Roberts F1, Kay C1,2
1Robert Gordon University, School of Health Sciences, Aberdeen, United Kingdom, 2Joanna Briggs Institute, The Scottish Centre for Evidence-based Multi-Professional Practice, Aberdeen, United Kingdom
Background: Improved skill development in university can reduce anxiety in practice, improving performance of skills and overall learning on clinical placement for health professions students. Yet the clinical environment appears most effective for learning. With pressures on clinical placements it is critical to ensure students are optimally equipped to gain the best learning possible from these experiences. Consequently there has been increased interest in the use of high-fidelity simulation (HFS) where students can test knowledge and skills in an increasingly self-directed way. No previous reviews on the effectiveness of HFS on skill development in physiotherapy students were identified.
Purpose: To evaluate the effectiveness of high fidelity simulation versus low fidelity simulation on practical/clinical skills development in pre-registration physiotherapy students.
Methods: Inclusion criteria: Experimental and quasi-experimental studies comparing HFS (simulated person, manikin, virtual simulation, video case-studies) to low fidelity simulation (peer role-play, paper-based case-studies) in pre-registration physiotherapy education were included. Primary outcomes were objective measures of skills performance; secondary outcomes were students' perceptions of the impact of simulation on learning measured using quantitative outcomes.
Methods: A three-step search strategy was employed:
1) Initial searching of CINAHL and Medline and analysis of text words.
2) Medline, CINAHL, Eric, AMED, EThOS and Google Scholar searched in November 2017.
3) Hand search of reference lists of studies included at critical appraisal stage.
Studies published in English from 1978 onwards were included. Title/abstract screening, critical appraisal, and data extraction were conducted by two independent reviewers; conflicts were resolved by discussion.
Results: Heterogeneity of data prevented meta-analysis, consequently results were presented in narrative form. Three randomized controlled trials and three quasi-experimental studies (310 participants) were included and were conducted in the USA and Australia. They evaluated standardized patients, near-peers, computerized mannequins, and virtual simulation in pre-registration BSc (Honours), MSc, and Doctoral physiotherapy students. One RCT was considered high quality, the remainder were moderate. Main findings: Motor Skill Performance: Increased number of safety fails with HFS (simulation 13.5% safety fails, simulation +video feedback 15.4% safety fails, control 8.1% safety fails). Assessment of Physiotherapy Practice: No significant improvement in scores (Sim 60.9(9.1), control 58.7 (8.4) p=0.35). Clinical reasoning: Only one of two studies showed a statistically significant difference with HFS (p=0.001) which became non-significant once students were on placement (p=0.328). Perception of communication skills: No significant difference (Simulation 9 (+/- 1.27), control 8.75(+/-1.2) p=0.482). General perceptions: Students significantly more positive about HFS for increasing awareness of; safety issues (p=0.002), patient's emotional status (p=0.002), handling skills (p 0.0001) and their ability to provide instructions to patients (p 0.0001).
Conclusion(s): Currently there is no high quality evidence that HFS improves motor skill performance in pre-registration physiotherapy students. There is a small amount of moderate quality evidence it may improve students' perception of their self-efficacy and communication skills. However, a lack of studies and variation in outcome measures used meant meta-analysis was not possible.
Implications: At present no recommendations can be made regarding the use of HFS to improve skill performance in this population. Further research using valid and reliable outcome measures is required.
Keywords: Education, High Fidelity Simulation, Systematic Review
Funding acknowledgements: No funding was received for this work.
Purpose: To evaluate the effectiveness of high fidelity simulation versus low fidelity simulation on practical/clinical skills development in pre-registration physiotherapy students.
Methods: Inclusion criteria: Experimental and quasi-experimental studies comparing HFS (simulated person, manikin, virtual simulation, video case-studies) to low fidelity simulation (peer role-play, paper-based case-studies) in pre-registration physiotherapy education were included. Primary outcomes were objective measures of skills performance; secondary outcomes were students' perceptions of the impact of simulation on learning measured using quantitative outcomes.
Methods: A three-step search strategy was employed:
1) Initial searching of CINAHL and Medline and analysis of text words.
2) Medline, CINAHL, Eric, AMED, EThOS and Google Scholar searched in November 2017.
3) Hand search of reference lists of studies included at critical appraisal stage.
Studies published in English from 1978 onwards were included. Title/abstract screening, critical appraisal, and data extraction were conducted by two independent reviewers; conflicts were resolved by discussion.
Results: Heterogeneity of data prevented meta-analysis, consequently results were presented in narrative form. Three randomized controlled trials and three quasi-experimental studies (310 participants) were included and were conducted in the USA and Australia. They evaluated standardized patients, near-peers, computerized mannequins, and virtual simulation in pre-registration BSc (Honours), MSc, and Doctoral physiotherapy students. One RCT was considered high quality, the remainder were moderate. Main findings: Motor Skill Performance: Increased number of safety fails with HFS (simulation 13.5% safety fails, simulation +video feedback 15.4% safety fails, control 8.1% safety fails). Assessment of Physiotherapy Practice: No significant improvement in scores (Sim 60.9(9.1), control 58.7 (8.4) p=0.35). Clinical reasoning: Only one of two studies showed a statistically significant difference with HFS (p=0.001) which became non-significant once students were on placement (p=0.328). Perception of communication skills: No significant difference (Simulation 9 (+/- 1.27), control 8.75(+/-1.2) p=0.482). General perceptions: Students significantly more positive about HFS for increasing awareness of; safety issues (p=0.002), patient's emotional status (p=0.002), handling skills (p 0.0001) and their ability to provide instructions to patients (p 0.0001).
Conclusion(s): Currently there is no high quality evidence that HFS improves motor skill performance in pre-registration physiotherapy students. There is a small amount of moderate quality evidence it may improve students' perception of their self-efficacy and communication skills. However, a lack of studies and variation in outcome measures used meant meta-analysis was not possible.
Implications: At present no recommendations can be made regarding the use of HFS to improve skill performance in this population. Further research using valid and reliable outcome measures is required.
Keywords: Education, High Fidelity Simulation, Systematic Review
Funding acknowledgements: No funding was received for this work.
Topic: Education; Education: methods of teaching & learning
Ethics approval required: No
Institution: Robert Gordon University
Ethics committee: School of Health Sciences Research Review Group
Reason not required: Systematic Review so not necessary
All authors, affiliations and abstracts have been published as submitted.
