clinical
judgment occurred
between Time 1 and
Time 3. Students'
perceptions of selfefficacy also increased
significantly from Time 1
to Time 3 and Time 2 to
Time 3. Regression
analysis revealed a slight
positive correlation
between students'
perceptions of selfefficacy and clinical
judgment.
Students demonstrated
an understanding of
acknowledging input
from others, as well as
the ability to synthesize
points on a difficult
question.
USA
Weak
USA
Weak
USA
Very weak
192
Planas, L. G., & Er, N. L. (2008). A
systems approach to scaffold
communication skills
development. American Journal
of Pharmaceutical Education,
72(2), 35.
To implement a
communication skills
development (CSD)
system and evaluate its
effectiveness in a clinical
communications course.
Medical
students
SPs
Mixed methods
Poulton, T., Conradi, E., Kavia, S.,
Round, J., & Hilton, S. (2009). The
replacement of 'paper' cases by
interactive online virtual patients
in problem-based learning.
Medical Teacher, 31(8), 752-758.
To evaluate the use of
interactive online virtual
patients (VPs) in a PBL
program in lieu of paper.
Medical
students
VPs
Mixed methods
Powell-Laney, S., Keen, C., & Hall,
K. (2012). The use of human
patient simulators to enhance
clinical decision-making of nursing
students. Education for Health,
25(1), 11-15.
To assess if HPS
technology leads to
greater clinical decisionmaking ability and
clinical performance
compared to the
teaching modality of a
paper and pencil case
study.
Nursing
students
Manikin
Quantitative
Students'
communication skills
improved as evidenced
by assessment scores.
Student and faculty
comments offered
additional evidence of
the effectiveness of SP
interviews, learning
strategies, and
assessment methods.
Both tutors and students
believed that the ability
to explore options and
consequences created
a more engaging
experience and
encouraged students to
explore their learning.
They regretted the loss of
paper and neither group
could see any value in
putting cases online
without the options.
Results indicated that
students in the simulation
groups were significantly
more likely to score
higher on the clinical
decision-making exams
and to respond clinically
by performing CPR more
quickly on the manikin
than students in the case
study groups. On the
100-point exam, the
simulation groups had a
20-point gain, while the
case study groups had a
12-point gain. Students in
the simulation groups
provided CPR to a
manikin 30 seconds
faster, on an average.
The differences were
statistically significant.
USA
Strong
UK
Weak
USA
Very strong
193
Preston, E., Ada, L., Dean, C. M.,
Stanton, R., Waddington, G., &
Canning, C. (2012). The
Physiotherapy eSkills Training
Online resource improves
performance of practical skills: a
controlled trial. [Controlled
Clinical Trial]. BMC Medical
Education, 12, 119. doi:
http://dx.doi.org/10.1186/14726920-12-119
Ray, S. M., Wylie, D. R., Shaun
Rowe, A., Heidel, E., & Franks, A. S.
(2012). Pharmacy student
knowledge retention after
completing either a simulated or
written patient case.
[Comparative Study
Randomized Controlled Trial].
American Journal of
Pharmaceutical Education, 76(5),
86. doi:
http://dx.doi.org/10.5688/ajpe765
86
Re, A. (2012). The impact of
human patient simulation on the
attainment of learning outcomes.
[Dissertation]. Dissertation
Abstracts International Section A:
Humanities and Social Sciences,
72(11-A), 4030.
To determine whether
the Physiotherapy eSkills
Training Online resource
in addition to usual
teaching improved the
performance of
practical skills in
physiotherapy students.
To determine pharmacy
students’ knowledge
retention from and
comfort level with a
patient-case simulation
compared with a written
patient case.
Interactions of students
with high fidelity
simulations were
examined to determine
if human patient
simulation produced
learning outcomes.
Physiotherapy
students
Pharmacy
students
Nursing
students;
Respiratory
therapist
students
OTHER
(Included
online videoclips of patienttherapist
simulations)
Manikin
Manikin
Quantitative
There was improvement
in performance of
practical skills in students
who had access to the
Physiotherapy eSkills
Training Online resource
in addition to usual
teaching.
Australia/NSW
Quantitative
Participation in the
simulated patient case
did not result in greater
knowledge retention or
comfort level than
participation in the
written patient case.
Students’ knowledge
improved postintervention regardless of
which teaching method
was used.
USA
Strong
Mixed methods
This study affirmed that
high fidelity simulation
led to the attainment of
learning outcomes as a
direct result of
interacting with the
human patient simulator.
Additionally, the study
statistically validated
such pedagogical
factors as student
learning and satisfaction,
student self-confidence,
experiential learning,
and debriefing are
common and
quantifiable in a human
patient simulation
classroom.
USA
Strong
Very strong
194
Reddy-Kolanu, G., & Alderson, D.
(2011). Evaluating the
effectiveness of the Voxel-Man
TempoSurg virtual reality simulator
in facilitating learning mastoid
surgery. [Comparative Study
Evaluation Studies]. Annals of the
Royal College of Surgeons of
England, 93(3), 205-208. doi:
http://dx.doi.org/10.1308/0035884
11X565987
To compare cadaveric
temporal bone (CTB)
simulation with the VoxelMan TempoSurg (VT)
virtual reality simulator in
addressing ten features
of high-fidelity medical
simulators that facilitate
learning
Medical
students
VR, cadaveric
Quantitative
Reilly, A., & Spratt, C. (2007). The
perceptions of undergraduate
student nurses of high-fidelity
simulation-based learning: a case
report from the University of
Tasmania. Nurse Education Today,
27(6), 542-550.
To: (1) investigate the
perceptions of second
year undergraduate
nurses and their
academic teachers of
their experiences of highfidelity simulation using
the Laerdal Vital Sim
Nursing Kelly and Nursing
Anne technology2 as
part of their preparation
for clinical practice, (2)
carry out curriculum
benchmarking audit
Nursing
students
Manikin
Not stated
The VT is better at
allowing repetitive
practice, ease of control
of difficulty, and
capturing clinical and
pathological variation.
The VT is as good as CTB
in curriculum integration,
allowing multiple
learning strategies,
providing a controlled
environment,
individualising learning
and defining
benchmarks. It appears
worse with regards to
face validity and
feedback.
Undergraduate nursing
students value the
opportunity to practice
nursing activities in a safe
environment prior to
clinical placement.
Students believed that
simulation is an
innovative strategy that
promotes active learning
and has great potential
for developing clinical
competence and
increasing confidence
prior to practise. The
academic staff reported
a similar belief about the
potential of high-fidelity
simulation in a casebased curriculum.
UK
Australia/TAS
Very weak
Weak
195
Reising, D. L., Carr, D. E., Shea, R.
A., & King, J. M. (2011).
Comparison of communication
outcomes in traditional versus
simulation strategies in nursing and
medical students. [Comparative
Study
Randomized Controlled Trial].
Nursing Education Perspectives,
32(5), 323-327.
To compare the
outcomes in affective
and communication
domains using a
traditional (roundtable)
model versus simulation
in nursing and medical
students.
Rethans, J.-J., Grosfeld, F. J. M.,
Aper, L., Reniers, J., Westen, J. H.,
van Wijngaarden, J. J., & van
Weel-Baumgarten, E. M. (2012). Six
formats in simulated and
standardized patients use, based
on experiences of 13
undergraduate medical curricula
in Belgium and the Netherlands.
Medical Teacher, 34(9), 710-716.
doi:
http://dx.doi.org/10.3109/0142159
X.2012.708466
To give an overview of
the formats used most in
undergraduate medical
education with SPs,
including a description
of the impact of these
formats on the different
aspects of SPs.
Reynolds, A., Ayres-de-Campos,
D., Bastos, L., van Meurs, W., &
Bernardes, J. (2008). Impact of
labor and delivery simulation
classes in undergraduate medical
learning. Medical Education
Online, 13, 14. doi:
http://dx.doi.org/10.3885/meo.200
8.Res00285
To evaluate the impact
on knowledge and
learner satisfaction of
adding a labour and
delivery simulator-based
training module versus a
self-study session to the
pre-existing theoretical
class, in the 5th year
undergraduate medical
curriculum.
Nursing and
medical
students
Medical
students
Medical
students
Not stated
SPs
Manikin
Quantitative
The simulation strategy
resulted in statistically
higher levels of stress as
identified by
participants. In addition,
nearly all participants
reported having a better
sense of the clinical role,
and with 55% of
participants stating that
the experience changed
their view of the role of
the clinical team. This
initial study indicates that
interprofessional
communication may be
enhanced using
simulation.
USA
Very weak
Descriptive
The working format with
SPs more or less
determines the whole
process of selection,
training, performance,
and logistics of SPs.
Belgium/
Netherlands
Very weak
Quantitative
Adding a simulatorbased training session for
medical students in
management of labour
and delivery to the
theoretical class led to a
higher short-term
increase in knowledge
and student satisfaction
than attending a selfstudy session. Significant
differences in knowledge
were no longer
demonstrable at 12-15
days.
Portugal
Very strong
196
Rezmer, J., Begaz, T., Treat, R., &
Tews, M. (2011). Impact of group
size on the effectiveness of a
resuscitation simulation curriculum
for medical students.
[Randomized Controlled Trial].
Teaching & Learning in Medicine,
23(3), 251-255. doi:
http://dx.doi.org/10.1080/1040133
4.2011.586920
To assess the impact of
varying group size on
medical students’
subjective experience of
simulation and on postsimulation exam
performance.
Ricciotti, H. A., Hacker, M. R., De
Flesco, L. D., Dodge, L. E., &
Huang, G. C. (2010). Randomized,
controlled trial of a normal
pregnancy virtual patient to
teach medical students
counseling skills. [Randomized
Controlled Trial
Research Support, Non-U.S. Gov't].
Journal of Reproductive
Medicine, 55(11-12), 498-502.
To determine whether
medical students using
the Normal Pregnancy
Virtual Patient program
(Harvard Medical School
and Beth Israel
Deaconess Medical
Centre, Boston,
Massachusetts) have
better knowledge and
skills in obstetric
counselling than
traditional clerkship
students.
Rickles, N. M., Tieu, P., Myers, L.,
Galal, S., & Chung, V. (2009). The
impact of a standardized patient
program on student learning of
communication skills. [Research
Support, Non-U.S. Gov't].
American Journal of
Pharmaceutical Education, 73(1),
4.
To determine the
quantitative and
qualitative value of a
lecture-laboratory
course with SPs on
student communication
skills.
Medical
students
Medical
students
Pharmacy
students
Not stated
VP
SPs
Quantitative
There were significant
increases in students’
confidence and
knowledge following
simulation. There were
no significant differences
in student perception of
the effectiveness or
realism of the simulation
or in performance on the
post-simulation exam as
a function of group size.
USA
Very strong
Quantitative
Stratified analyses
indicated the virtual
patient group provided
significantly better
preconception
counselling than
controls. Overall,
students who completed
the Virtual Patient
program scored higher
than those in traditional
clerkship alone, though
not significantly.
USA
Very strong
Mixed methods
Students had significant
and progressively higher
scores on the assessment
across baseline,
midpoint and final time
points. Students had
significantly higher final
assessment scores across
all subsections than at
baseline. Students and
SPs were favourable
towards the laboratories
and made useful
recommendations.
USA
Strong
197
Riesen, E., Morley, M.,
Clendinneng, D., Ogilvie, S., & Ann
Murray, M. (2012). Improving
interprofessional competence in
undergraduate students using a
novel blended learning
approach. [Evaluation Studies
Research Support, Non-U.S. Gov't].
Journal of Interprofessional Care,
26(4), 312-318. doi:
http://dx.doi.org/10.3109/1356182
0.2012.660286
To explore a novel way
to overcome the
challenges associated
with scheduling
interprofessional learning
experiences through the
use of simulations in a
virtual environment
(Web.Alive™) where
learners interact as
avatars.
Recent
graduates from
nursing,
paramedic,
police, and
child and youth
service
programs
VR
Not stated
Robinson, J. D., Bray, B. S., Willson,
M. N., & Weeks, D. L. (2011). Using
human patient simulation to
prepare student pharmacists to
manage medical emergencies in
an ambulatory setting.
[Randomized Controlled Trial].
American Journal of
Pharmaceutical Education, 75(1),
3.
To evaluate a simulationbased educational
experience focused on
medical emergencies in
an ambulatory
pharmacy setting.
Pharmacy
students
Manikin
Quantitative
Robison, E. S. (2013). Influence of
learning style and learning
flexibility on clinical judgment of
prelicensure nursing students
within a human patient computer
simulation environment.
[Dissertation]. Dissertation
Abstracts International: Section B:
The Sciences and Engineering,
73(12-B(E)), No Pagination
Specified.
To examine pre-licensure
nursing students' learning
styles and flexibilities
relative to clinical
judgment performance
to support development
of evidence-based
practice in implementing
simulation.
Nursing
students
VPs
Quantitative
Results from the study
indicate that from
baseline to postintervention, there was
significant improvement
in learners'
interprofessional
competence across all
outcomes, and that the
blended learning
environment provided
an acceptable way to
develop these
competencies.
Ninety-three per cent of
student groups correctly
identified the
emergency. A postactivity survey instrument
was administered, and
83% of responders
indicated this activity
was effective or very
effective.
Learning style
significantly influenced a
pre-licensure nursing
student's clinical
judgment within a
human patient
computer simulation
environment. When the
learning style variables
were entered into a
regression model, the
variance in clinical
judgment was
influenced by the way
an individual reflects and
transforms the
experience. The study's
findings did not indicate
a significant relationship
between learning
flexibility and clinical
judgment.
Canada
Weak
USA
Weak
USA
Weak
198
Rochester, S., Kelly, M., Disler, R.,
White, H., Forber, J., & Matiuk, S.
(2012). Providing simulation
experiences for large cohorts of
1st year nursing students:
evaluating quality and impact.
Collegian: Journal of the Royal
College of Nursing, Australia,
19(3), 117-124.
To describe one
approach used to
manage a simulation for
375 1st year nursing
students and to report
on the quality of the
experience from the
student's perspective. To
ensure quality was
maintained within the
large cohort, aspects of
the simulation were
assessed against the
following indicators:
alignment with
curriculum pedagogy
and goals; preparation
of students and staff;
fidelity; and debriefing.
Nursing
students
Not stated
Qualitative
Rogers, L. (2011). Developing
simulations in multi-user virtual
environments to enhance
healthcare education. British
Journal of Educational
Technology, 42(4), 608-615.
To investigate how a
simulation could be
optimised in Second Life
to encourage teamwork
and collaborative
problem solving based
on the habits,
experiences and
perceptions of nursing
students towards Second
Life as a simulation
platform.
Nursing
students
VR; game
Qualitative
Rull, G., Rosher, R. B., McCannStone, N., & Robinson, S. B. (2006).
A simulated couple aging across
the four years of medical school.
Teaching & Learning in Medicine,
18(3), 261-266.
To present a program
which was designed
around a couple that
aged from 60 to 90 years
over the 4 years of
medical school. The
woman represents the
healthy aging process,
whereas the man
represents an elder
experiencing multiple
health problems.
Medical
students
SPs
Not stated
The following themes
emerged from the data:
knowing what to expect;
assuming roles for the
simulation; authenticity
and thinking on your
feet; feeling the RN role;
and, preparation for
clinical practice.
A common theme,
which emerged from this
research, which is
discussed in this paper,
was the student's ability
to work in an artificial
social structure where
they could actively coconstruct mental models
of technical and
interpersonal skills
through experiencing
human interaction in a
computer-based
simulated environment.
Sessions were rated
good to excellent.
Comments were
positive, especially
regarding interactions
with the aging couple.
Aging Couple Across the
Curriculum allowed the
interweaving of multiple
issues that are
characteristic of many
geriatric cases. Students
Australia
Weak
Australia
Weak
USA
Very weak
199
were able to see the
complexity of issues and
the impact on other
family members.
Russo, S. G., Bollinger, M., Strack,
M., Crozier, T. A., Bauer, M., &
Heuer, J. F. (2013). Transfer of
airway skills from manikin training
to patient: success of ventilation
with facemask or LMASupreme(TM) by medical
students. Anaesthesia, 68(11),
1124-1131. doi:
http://dx.doi.org/10.1111/anae.12
367
Rutherford-Hemming, T. (2012).
Learning in simulated
environments: effect on learning
transfer and clinical skill
acquisition in nurse practitioner
students. Journal of Nursing
Education, 51(7), 403-406. doi:
http://dx.doi.org/10.3928/0148483
4-20120427-04
To study the transfer of
skills learnt on a manikin
to the clinical situation in
novice medical students
during their anaesthesia
rotation.
To examine whether a
transfer of learning (i.e.,
growth in clinical
competency) occurred
from the simulation
laboratory to the clinical
bedside and if it did
occur, how.
Medical
students
Nurse
practitioner
students
Manikin
SPs
Quantitative
Conclude that the results
obtained in manikin
studies cannot be
transferred directly to the
clinical situation and that
guidelines should take
this into account.
Germany
Strong
Mixed methods
The results showed
significant growth in
overall clinical
competency from the
simulation laboratory to
the clinical bedside. A
statistically significant
correlation was noted
between the overall
competency scores of
students in the simulation
laboratory and the
overall competency
scores in the clinical
setting. Three themes
emerged from the
students’ responses
regarding how the
simulation experience
affected their clinical
competency.
USA
Strong
200
Sabus C, Sabata D, Antonacci D.
Use of a virtual environment to
facilitate instruction of an
interprofessional home
assessment. Journal of Allied
Health. 2011;40(4):199-205.
To better understand the
utility of a web-based
virtual environment as a
teaching tool to
represent clinical
assessment and
interventions in the home
environment
Physiotherapy
students;
Occupational
therapy
students
VR
Mixed methods
Scholes J, Endacott R, Biro M, Bulle
B, Cooper S, Miles M, et al. Clinical
decision-making: midwifery
students' recognition of, and
response to, post partum
haemorrhage in the simulation
environment. BMC Pregnancy
Childbirth. 2012;12:19.
To report the findings of
a study of how midwifery
students responded to a
simulated post partum
haemorrhage (PPH).
Midwifery
students
SPs; Hybrid
Qualitative
Assignment analysis
revealed contextual and
client-centred
recommendations.
Student surveys revealed
that students found the
virtual environment
supportive of learning.
Student surveys and
reflection statements
were supportive of the
interprofessional
collaboration. Use of a
virtual environment in
instruction allows an
authentic means of
representing
interprofessional home
assessment. The virtual
environment allowed a
temporal depiction of
home environment issues
and solutions providing
the unique opportunity
for students to evaluate
home
recommendations.
The students' clinical
management of the
situation varied
considerably. Students
struggled to prioritize
their actions where more
than one response was
required to a clinical cue
and did not necessarily
use mnemonics as
heuristic devices to
guide their actions.
Driven by a response to
single cues they also
showed a reluctance to
formulate a diagnosis
based on inductive and
deductive reasoning
cycles. This meant they
did not necessarily
USA
Weak
UK
Weak
201
Schubart JR, Erdahl L, Smith JS, Jr.,
Purichia H, Kauffman GL, Kass RB.
Use of breast simulators
compared with standardized
patients in teaching the clinical
breast examination to medical
students. J Surg Educ.
2012;69(3):416-22.
To compare learning the
clinical breast
examination (CBE) on a
breast palpation
simulator with learning
on a SP with respect to
skill acquisition and
comfort level.
Schwartz A, Weiner SJ, Harris IB,
Binns-Calvey A. An educational
intervention for contextualizing
patient care and medical
students' abilities to probe for
contextual issues in simulated
patients. Jama. 2010;304(11):11917.
To evaluate an
educational intervention
designed to increase
physicians' skills in
incorporating the
patient's context in
assessment and
management of care
and to thereby decrease
the rate of contextual
errors.
Medical
students
Medical
students
SPs Hybrid
SPs
Quantitative
Quantitative
introduce new
hypothetical ideas
against which they might
refute or confirm a
diagnosis and thereby
eliminate fixation error.
The students response
demonstrated that a
number of clinical skills
require updating on a
regular basis. Heuristic
devices helped the
students to evaluate
their interventions to
illuminate what else
could be done whilst
they awaited the
emergency team. They
did not necessarily serve
to prompt the students'
or help them plan care
prospectively.
Medical students who
learned the CBE on
breast palpation
simulators performed as
well or better than those
who learned on SPs;
however, a subgroup
analysis revealed that
the benefit was limited
to students with less
clinical experience.
Medical students who
underwent an
educational intervention
were more likely to
contextualize care for
individual SPs.
USA
Strong
USA
Weak
202
Schwartz LR, Fernandez R,
Kouyoumjian SR, Jones KA,
Compton S. A randomized
comparison trial of case-based
learning versus human patient
simulation in medical student
education. Acad Emerg Med.
2007;14(2):130-7.
To evaluate the efficacy
of simulation training as
compared with casebased learning (CBL)
among fourth-year
medical students as
measured by observable
behavioural actions.
Medical
students
Manikin; OSCEs
Quantitative
Schweller M, Costa FO, Antonio
MARGM, Amaral EM, de
Carvalho-Filho MA. The impact of
simulated medical consultations
on the empathy levels of students
at one medical school. Academic
Medicine. 2014;89(4):632-7.
To examine the impact
of simulated medical
consultations using SPs
(SPs) on the empathy
levels of fourth- and sixthyear students.
Medical
students
SPs
Quantitative
Seago BL, Ketchum JM, Willett RM.
Pelvic examination skills training
with genital teaching associates
and a pelvic simulator: does
sequence matter? Simul.
2012;7(2):95-101.
To evaluate an
educational intervention
adding the use of a
pelvic examination
simulator (SIM) to the use
of genital teaching
associates (GTAs) in a
pelvic examination skills
curriculum for secondyear medical students.
Medical
students
SPs
Quantitative
Human patient
simulation (HPS) training,
utilizing computerized,
physiologically
responding mannequins
offers no advantage to
CBL as measured by
medical student
performance on a chest
pain objective structured
clinical examination
Although the study
results were obtained via
self-report-a limitationthey suggest that the
effective simulation of
medical consultations
with SPs may improve
medical students'
empathy levels.
When using simulation to
teach the pelvic
examination to novices,
SPs seem to be the
better initial training
experience, reducing
student anxiety and
improving learner
engagement with
subsequent mechanical
simulation practice of
psychomotor skills.
USA
Strong
Brazil
Weak
USA
Strong
203
Secomb J, McKenna L, Smith C.
The effectiveness of simulation
activities on the cognitive abilities
of undergraduate third-year
nursing students: a randomised
control trial. J Clin Nurs.
2012;21(23-24):3475-84.
To provide evidence on
the effectiveness of
simulation activities on
the clinical decisionmaking abilities of
undergraduate nursing
students.
Nursing
students
Computerbased
simulation
Quantitative
Seybert AL, Barton CM. Simulationbased learning to teach blood
pressure assessment to doctor of
pharmacy students. Am J Pharm
Educ. 2007;71(3):48.
To assess the effect of
simulation-based
learning on doctor of
pharmacy (PharmD)
students' ability to
perform accurate blood
pressure assessments
and to measure student
satisfaction with this
novel teaching method.
Pharmacy
students
Manikin
Quantitative
There was no significant
difference in cognitive
development following
two cycles of simulation
activities. Therefore, it is
reasonable to assume
that two simulation tasks,
either computer-based
or laboratory-based,
have no effect on an
undergraduate student's
ability to make clinical
decisions in practice.
However, there was a
significant finding for
non-English firstlanguage students,
which requires further
investigation. More
longitudinal studies that
quantify the education
effects of simulation on
the cognitive, affective
and psychomotor
attributes of health
science students and
professionals from both
English-speaking and
non-English-speaking
backgrounds are
urgently required
Pharmacy students
showed significant
improvement in clinical
skills performance and in
their knowledge of the
pharmacotherapy of
hypertension. Students
expressed high levels of
satisfaction with this type
of learning experience.
Australia
Strong
USA
Weak
204
Seybert AL, Kane-Gill SL. Elective
course in acute care using online
learning and patient simulation.
Am J Pharm Educ. 2011;75(3):54.
To enhance students'
knowledge of and
critical-thinking skills in
the management of
acutely ill patients using
online independent
learning partnered with
high-fidelity patient
simulation sessions.
Pharmacy
students
Manikin
Qualitative
Shanks D, Brydges R, den Brok W,
Nair P, Hatala R. Are two heads
better than one? Comparing
dyad and self-regulated learning
in simulation training. Medical
Education. 2013;47(12):1215-22.
To compare the relative
effectiveness and
efficiency of dyad versus
directed self-regulated
learning (DSRL) training
of simulation-based
lumbar puncture
Junior doctors
Task trainer
Quantitative
Sherman JJ, Riche DM, Stover KR.
Physical assessment experience in
a problem-based learning course.
Am J Pharm Educ. 2011;75(8):156.
To evaluate the impact
of a physical-assessment
learning experience
implemented in the
problem-based learning
(PBL) format of the third
year of a doctor of
pharmacy (PharmD)
program.
Pharmacy
students
Hybrid
Quantitative
Shinnick MA, Woo M, Evangelista
LS. Predictors of knowledge gains
using simulation in the education
of prelicensure nursing students. J
Prof Nurs. 2012;28(1):41-7.
To examine predictors of
knowledge gains using
human patient
simulation (HPS) in the
education of prelicensure nursing students
Nursing
students
Manikin
Quantitative
Shishani K, Stevens K, Dotson J,
Riebe C. Improving nursing
students' knowledge using online
education and simulation to help
smokers quit. Nurse Educ Today.
2013;33(3):210-3.
To examine an
evidence-based
smoking cessation
education program
effect on nursing
students' perceptions
and self-confidence to
help smokers quit
Nursing
students
Not stated
Quantitative
Participation in an
elective course that
combined self-directed
Web-based learning and
hands-on patient
simulation exercises
increased pharmacy
students' knowledge and
critical-thinking skills in
acute care.
The results indicate that
learning in pairs is as
effective as
independent DSRL. Dyad
training permits the more
efficient use of simulators
as two learners use the
same resources as an
individual.
Use of a simulation
stethoscope in a
physical-assessment
learning experience
increased pharmacy
students' knowledge in
performing pulmonary
and cardiovascular
assessment techniques.
The findings show that
HPS can independently
improve test scores. This
study provides evidence
that HPS; is an effective
teaching methodology
for pre-licensure nursing
students regardless of
age, learning style, or
critical thinking ability.
Integration of evidencebased didactic and
practical smoking
cessation program into
curricula improves
nursing students' clinical
skills in helping smokers to
quit.
USA
Weak
Canada
Strong
USA
Weak
USA
Strong
USA
Weak
205
smoking.
Shrader S, Kern D, Zoller J, Blue A.
Interprofessional teamwork skills as
predictors of clinical outcomes in
a simulated healthcare setting.
Journal of Allied Health.
2013;42(1):e1-6.
To examine the
relationship between IP
teamwork skills, attitudes
and clinical outcomes in
a simulated clinical
setting.
Medical
students;
Pharmacy
students;
Physician
assistant
students
Not stated
Quantitative
Shrader S, McRae L, King WMt,
Kern D. A simulated
interprofessional rounding
experience in a clinical
assessment course. Am J Pharm
Educ. 2011;75(4):61.
To implement a
simulated
interprofessional
rounding experience
using human patient
simulators as a required
activity for third-year
pharmacy students in a
clinical assessment
course.
Pharmacy
students
SPs
Quantitative
Shukla A, Kline D, Cherian A,
Lescanec A, Rochman A, Plautz
C, et al. A simulation course on
lifesaving techniques for third-year
medical students. Simul.
2007;2(1):11-5.
To evaluate a course
developed to meet
objectives previously
covered in the animal
laboratory.
Medical
students
Task trainer;
Manikin
Quantitative
Siassakos D, Draycott T, O'Brien K,
Kenyon C, Bartlett C, Fox R.
Exploratory randomized controlled
trial of hybrid obstetric simulation
training for undergraduate
students. Simul. 2010;5(4):193-8.
To assess whether
simulation is useful for
improving medical
students' skills.
Nursing
students
Hybrid
Quantitative
Interprofessional
curricular models that
produce effective
teamwork skills can
improve student
performance in clinical
environments and likely
improve teamwork
practice to positively
affect patient care
outcomes.
Incorporating a
simulated
interprofessional
rounding experience into
a required clinical
assessment course
improved student
attitudes regarding
interprofessional
teamwork and was
associated with high
student satisfaction.
This lifesaving techniques
course utilising simulation
technology successfully
covered objectives
previously taught with
animal vivisection,
increased students'
confidence levels in
performing lifesaving
procedures and was
highly accepted by the
medical students.
High-fidelity simulation
can be used to train and
evaluate learning. The
use of patient-actors
during simulation
improves students'
USA
Weak
USA
Weak
USA
Weak
UK
Strong
206
communication skills.
Siebeck M, Schwald B, Frey C,
Roding S, Stegmann K, Fischer F.
Teaching the rectal examination
with simulations: effects on
knowledge acquisition and
inhibition. Medical Education.
2011;45(10):1025-31.
To examine the effects
of low-fidelity (LFS) and
high-fidelity (HFS)
simulation on the
acquisition of the
necessary knowledge
and inhibition about
carrying out the rectal
examination. In addition,
to investigate the effects
of the different
sequencing of the two
simulations (HFS-LFS
versus LFS-HFS).
Medical
students
SPs; Manikin
Quantitative
Simmenroth-Nayda A, Weiss C,
Fischer T, Himmel W. Do
communication training programs
improve students' communication
skills?--a follow-up study. BMC Res
Notes. 2012;5:486.
To analyse whether a
communication course
measurably improves the
communicative
competence of thirdyear medical students at
a German medical
school and whether
technical or emotional
aspects of
communication
changed differently.
Medical
students
SPs
Quantitative
Simon EL, Lecat PJ, Haller NA,
Williams CJ, Martin SW, Carney JA,
et al. Improved auscultation skills
in paramedic students using a
modified stethoscope. J Emerg
Med. 2012;43(6):1091-7.
To test the effectiveness
of the Ventriloscope as a
training device in
teaching heart and lung
auscultatory findings to
paramedic students.
Paramedic
students
Hybrid
Quantitative
Teaching the rectal
examination with the
help of SPs, who
represent an HFS, can
help medical
undergraduate students
to overcome inhibition
about this examination.
Standardised patient
simulation is far more
effective than that
achieved using a
manikin, which
represents an LFS. Both
types of simulation
support the acquisition
of knowledge.
The communication
course measurably
improved
communication skills,
especially for female
students. These
improvements did not
depend predominantly
on an extension of the
interview time.
Obviously, "technical"
aspects of
communication can be
taught better than
"emotional"
communication skills.
Simulation training using
a modified stethoscope
in conjunction with SPs
allows for realistic
learning of heart and
lung sounds. This
technique of simulation
training achieved
Germany
Weak
Germany
Strong
USA
Strong
207
proficiency and better
retention of heart and
lung sounds in a safe
teaching environment.
Smithburger PL, Kane-Gill SL, Ruby
CM, Seybert AL. Comparing
effectiveness of 3 learning
strategies: simulation-based
learning, problem-based learning,
and standardized patients. Simul.
2012;7(3):141-6.
To compare
effectiveness of 3
learning strategies:
simulation-based
learning, problem-based
learning, and SPs
Pharmacy
students
SPs; Manikin
Quantitative
Smolle J, Prause G, Smolle-Juttner
F-M. Emergency treatment of
chest trauma--an e-learning
simulation model for
undergraduate medical students.
Eur J Cardiothorac Surg.
2007;32(4):644-7.
To evaluate the
effectiveness of a
computer simulation
model on thoracic
trauma management.
Medical
students
OTHER
(computer
simulation
model)
Quantitative
Sookpotarom P, Siriarchawatana
T, Jariya Y, Vejchapipat P.
Demonstration of nasogastric
intubation using video compact
disc as an adjunct to the teaching
processes. J Med Assoc Thai.
2007;90(3):468-72.
Soucy EC. The effects of highfidelity simulators on nursing
students' critical thinking and selfconfidence. Dissertation Abstracts
International Section A:
Humanities and Social Sciences.
2012;73(4-A):1296.
To quantitatively
evaluate the effect of
the video compact disc
(VCD) demonstrating
nasogastric intubation
on our medical students'
procedural skills.
To investigate the effects
of high-fidelity simulator
use on nursing students'
critical thinking skills and
feelings of selfconfidence.
Medical
students
Nursing
students
Manikin
Manikin
High-fidelity simulation is
an effective learning
strategy. When it is
compared with SPs and
mPBL strategies, students
performed better on
knowledge-based
quizzes and had higher
levels of satisfaction.
Computer simulation of
chest trauma
emergency treatment
options is a safe and
efficient learning
approach in
undergraduate medical
education, which is
highly appreciated by
the students.
USA
Strong
Austria
Weak
Quantitative
The medical students
were able to selfimprove their procedural
skills of nasogastric
intubation after viewing
the VCD.
Thailand
Strong
Quantitative
Study findings suggested
that human patient
simulators do increase
student critical thinking
abilities but not selfconfidence.
USA
Strong
208
Souder DM. Teaching
interpersonal and communication
feedback skills to standardized
patients: Assessment of a
cognitive model. Dissertation
Abstracts International: Section B:
The Sciences and Engineering.
2009;70(5-B):2804.
To examine the
effectiveness of a
training intervention for
SPs to improve their
verbal feedback to
medical students.
Medical
students
SPs
Mixed methods
Sperling JD, Clark S, Kang Y.
Teaching medical students a
clinical approach to altered
mental status: simulation
enhances traditional curriculum.
Med. 2013;18:1-8.
To measure simulation's
impact on students'
knowledge acquisition,
comfort, and perceived
competence with
regards to the altered
mental status (AMS)
patient.
Medical
students
Manikin
Quantitative
Although three of the
four assessment
instruments used
indicated the SPs
provided quality
feedback, it cannot be
determined conclusively
if the improved
feedback was the effect
of the feedback
intervention in the
revised training protocol.
Direct observations of
the independent raters
must be considered as
the SPs had less than
satisfactory scores on the
Quality of SP Feedback
form, indicating a lower
quality of feedback.
Further research with
psychometrically sound
instruments is needed to
delineate variables
contributing to the
knowledge and skills of
SPs as they learn to
provide quality verbal
feedback.
Students who
participated in a
simulation exercise
performed better on a
knowledge-based test
and reported increased
comfort and perceived
competence in their
clinical approach to
AMS. SBME shows
significant promise for
teaching clinical skills to
medical students during
pre-clinical curriculum.
USA
Weak
USA
Weak
209
Srinivasan M, Hauer KE, DerMartirosian C, Wilkes M,
Gesundheit N. Does feedback
matter? Practice-based learning
for medical students after a multiinstitutional clinical performance
examination. Medical Education.
2007;41(9):857-65.
Stasi JP. Effects of oncologist
communication style about bad
health and oncologist gender on
emotional arousal, irrational
statements, information recall,
and the physician-patient
relationship. Dissertation Abstracts
International: Section B: The
Sciences and Engineering.
2014;74(10-B(E)):No Pagination
Specified.
Steadman RH, Coates WC, Huang
YM, Matevosian R, Larmon BR,
McCullough L, et al. Simulationbased training is superior to
problem-based learning for the
acquisition of critical assessment
and management skills. Crit Care
Med. 2006;34(1):151-7.
To examine the impact
of receiving feedback
via performance
benchmarks on medical
students' self-assessment
after a clinical
performance
examination (CPX).
To assess the effects of
oncologist gender and
three communication
styles (factual, assertive,
and accusatory) on
simulated patients'
verbalisations of
negative and positive
affect, irrational
statements, information
recall, and the
perceived oncologistpatient relationship as
they were receiving a
diagnosis.
To determine whether
full-scale simulation (SIM)
is superior to interactive
problem-based learning
(PBL) for teaching
medical students acute
care assessment and
management skills.
Medical
students
SPs; OTHER
(CPX)
Quantitative
Medical
students
SPs
Qualitative
Medical
students
Manikin
Quantitative
The accuracy of student
self-assessment was poor
after a CPX, but
improved significantly
with performance
feedback (scores and
benchmarks). Videotape
review alone (without
feedback) did not
improve self-assessment
accuracy. Practicebased learning exercises
that incorporate
feedback to medical
students hold promise to
improve self-assessment
skills.
Results showed that the
expected main effects
of communication style
on verbalisations of
negative affect, positive
affect, and irrational
statements were not
found. Overall, the
findings suggest that an
accusatory
communication style
can be detrimental to
information recall and
the oncologist-patient
relationship.
For fourth-year medical
students, simulationbased learning was
superior to problembased learning for the
acquisition of critical
assessment and
management skills.
USA
Weak
USA
Strong
USA
Strong
210
Stewart F, Cleland J. The
introduction of standardized
clinical surgical teaching:
students' and tutors' perceptions
of new teaching and learning
aids. Medical Teacher.
2008;30(5):508-12.
To design, implement
and evaluate
standardised clinical
surgical teaching for 3rd
year undergraduate
medical students.
Medical
students
SPs
Quantitative
Stolz D, Langewitz W, Meyer A,
Pierer K, Tschudi P, S'ng CT, et al.
Enhanced didactic methods of
smoking cessation training for
medical students--a randomized
study. Nicotine & Tobacco
Research. 2012;14(2):224-8.
To study enhanced
didactic methods of
smoking cessation
training for medical
students.
Medical
students
Role-play
Quantitative
Streiff S, Tschan F, Hunziker S,
Buehlmann C, Semmer NK,
Hunziker P, et al. Leadership in
medical emergencies depends
on gender and personality. Simul.
2011;6(2):78-83.
To determine predictors
of leadership in a
medical emergency.
Medical
students
Not stated
Quantitative
Forced-choice student
data showed a
preference for the
subject-specific
checklists but their open
comments
acknowledged the
checklists' limitations.
Tutors viewed the
subject-specific
checklists as detrimental
to learning and the
generic checklist as not
adding value. Both tutors
and students valued SPs,
but more so by students
who had also received
the subject-specific
checklists. Students' and
tutors' views differed on
forced-choice
evaluation forms, but
were similar when open
comments were taken
into account. Reviewing
open comments is timeconsuming but there is
much value in including
them in evaluation.
Role-playing and
interaction with real
patients are equally
efficient and both more
powerful learning tools
than web-based
learning with or without a
lecture.
During the initial phase
of a medical
emergency, there is a
substantial interindividual variation in the
amount of leadership.
Leadership behaviour as
assessed by the number
of leadership statements
UK
Weak
Switzerland
Strong
Switzerland
Strong
211
is determined by gender
and personality and not
by knowledge or
experience.
Subramanian A, Timberlake M,
Mittakanti H, Lara M, Brandt ML.
Novel educational approach for
medical students: improved
retention rates using interactive
medical software compared with
traditional lecture-based
format.[Erratum appears in J Surg
Educ. 2012 May-Jun;69(3):443]. J
Surg Educ. 2012;69(2):253-6.
Takayesu, J. K., Farrell, S. E., Evans,
A. J., Sullivan, J. E., Pawlowski, J. B.,
& Gordon, J. A. (2006). How do
clinical clerkship students
experience simulator-based
teaching? A qualitative analysis.
[Evaluation Studies
Research Support, Non-U.S. Gov't].
Simulation in Healthcare: The
Journal of The Society for Medical
Simulation, 1(4), 215-219. doi:
http://dx.doi.org/10.1097/01.SIH.00
00245787.40980.89
To determine whether
the StepStone
Interactive Medical
Software (SS) learning
modality is superior to
traditional lecture format
in medical student
learning and retention.
To critically analyse the
experience of clinical
clerkship students
exposed to simulatorbased teaching, in order
to better understand
student perspectives on
its utility.
Medical
students
Medical
students
VR
Manikin
Quantitative
The SS learning modality
demonstrated a
significant improvement
in student learning
retention compared to
traditional didactic
lecture format. SS is an
effective web-based
medical education tool.
USA
Strong
Mixed methods
Six major thematic
categories emerged
from the qualitative
analysis: The
“Knowledge and
Curriculum” domain was
described by 35% of
respondents, who
commented on the
opportunity for selfassessment, recall and
memory, basic and
clinical science learning,
and motivation.
“Applied Cognition and
Critical Thought” was
highlighted by 53% of
respondents, who
commented on the
value of decisionmaking, active thought,
clinical integration, and
the uniqueness of
learning-by-doing.
“Teamwork and
Communication” and
“Procedural/Hands-On
Skills” were each
mentioned by 12% of
subjects. 80% of students,
USA
Weak
212
who commented on the
realism, interactivity,
safety, and emotionality
of the experience
offered observations on
the “Teaching/Learning
Environment”; here they
also offered feedback
on format, logistics, and
instructors. Finally,
“Suggestions for
Use/Place in
Undergraduate Medical
Education” were
provided by 22% of
subjects, who primarily
recommended more
exposure. On a simple
rating scale, 94% of
students rated the
quality of the simulator
session as “excellent,”
whereas 91% felt the
exercises should be
“mandatory.”
Tan, A., Ross, S. P., & Duerksen, K.
(2013). Death is not always a
failure: outcomes from
implementing an online virtual
patient clinical case in palliative
care for family medicine clerkship.
[Evaluation Studies]. Medical
Education Online, 18, 22711. doi:
http://dx.doi.org/10.3402/meo.v18
i0.22711
To address the need for
more formal curriculum
in EOL care, an online
virtual patient (VP)
clinical case in Palliative
Care into the 2010–2011
Year Three Family
Medicine Clerkship
rotation curriculum was
developed and
implemented.
Medical
students
VP
Mixed methods
The group knowledge
score increased
significantly from a precourse average, postcourse average. The
students’ self-assessed
comfort level increased
significantly with all
aspects of EOL
management from precourse to post-course.
Nearly, 91.1% of the
students rated the VP
realism as ‘Good to
Excellent’, 86% rated the
case as educationally
beneficial. Nearly 59.3%
of students felt
emotionally engaged
with the VP. Qualitative
feedback found that the
Canada
Strong
213
case content was very
useful and realistic, but
that the interface was
sometimes awkward to
navigate.
Ten Eyck, R. P., Tews, M., &
Ballester, J. M. (2009). Improved
medical student satisfaction and
test performance with a
simulation-based emergency
medicine curriculum: a
randomized controlled trial.
[Comparative Study
Randomized Controlled Trial].
Annals of Emergency Medicine,
54(5), 684-691. doi:
http://dx.doi.org/10.1016/j.annem
ergmed.2009.03.025
To determine the effect
of a simulation-based
curriculum on fourth-year
medical student test
performance and
satisfaction during an
emergency medicine
clerkship.
Medical
students
Not stated
Quantitative
Ten Eyck, R. P., Tews, M., Ballester,
J. M., & Hamilton, G. C. (2010).
Improved fourth-year medical
student clinical decision-making
performance as a resuscitation
team leader after a simulationbased curriculum. [Randomized
Controlled Trial]. Simulation in
Healthcare: The Journal of The
Society for Medical Simulation,
5(3), 139-145. doi:
http://dx.doi.org/10.1097/SIH.0b01
3e3181cca544
To determine the impact
of simulation-based
instruction on student
performance in the role
of emergency
department resuscitation
team leader.
Medical
students
Not stated
Quantitative
Significantly fewer
questions were missed
for material presented in
simulation format
compared with group
discussion. Those in the
experimental group
scored higher than the
control group. Students
rated simulation as more
stressful, but also more
enjoyable, more
stimulating, and closer to
the actual clinical setting
compared with group
discussion.
The mean post
intervention case
performance was
significantly better for
the students allocated to
simulation instruction
compared with the
group discussion
students for four
outcomes including a
decrease in mean time
to (1) order an
intravenous line; (2)
initiate cardiac
monitoring; (3) order
initial laboratory tests;
and (4) initiate blood
pressure monitoring.
Paired comparisons of
each student’s initial and
follow-up simulations
demonstrated significant
improvement in the
same four areas, in
USA
Very strong
USA
Very strong
214
mean time to order an
abdominal radiograph
and in obtaining an
allergy history.
Theroux, R., & Pearce, C. (2006).
Graduate students' experiences
with standardized patients as
adjuncts for teaching pelvic
examinations. [Comparative
Study
Evaluation Studies
Research Support, Non-U.S. Gov't].
Journal of the American
Academy of Nurse Practitioners,
18(9), 429-435.
To explore graduate
nurse practitioner
students’ perceptions of
their experiences when
learning to perform
pelvic examinations in
the laboratory and
performing them in
subsequent clinical
rotations with voluntary
peer examination, and
the other two groups
were taught by SPs (SPs)
Nursing
students
SPs
Mixed methods
Thompson, B. M., Teal, C. R., Scott,
S. M., Manning, S. N., Greenfield,
E., Shada, R., & Haidet, P. (2010).
Following the clues: teaching
medical students to explore
patients' contexts. [Evaluation
Studies
Research Support, N.I.H.,
Extramural
Research Support, U.S. Gov't,
P.H.S.]. Patient Education &
Counseling, 80(3), 345-350. doi:
http://dx.doi.org/10.1016/j.pec.20
10.06.035
To evaluate a program
that uses SPs to increase
medical students’
knowledge and skills in
identifying contextual
issues.
Medical
students
SPs
Mixed methods
All groups reported
feeling anxious while
learning pelvic exam
techniques and in
subsequent clinical
experiences. SPs
provided immediate
feedback to students,
decreased their feelings
of anxiety, and
increased their
confidence in
performing
examinations. Students
who were taught pelvic
examination techniques
by SPs rated their
learning experiences
more positively and
reported a better
understanding of exam
techniques than students
who learned to perform
exams by voluntary
examination of
classmates.
SP encounters, coupled
with activities designed
to trigger reflection, can
help students identify
patients’ contextual
clues. Students’
confidence in eliciting
patient clues significantly
increased after the
intervention. The results
suggest that some
contextual clues were
more difficult for students
to elicit.
USA
Weak
USA
Weak
215
Tokunaga, J., Takamura, N.,
Ogata, K., Setoguchi, N.,
Matsuoka, T., & Sato, K. (2011).
Preparation of simulation
programs regarding excess-dose
drug administration and acutephase condition changes and its
evaluation by students. [Research
Support, Non-U.S. Gov't].
Yakugaku Zasshi - Journal of the
Pharmaceutical Society of Japan,
131(4), 655-659.
Tokunaga, J., Takamura, N.,
Ogata, K., Yoshida, H., Setoguchi,
N., Matsuoka, T., . . . Sato, K.
(2010). Vital sign monitoring using
human patient simulators at
pharmacy schools in Japan.
[Evaluation Studies
Research Support, Non-U.S. Gov't].
American Journal of
Pharmaceutical Education, 74(7),
132.
Torain, L. J. (2012). Use of Human
Patient Simulators as an
alternative teaching tool for
clinical site experiences in
baccalaureate nursing programs.
[Dissertation]. Dissertation
Abstracts International Section A:
Humanities and Social Sciences,
73(3-A), 894.
To discuss a program
that promote the
acquisition of basic skills
of vital-sign checking
and physical assessment
to evaluate the patient
condition/drug efficacy
or prevent adverse
reactions to drugs.
To develop, implement,
and assess an
experience-based
education program
using human patient
simulators to instruct
pharmacy students in
monitoring vital signs to
identify drug treatment
effects and adverse
events.
To determine if the use of
the Human Patient
Simulator (HPS) in a
nursing laboratory can
be used as an effective
alternative teaching tool
for the clinical site
experience in a
baccalaureate-nursing
program.
Pharmacy
students
Pharmacy
students
Nursing
students
Emergencycare simulator
equipped with
a personal
computer
Manikin
Manikin
Quantitative
Evaluation of the student
for these program
contents increased
significantly (p<0.01).
These programs can be
downloaded via the
Internet. Experience
regarding excess-dose
drug
administration/condition
changes with an
emergency-care
simulator is useful for
checking patients' vital
signs, evaluating the
drug efficacy, and
confirming adverse
reactions to drugs.
Japan
Very weak
Quantitative
Students successfully
learned how to monitor
routes of drug
administration, vital signs,
and pathological
conditions. There was a
significant increase in
students' recognition of
the importance of vitalsign monitoring.
Japan
Very weak
Quantitative
Results of the study
indicated no significant
differences between the
two groups on pre-test
and post-test
measurements.
USA
Strong
216
Traynor, M., Gallagher, A., Martin,
L., & Smyth, S. (2010). From novice
to expert: using simulators to
enhance practical skill. British
Journal of Nursing, 19(22), 14221426.
To report (1) on the
introduction of simulation
(using a high fidelity
patient simulator) into an
undergraduate-nursing
curriculum
in Northern Ireland to
develop confidence
and proficiency without
compromising patient
safety, (2) on how the
students
perceived the impact of
this experience on their
clinical practice.
Nursing
students
Manikin
Quantitative
Tsai, M.-H., Lu, F.-H., & Frankel, R.
M. (2013). Learning to listen:
Effects of using conversational
transcripts to help medical
students improve their use of open
questions in soliciting patient
problems. Patient Education and
Counseling, 93(1), 48-55. doi:
http://dx.doi.org/10.1016/j.pec.20
13.03.022
To report effects of a
‘bottom-up’ pedagogy
using doctor–patient
conversation transcripts
to improve medical
students’ use of open
questions in soliciting
patient problems.
Medical
students
Role-play; SPs
Quantitative
Students' responses
showed that the
simulation helped them
to gain a perspective on
the role of a qualified
nurse and also
enhanced their
understanding of the
relationship between
theory and practice.
Students also reported
that they valued the
experience as a means
of highlighting gaps in
their knowledge, but it
also had given them
confidence for future
clinical practice.
Across the full encounter,
use of general and
psychosocial open
questions increased
significantly after
training. The high rates of
narrowly focused
opening questions (52%
of initial position
questions, 74% of second
position questions, and
85% of third position
questions) prior to
training were reduced to
11%, 15%, and 15%
respectively after
training. Students also
shifted from a micro
(narrow) to a macro
(broad) pattern of
questioning.
Northern
Ireland
Weak
Taiwan
Strong
217
Turner, M. K., Simon, S. R.,
Facemyer, K. C., Newhall, L. M., &
Veach, T. L. (2006). Web-based
learning versus standardized
patients for teaching clinical
diagnosis: a randomized,
controlled, crossover trial.
[Comparative Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't].
Teaching & Learning in Medicine,
18(3), 208-214.
To compare the
efficacy, student
preference, and cost of
a Web-based (WB)
program versus a SP (SP)
encounter for teaching
clinical diagnosis skills to
2nd-year medical
students.
Medical
students
SPs
Quantitative
Ulbrich, T., Hamer, D., & Lehotsky,
K. (2012). Second-year pharmacy
students' perceptions of adhering
to a complex simulated
medication regimen.
[Comparative Study]. American
Journal of Pharmaceutical
Education, 76(1), 11. doi:
http://dx.doi.org/10.5688/ajpe761
11
To conduct a simulated
medication regimen with
2nd year pharmacy
students to determine
their anticipated versus
actual difficulty in
adhering to it.
Pharmacy
students
OTHER (A
simulated
medication
regimen)
Quantitative
Urbankova, A. (2010). Impact of
computerized dental simulation
training on preclinical operative
dentistry examination scores.
[Randomized Controlled Trial
Research Support, Non-U.S. Gov't].
Journal of Dental Education,
74(4), 402-409.
To compare eight hours
of adjunctive
computerized dental
simulator (CDS) training
at two different time
points to traditional
teaching alone.
Dentistry
students
OTHER
(Computerized
dental
simulator)
Not stated
WB and SP training
produced similar scores
on both the Abdominal
Pain checklist and
Headache checklist. WB
training produced a
higher score on the
Abdominal Pain SOAP
note, but not the
Headache SOAP note.
Students rated the SP
format higher than the
WB format on all 7
preference measures.
The 69 (96%) students
who participated in the
study missed on average
16% of all simulated
medication doses and
noted that adhering to
the complex medication
regimen was more
difficult than they had
anticipated. Eighty-nine
per cent of students
agreed or strongly
agreed the project was
valuable in developing
empathy towards
patients taking complex
medication regimens.
CDS-trained students
performed significantly
better than controls on
exams 1 and 2 and were
higher but not
significantly so on exam
3. There were no
differences between
CDS groups. These results
suggest that eight hours
of CDS training
administered early in the
preclinical operative
dentistry may improve
student performance.
USA
Very strong
USA
Weak
USA
Very strong
218
van Schaik, S. M., Plant, J., Diane,
S., Tsang, L., & O'Sullivan, P. (2011).
Interprofessional team training in
pediatric resuscitation: a low-cost,
in situ simulation program that
enhances self-efficacy among
participants. [Research Support,
N.I.H., Extramural]. Clinical
Pediatrics, 50(9), 807-815. doi:
http://dx.doi.org/10.1177/0009922
811405518
To discuss an in situ,
simulation-based
interprofessional teamtraining program around
paediatric emergencies
for physicians, nurses,
respiratory therapists,
and pharmacists at their
institution and performed
an analysis of the
program’s impact on
self-efficacy in
resuscitation skills among
paediatric residents and
nurses.
Junior doctors;
Nurses
Not stated
Not stated
Velde, B. P., Lane, H., & Clay, M.
(2009). Hands on learning: the use
of simulated clients in intervention
cases. Journal of Allied Health,
38(1), E17-21.
To describe the use of
standardised clients in a
simulation learning
experiences and the
responses of
occupational therapy
students to the
instructional modality.
Occupational
therapy
students
SPs
Mixed methods
Vincent, D. S., Sherstyuk, A.,
Burgess, L., & Connolly, K. K.
(2008). Teaching mass casualty
triage skills using immersive threedimensional virtual reality.
Academic Emergency Medicine,
15(11), 1160-1165. doi:
http://dx.doi.org/10.1111/j.15532712.2008.00191.x
The authors measured
the acquisition of triage
skills by novice learners
after exposing them to
three sequential
scenarios (A, B, and C)
of five simulated patients
each in a fully immersed
three-dimensional VR
environment. The
hypothesis was that
Medical
students
VR
Quantitative
The results showed that
with a design based in
best principles of team
training and simulation
education,
interprofessional team
training is feasible and
sustainable. The program
had a beneficial effect
on self-efficacy in
resuscitation skills among
both residents and
nurses at the authors’
institution and received
widespread
acceptance.
Qualitative data was
analysed and resulted in
the following themes: "I
felt like a therapist", "I
integrated knowledge
and applied my skills with
the help of my partner",
and "The experience
could be enhanced". On
a survey, students rated
the live simulated
learning experience
higher than all other
instructional methods
presented. Included are
recommendations for
structuring activities
using simulated clients
and future research.
Triage scores and
intervention scores
improved significantly
during Scenario B (p <
0.001). Time to complete
each scenario
decreased significantly
from A (8:10 minutes) to
B (5:14 minutes; p <
0.001) and from B to C
(3:58 minutes; p < 0.001).
USA
Very weak
USA
Weak
USA
Strong
219
learners would improve
in speed, accuracy, and
self-efficacy.
Self-efficacy improved
significantly in the areas
of prioritizing treatment,
prioritizing resources,
identifying high-risk
patients, and beliefs
about learning to be an
effective first responder.
Vukanovic-Criley, J. M., Boker, J.
R., Criley, S. R., Rajagopalan, S., &
Criley, J. M. (2008). Using virtual
patients to improve cardiac
examination competency in
medical students. [Randomized
Controlled Trial
Research Support, N.I.H.,
Extramural]. Clinical Cardiology,
31(7), 334-339. doi:
http://dx.doi.org/10.1002/clc.2021
3
To evaluate whether
VPEs improve Cardiac
examination (CE) skills,
and whether any
improvements are
retained.
Medical
students
VP
Quantitative
Vyas, D., McCulloh, R., Dyer, C.,
Gregory, G., & Higbee, D. (2012).
An interprofessional course using
human patient simulation to
teach patient safety and
teamwork skills. American Journal
of Pharmaceutical Education,
76(4), 71. doi:
http://dx.doi.org/10.5688/ajpe764
71
To assess the
effectiveness of human
patient simulation to
teach patient safety,
team-building skills, and
the value of
interprofessional
collaboration to
pharmacy students.
Pharmacy
students
Manikin
Quantitative
The Intervention group
improved significantly in
overall mean scores. The
Control group did not
improve. The Intervention
group improved
inspection, auscultation,
and knowledge (all
statistically significant);
control group showed no
improvement. Fourteen
months after the study, 8
students from the
intervention group were
re-tested and mean
scores improved further
with statistical
significance; controls
showed improvement on
re-testing, but it was not
significant.
Pharmacy students’
scores on 8 of 30 items
on a post-simulation
survey of knowledge,
skills, and attitudes
improved over presimulation scores.
Students’ scores on 3 of
10 items on a team
building and
interprofessional
communications survey
also improved after
participating in the
simulation exercise. Over
USA
Very strong
USA
Strong
220
90% of students reported
that simulation increased
their understanding of
professional roles and
the importance of
interprofessional
communication.
Wagenschutz, H., Ross, P., Purkiss,
J., Yang, J., Middlemas, S., &
Lypson, M. (2011). Standardized
Patient Instructor (SPI) interactions
are a viable way to teach
medical students about health
behavior counseling. Patient
Education & Counseling, 84(2),
271-274. doi:
http://dx.doi.org/10.1016/j.pec.20
10.07.047
To explore comfort levels
of third-year medical
(M3) students through
two health behaviour
counselling (HBC)
interactions with SP
Instructors (SPIs) in
tobacco cessation (TCC)
and nutrition and
physical activity (NPA).
Medical
students
SPs
Quantitative
Walker, S. (2009). A comparison of
perceived self-efficacy and
learner satisfaction between
human patient and standardized
patient simulations. [Dissertation].
Dissertation Abstracts
International: Section B: The
Sciences and Engineering, 70(2-B),
944.
To compare perceived
self-efficacy and learner
satisfaction between 91
undergraduate nursing
students participating in
human patient simulator
(n=51) and SP (n=40)
simulations.
Nursing
students
Manikin; SPs
Quantitative
The use of SPIs is a viable
approach to exposing
medical students and
future doctors to health
behaviour counselling,
and increasing comfort
level with such skills. The
SPI experience ensures
that HBC opportunities
are available and
contain meaningful
feedback on
performance.
The human patient
simulator students were
statistically more selfefficacious than the SP
students. There was no
statistically significant
difference between the
two groups when
measuring learner
satisfaction.
USA
Very weak
USA
Weak
221
Walsh, S. A. (2011). The effects of
pattern recognition based
simulation scenarios on symptom
recognition of myocardial
infarction, critical thinking, clinical
decision-making, and clinical
judgment in nursing students.
[Dissertation]. Dissertation
Abstracts International: Section B:
The Sciences and Engineering,
72(5-B), 2709.
To test an educational
intervention using
theories of pattern
recognition to develop
CT in MI and improve
nursing students’ clinical
decision-making and
clinical judgment using
high fidelity patient
simulation.
Nursing
students
Manikin
Mixed methods
Students who were given
prototypes for MI using
simulation significantly
improved critical thinking
as measured by pattern
recognition in MI
compared with the nonsimulation control group.
Qualitative findings
showed that students
receiving the
experimental simulation
with a non-MI scenario
and feedback-based
debriefing had greatest
gains in clinical
reasoning which
included development
of clinical decisionmaking using analytic
hypothetico-deductive
and Bayesian reasoning
processes and learned
avoidance of heuristics.
Students receiving the
experimental simulation
learned to identify salient
symptom cues, analysed
data more complexly,
and reflected on their
simulation experience in
a way which students
reported improved
learning. Students who
were given MI only
simulation scenarios
developed deleterious
heuristics and showed
fewer gains in clinical
reasoning, though both
simulation groups
demonstrated greater
critical thinking ability
than the non-simulation
control group.
USA
Very strong
222
Wamsley, M., Staves, J., Kroon, L.,
Topp, K., Hossaini, M., Newlin,
B., . . . O'Brien, B. (2012). The
impact of an interprofessional
standardized patient exercise on
attitudes toward working in
interprofessional teams.
[Comparative Study
Research Support, Non-U.S. Gov't].
Journal of Interprofessional Care,
26(1), 28-35. doi:
http://dx.doi.org/10.3109/1356182
0.2011.628425
Wanggren, K., Fianu Jonassen, A.,
Andersson, S., Pettersson, G., &
Gemzell-Danielsson, K. (2010).
Teaching pelvic examination
technique using professional
patients: a controlled study
evaluating students' skills.
[Comparative Study
Controlled Clinical Trial
Research Support, Non-U.S. Gov't].
Acta Obstetricia et Gynecologica
Scandinavica, 89(10), 1298-1303.
doi:
http://dx.doi.org/10.3109/0001634
9.2010.501855
Wanggren, K., Pettersson, G.,
Csemiczky, G., & GemzellDanielsson, K. (2005). Teaching
medical students gynaecological
examination using professional
patients-evaluation of students'
skills and feelings. [Evaluation
Studies
Research Support, Non-U.S. Gov't].
Medical Teacher, 27(2), 130-135.
To describe the
interprofessional SP
exercise (ISPE) and
evaluates its impact on
students' attitudes
toward working in
interprofessional teams.
To compare the skills in
pelvic examination
technique between
students who have had
training with professional
patients and a control
group of students trained
using clinical patients.
To evaluate the
outcome, attitudes and
feelings towards the use
of professional patients
and to gain knowledge
on how to further
develop the method.
Interprofessional students
Medical
students
Medical
students
SPs
SPs
SPs
Mixed methods
Students' attitudes
toward team-based
care improved
significantly on the team
value and team
efficiency subscales of
the ATHCT. There were
significant differences in
attitudes toward teambased care by
profession. Faculty and
student satisfaction with
the ISPE was high.
USA
Mixed methods
Students who had
training with professional
patients were more
skilled in performing a
pelvic examination and
better prepared to
examine their own
patients than students
trained using clinical
patients.
Sweden
Very strong
Quantitative
In conclusion students,
teachers and
professional patients
found this training
program with
professional patients to
be of great value. It was
felt that the teaching
session reduced stress
and anxiety; the students
were relieved, calmer
and more secure after
the training.
Sweden
Strong
Weak
223
Watson, K., Wright, A., Morris, N.,
McMeeken, J., Rivett, D.,
Blackstock, F., . . . Jull, G. (2012).
Can simulation replace part of
clinical time? Two parallel
randomised controlled trials.
[Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't].
Medical Education, 46(7), 657-667.
doi:
http://dx.doi.org/10.1111/j.13652923.2012.04295.x
To investigate if
simulation can replace
part of clinical time
Physiotherapy
students
SPs; Role-play;
Task trainers;
Manikin
Quantitative
Welk, A., Maggio, M. P., Simon, J.
F., Scarbecz, M., Harrison, J. A.,
Wicks, R. A., & Gilpatrick, R. O.
(2008). Computer-assisted
learning and simulation lab with
40 DentSim units. [Research
Support, Non-U.S. Gov't].
International Journal of
Computerized Dentistry, 11(1), 1740.
To explore efficient ways
to use and to manage a
computer-assisted
dental simulation lab
with 40 DentSim units
Dentistry
students
OTHER
(Computerassisted dental
simulation lab)
Quantitative
Students’ achievement
of clinical competencies
was no worse in the SLE
groups than in the
Traditional groups in
either RCT. These RCTs
provide evidence that
clinical education in an
SLE can in part (25%)
replace clinical time with
real patients without
compromising students’
attainment of the
professional
competencies required
to practise.
The indirect knowledge
retention rate /
incidental learning rate
of the preparation
exercises in the sense of
computer-assisted
problem-oriented
learning regarding
anatomy, preparation
procedures, and cavity
design was promising.
The wide- ranging
number of prepared
teeth needed to acquire
the necessary skills shows
the varied individual
learning curves of the
students. The
acceptance of, and
response to, additional
elective training time in
the computer-assisted
simulation lab were very
high. Integrating the
DentSim technology into
the existing curriculum is
a way to improve dental
education, but it is also a
challenge for both
teachers and the
students. It requires a
Australia
USA
Very strong
Weak
224
Westberg, S. M., Adams, J.,
Thiede, K., Stratton, T. P., &
Bumgardner, M. A. (2006). An
interprofessional activity using
standardized patients. American
Journal of Pharmaceutical
Education, 70(2), 34.
To describe the
development and
implementation of an
interprofessional activity
using SPs.
Westberg, S. M., Bumgardner, M.
A., Brown, M. C., & Frueh, J. (2010).
Impact of an elective diabetes
course on student pharmacists'
skills and attitudes. American
Journal of Pharmaceutical
Education, 74(3), 49.
To assess the impact of
an elective diabetes
course on student
pharmacists' skills and
attitudes about diabetes
management.
Williams, B., Brown, T., & Archer, F.
(2009). Can DVD simulations
provide an effective alternative
for paramedic clinical placement
education? [Evaluation Studies
Research Support, Non-U.S. Gov't].
Emergency Medicine Journal,
26(5), 377-381. doi:
http://dx.doi.org/10.1136/emj.200
8.060723
To evaluate the usability
of DVD simulations, the
impact on student
learning satisfaction and
the potential for using
DVD simulations to
reduce the clinical
placement burden on
the current healthcare
system.
Pharmacy
students;
Medical
students;
Nursing
students.
SPs
Pharmacy
students
OTHER (1-week
simulation of
living as a
diabetic
patient)
Paramedic
students
OTHER (DVD
simulation)
Not stated
shift in both curriculum
and instructional goals
that have to be
revaluated and
optimized continuously.
Despite multiple
challenges, an
interprofessional activity
involving multiple health
professionals from
multiple institutions can
be successfully
implemented. Feedback
from pharmacy students
indicated that this
activity increased
students' awareness and
ability to work as
members of the health
professional team.
USA
Very weak
Mixed methods
Students' confidence in
performing and
teaching diabetes selfmanagement skills
significantly improved.
USA
Weak
Mixed methods
Overall, paramedic
students positively
perceived the DVD
simulations with relation
to learning satisfaction
and information
processing quality. The
simulations maintained
students’ attention and
concentration and
provided clinical
authenticity and
relevance to practice. A
number of themes
emerged from the focus
group data including the
impact on employment,
greater appreciation of
healthcare teamwork
Australia
Weak
225
and notion of
interdisciplinary
teamwork, the fact that
DVD simulations have
the capacity to replace
some clinical placement
rotations and should be
integrated into standard
curriculum, and that
varying amounts of
learning wastage occur
during clinical
placements.
Williams, B., French, J., & Brown, T.
(2009). Can interprofessional
education DVD simulations
provide an alternative method for
clinical placements in nursing?
[Evaluation Studies
Research Support, Non-U.S. Gov't].
Nurse Education Today, 29(6), 666670. doi:
http://dx.doi.org/10.1016/j.nedt.20
09.02.008
To evaluate the usability
of DVD simulations, the
impact on student
learning, clinical
placement orientation,
and the potential for
using DVD simulations to
reduce the clinical
placement burden on
the health care system
with nursing students.
Nursing
students
OTHER (DVD
simulation)
Mixed methods
Overall, nursing students
perceived the DVD
simulations positively in
relation to learning
attention, learning
potential, clinical
relevance to practice
and information
processing quality. The
following themes
emerged from the focus
groups: provided
familiarisation for clinical
placements, learning
wastage occurs in
varying amounts,
simulations could
replace some clinical
placement rotations,
supportive of
multidisciplinary
approach and
integration, and
simulations should have
pedagogical integration
into weekly clinical
cases.
Australia
Weak
226
Wilson, M., Shepherd, I., Kelly, C.,
& Pitzner, J. (2005). Assessment of
a low-fidelity human patient
simulator for the acquisition of
nursing skills. [Comparative Study
Evaluation Studies]. Nurse
Education Today, 25(1), 56-67.
To assess the userfriendliness of a lowfidelity human patient
simulator as a precursor
to developing and
evaluating nurses' health
assessment knowledge
and skills.
Nurses
Manikin
Mixed methods
Wiskin, C., Roberts, L., & Roalfe, A.
(2011). The impact of discussing a
sexual history in role-play
simulation teaching on pre-clinical
student attitudes towards people
who submit for STI testing.
[Randomized Controlled Trial].
Medical Teacher, 33(6), e324-332.
doi:
http://dx.doi.org/10.3109/0142159
X.2011.575902
To identify whether
facilitated simulations
featuring a sexual history
scenario affected
change in students’
attitudes towards people
who need STI testing.
Medical
students
SPs
Quantitative
Nurses reported that
most of the components
and functions
(appearance,
movement, procedures
and sounds) of Nursing
Anne Complete were
realistic, better than
existing training
products, and suitable
for teaching purposes.
Additional comments
included suggestions for
improvement. Overall,
the results indicated that
this manikin is a very
useful training product
for nursing education.
There were no significant
differences in attitude,
either in negative or
positive direction,
observed between
control and intervention
groups. Ethnicity was a
significant variable, with
white-British students selfreporting more positive
attitudes. Twenty five per
cent students admitted
personal STI exposure.
Again response varied
significantly between
ethnic groups (the whiteBritish group reporting 4×
the exposure). Females
reported more positive
attitudes than males,
most marked in relation
to ‘willingness to date’
someone who admitted
to STI testing.
Australia
Very weak
UK
Very strong
227
Wood, R. Y., & Toronto, C. E.
(2012). Measuring critical thinking
dispositions of novice nursing
students using human patient
simulators. [Randomized
Controlled Trial]. Journal of Nursing
Education, 51(6), 349-352. doi:
http://dx.doi.org/10.3928/0148483
4-20120427-05
To assess the influence of
human patient simulator
(HPS) practice on critical
thinking dispositions in a
sample of novice
baccalaureate nursing
students.
Nursing
students
Manikin
Quantitative
Wotton, K., Davis, J., Button, D., &
Kelton, M. (2010). Third-year
undergraduate nursing students'
perceptions of high-fidelity
simulation. [Evaluation Studies].
Journal of Nursing Education,
49(11), 632-639. doi:
http://dx.doi.org/10.3928/0148483
4-20100831-01
To examine third-year
students’ perceptions
about the
implementation of highfidelity simulation into an
existing clinical course.
Nursing
students
Manikin
Not stated
No between-group
differences were found
on overall or subscale
Critical Thinking
Disposition Inventory
(CCTDI) mean scores.
Within-group differences
for the HPS practice
group were significant
for overall scores and the
truth seeking and
judiciousness or maturity
of judgment subscales.
This preliminary data
analysis suggests
disposition gains for
individual students
practicing critical
assessment skills using
HPS.
Students perceived
high-fidelity simulation as
enjoyable, with an
appropriate degree of
challenge yet possessing
congruency with
concepts studied in the
course. Students’
transient feelings of
confusion were
interpreted as a natural
component of the
problem solving process
as they analysed,
clustered, and
interpreted cues to
respond to rapid
changes in the simulated
patient’s clinical
condition. Debriefing
was viewed as an
important component
and assisted in clarifying
students’ knowledge
and rationale for
practice.
USA
Australia
Very strong
Weak
228
Wunschel, M., Leichtle, U., Wulker,
N., & Kluba, T. (2010). Using a webbased orthopaedic clinic in the
curricular teaching of a German
university hospital: analysis of
learning effect, student usage
and reception. [Research
Support, Non-U.S. Gov't].
International Journal of Medical
Informatics, 79(10), 716-721. doi:
http://dx.doi.org/10.1016/j.ijmedin
f.2010.07.007
To describe the usage of
a web-based virtual
outpatient clinic in the
teaching curriculum of
undergraduate medical
students, its effect on
learning success, and
student reception.
Medical
students
Virtual world
Quantitative
Yardley, S., Irvine, A. W., & Lefroy,
J. (2013). Minding the gap
between communication skills
simulation and authentic
experience. Medical Education,
47(5), 495-510. doi:
http://dx.doi.org/10.1111/medu.1
2146
To address two
questions: (1) How do
new undergraduate
medical students
understand
contemporaneous
interactions with
simulated and authentic
patients?; and (2) How
and why do student
perceptions of
differences between
simulated and authentic
patient interactions
shape their learning?
Medical
students
SPs
Mixed methods
Regarding learning
success, it was found
that the examination
results were significantly
better after using the
system. Eighty per cent
of the students enjoyed
dealing with the virtual
patients emphasizing the
completeness of patient
cases, the artistic
graphic design and the
expert comments
available, as well as the
good applicability to
real cases. Eighty-seven
per cent of the students
graded the virtual
orthopaedic clinic as
appropriate to teach
orthopaedic content.
It was identified that
students generate
knowledge and
meaning from their
simulated and authentic
experiences relative to
each other and that the
resultant learning differs
in quality according to
meaning created by
comparing and
contrasting
contemporaneous
experiences. Three
themes were identified
that clarify how and why
the contrasting of
differences is an
important process for
learning outcomes.
These are preparedness,
responsibility for safety,
and perceptions of a
gap between theory
and practice.
Germany
Strong
UK
Strong
229
Yuasa, M., Bell, C. L., Inaba, M.,
Tamura, B. K., Ahsan, S., Saunders,
V., & Masaki, K. (2013). "You're
being paged!" outcomes of a
nursing home on-call role-playing
and longitudinal curriculum.
[Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't,
P.H.S.]. Journal of the American
Geriatrics Society, 61(11), 19761982. doi:
http://dx.doi.org/10.1111/jgs.1251
5
To describe and
evaluate the
effectiveness of a novel
structured role-playing
didactic session followed
by an on-call nursing
home (NH) longitudinal
clinical experience.
Junior doctors
and faculty;
Nursing
students; Other
learners
Role-play
Quantitative
Zavertnik, J. E., Huff, T. A., & Munro,
C. L. (2010). Innovative approach
to teaching communication skills
to nursing students. [Controlled
Clinical Trial
Research Support, Non-U.S. Gov't].
Journal of Nursing Education,
49(2), 65-71. doi:
http://dx.doi.org/10.3928/0148483
4-20090918-06
To assess the
effectiveness of a
learner-centred
simulation intervention
designed to improve the
communication skills of
pre-professional
sophomore nursing
students.
Nursing
students
SPs
Quantitative
Significant improvements
were found in overall
mean attitudes and skills
scores. For all learners,
the greatest
improvements were seen
in “comfort in managing
residents at the NH,”
“managing feeding or
gastrostomy tube
dislodgement,”
“identifying different
availability of
medications, laboratory
studies, and procedures
in NH,” and “describing
steps to send NH
residents to the
emergency
department.” Geriatric
medicine fellows'
attitudes and skills
improved significantly
after the longitudinal
clinical experience. The
faculty survey
demonstrated improved
documentation,
communication, and
fellows' management of
on-call problems after
curriculum
implementation.
The intervention group
performed better than
the control group in all
four tested domains
related to
communication skills,
and the difference was
statistically significant in
the domain of gathering
information.
USA
Weak
USA
Very strong
230
Zendejas, B., Cook, D. A., & Farley,
D. R. (2010). Teaching first or
teaching last: does the timing
matter in simulation-based
surgical scenarios? [Comparative
Study
Research Support, N.I.H.,
Extramural]. Journal of Surgical
Education, 67(6), 432-438. doi:
http://dx.doi.org/10.1016/j.jsurg.20
10.05.001
To determine how
varying the timing of
instruction, either before
(teaching first) or after
(teaching last) the
simulation, affects
knowledge outcomes of
surgical trainees.
Medical
students; Junior
doctors
Simulationbased
scenarios
Quantitative
The change in scores
from pre-test to post-test
varied with statistical
significance between
the 2 groups. The mean
post-test score was 8.24
(standard error [SE], 0.29)
for the teaching-last
group and 6.68 (SE, 0.27)
for the teaching-first
group (mean difference,
1.56; 95% confidence
interval, 0.79–2.33). Both
teaching-last and
teaching-first group
participants
preferentially rated
debriefings and
scenarios, respectively,
as the better learning
experience. Participants
who received instruction
after simulated scenarios
achieved higher mean
knowledge scores than
those who received
instruction before
simulated scenarios.
USA
Strong
231
Table 3: Number of papers by respondent group
Respondent group
Audiology students
Dentistry students
Junior doctors
Medical students
Midwifery
Nursing students
Occupational therapy students
Paramedic students
Pharmacy students
Physiotherapy
Combination (e.g. Medical and nursing students etc.)
Number of papers
1
15
10
218
3
119
2
3
36
5
27
232
Table 4: Number of papers by simulation modality
Simulation modalities
Cadaveric
Games
Manikin
Simulated patients (SPs)
Virtual patients (VPs)
Virtual reality (VR)
Role-play
Task trainers
Hybrid
OSCE
Computer-based simulation
Others (e.g. 1-week simulation of living as a diabetic
patient)
Multiple (e.g. Manikins and SPs; Manikins and VR;
Manikins, SPs and Task trainers etc)
Not stated
Number of papers
1
1
92
92
24
19
21
21
3
16
6
21
72
39
233
Table 5: Number of papers by study design
Study design
Descriptive
Mixed methods
Qualitative
Quantitative
Not stated
Number of papers
34
66
45
277
17
234
Table 6: Number of papers by quality rating
Study design
Very strong
Strong
Weak
Very weak
Not applicable
Number of papers
30
167
167
72
3
235