Introduction:

Table-top simulation is an innovative low fidelity simulation tool which has become trendy over the last few years. Despite its popularity the effectiveness of table-top exercises has not yet been examined in the literature. This narrative review aimed to examine if table-top simulation is an effective educational tool.

Introduction:

Sensory overload in children with autism spectrum disorder (ASD) poses considerable challenges within hospital environments, often resulting in heightened anxiety and behavioural disturbances [1]. Despite the increasing recognition of these needs, there remains a significant gap in research concerning the use of simulation-based education as a preparatory tool for healthcare professionals [2]. This review examines the impact of simulation training on paediatric staff managing sensory distress and aggression in children with ASD. In addition, the review will examine outcomes related to knowledge retention and practical skill development, while identifying barriers to the implementation of such training in clinical settings.

Supporting Documents – Figure 1-A60

Introduction:

Autism is characterised by lifelong differences in communication, behaviour, and social interaction [1]. Despite growing recognition of autistic individuals in healthcare professions [2], little is known about supporting autistic learners in simulation-based healthcare education (SBHE). This scoping review aimed to identify existing research on autistic learners in SBHE, map the current evidence base, and identify gaps to inform future research and educational practice.

Introduction:

Simulated patients (SPs) are widely used in healthcare professions education (HPE) to enhance experiential learning, support assessment, and provide realistic, safe environments for developing clinical and communication skills [1,2]. Despite the acknowledged value of SPs in simulation-based education, there is limited consensus on what constitutes effective SP training [3]. The absence of standardised curricula raises concerns about consistency, educational outcomes, and quality assurance. This scoping review sought to explore: What does current literature reveal about the content, methods, and gaps in SP training within HPE?

Supporting Documents – Figure 1-A18

Introduction:

Simulation-based education (SBE) has become a cornerstone of healthcare training, providing hands-on learning experiences that develop technical proficiency while also promoting critical thinking and clinical judgement [1-3]. These cognitive skills are essential for delivering safe and effective patient care. This scoping review explores recent innovations in SBE and examines their impact on the development of critical thinking and decision-making among undergraduate and postgraduate healthcare learners.

Extended reality (XR) is being increasingly used to support the delivery of healthcare education and training, offering affordable, accessible, replicable and flexible learning at scale without risk [1, 2]. XR is an overarching term for virtual reality (VR), augmented reality (AR) and mixed reality (MR) [1, 2]. A key strategic objective of the All Wales Simulation-Based Education and Training Strategy is to create the vision for how extended reality should be embedded in healthcare education and training ensuring equitable access for the workforce in Wales [3]. A literature review was undertaken to inform this and address the following questions:

● What are the application areas of XR in healthcare education and training?

● What is the effectiveness of XR upon learner/educational outcomes compared to other education and training modalities?

● What are learners’/facilitators’ perceptions of XR?

● Is XR cost-effective?

Methods:

A literature search was conducted of six databases (CINAHL, Medline, Cochrane, Scopus, ERIC, Embase) from 2020 onwards. Inclusion criteria- any empirical research, XR (VR, AR, MR), medical/nursing/health/healthcare and education/training.

Results:

A total of n=2,963 papers were identified after duplicates were removed. Following eligibility screening a decision was made to limit to systematic reviews (SRs) (Figure 1-A128). Fifty SRs met the inclusion criteria; VR (n=29), AR (n=10), VR & AR (n=4) and all three types of XR (n=7). Forty-four SRs featured doctors and healthcare students; medical (n=32) nursing (n=12), paramedic (n=2) and dental (n=2), physiotherapist (n=1) and speech therapy (n=1). The most common application area was surgery (n=19), followed by nurse education (n=8), minimally invasive surgery (n=7) ophthalmology (n=5), anatomy (n=5) Eleven SRs included a meta-analysis. XR was widely accepted by participants, but some differences were noted depending on type. Non-significant improvements in knowledge, technical skills and task performance were reported, with increased operative and surgical procedural duration. Participants reported increased learner satisfaction, higher levels of self-efficacy and reduced anxiety levels, as well as barriers and adverse effects with VR and AR. Repeated use of immersive technology was shown to help improve confidence and engagement levels. No cost effectiveness or patient outcomes were reported.

Figure 1-A128.

PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers and other sources*Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers).**If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools.From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/

Discussion:

XR is equivocal to traditional methods of learning and can complement existing education and training approaches. Further research is needed into the cost effectiveness of XR and the transfer of learning in clinical practice and impact on patient outcomes. Greater understanding of how to support learning through XR and mitigate barriers is required.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable

References

1. NHSX, Health Education England Technology Enhanced Learning Team, UKRI Audience of the Future Challenge, NIHR Mental Health Medtech Cooperative (MindTech) and Rescape. The Growing Value of XR in Healthcare Report. 2020. Available from: https://www.xrhealthuk.org/the-growing-value-of-xr-in-healthcare. [Accessed 22 April 2024].

2. Topol E. Topol review: Preparing the healthcare workforce to deliver the digital future Health Education England The Topol Review — NHS Health Education England. 2019. Available from: hee.nhs.uk. [Accessed 22 April 2024].

3. Health Education and Improvement Wales (HEIW). All Wales Simulation-Based Education and Training Strategy for the Healthcare Workforce The vision for the next five years: 2022 – 2027. 2022. Available from: heiw.nhs.wales/files/all-wales-simulation-strategy-mg-draft-6pdf/. [Accessed 22 April 24].

Communication skills are integral amongst healthcare students and professionals. With growing numbers of students and need for undergraduate and post- graduate training, it is often difficult to further enhance communication skills training through usual methods such as clinical placements or standardised patients [1]. With a digital shift in healthcare, especially catalysed within healthcare education during the Coronavirus-19 pandemic [2], there could be potential use for the application of Virtual Standardised Patients (VSPs) to enhance such training, providing an emotionally intelligent, and conversational interface [3]. This systematic review aims to evaluate the efficacy of using Virtual Standardised Patients for communication skills training within healthcare professionals and students compared to other educational activity.

Methods:

This systematic review combined searches from 5 bibliographic databases (MEDLINE OVID, EMBASE OVID, ERIC EBSCO, AMED EBSCO, and CINAHL EBSCO) and search of reference lists to scope RCTs that met the study’s pre-determined eligibility criteria. Upon retrieval of studies, data collection and critical analysis of risk of bias and methodological quality took place. A narrative synthesis was then conducted exploring findings based on the Kirkpatrick’s Four-Level Training Evaluation Model.

Results:

Upon search retrieval: MEDLINE OVID= 1248, EMBASE OVID=2410, ERIC EBSCO= 27, AMED EBSCO= 16, and CINAHL EBSCO= 127, six studies successfully met the eligibility criteria and were included in the result synthesis, with a total of 816 participants. Studies showed an overall greater effect in favour of VSPs in comparison to other educational activity, as well as maintenance of this difference, however, showed inconsistency in findings for user experience.

Discussion:

Although not to replace current training, VSP, as an interactive, conversational tool, can provide scope to enhance communication skill training. However, further research is necessary to assess effects of more long-term training and clinical outcomes.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. NHS Choices. Available from: https://www.england.nhs.uk/publication/nhs-long-term-workforce-plan/. [Accessed 27 February 2024].

2. Ashokka B, Ong SY, Tay KH, Loh NH, Gee CF, Samarasekera DD. Coordinated responses of academic medical centres to pandemics: sustaining medical education during COVID-19. Medical Teacher. 2020;42(7):762–771.

3. Gratch J, Rickel J, André E, Cassell J, Petajan E, Badler N. Creating interactive virtual humans: Some assembly required. IEEE Intelligent Systems. 2002;17(4):54–63.

Acknowledgments:

I would like to extend my sincere gratitude to my dissertation supervisor, Marie McGee, for her invaluable expertise, guidance and support throughout the Systematic Review.

Whilst the use of simulation-based education (SBE), in nursing education, allows nurse educators to replicate what happens in real-life clinical practice, and enables students to experience experiential learning, most research has focused on students’ skill and knowledge acquisition and self-reported confidence, with limited exploration of transfer of learning from SBE to clinical practice. Research on learning transfer suggests that it is not automatic and can be difficult to stimulate. Although SBE provides the opportunity to recreate realistic patient scenarios whereby students can learn and develop their knowledge and skills in a safe environment, it is not a real-life experience. Whether knowledge and skills gained from SBE can be transferred into nursing practice is a growing area of interest in simulation research. This scoping review aimed to identify and map primary research on transfer of learning transfer from SBE to clinical practice, in pre-registration nursing students.

Research question: What is known from existing empirical evidence about the transfer of learning from simulation-based education (SBE) to clinical practice, in pre-registration nursing students?

Methods:

This scoping review followed the Joanna Briggs Institute, Methodology for JBI Scoping Reviews guidance. The review followed a results-based convergent synthesis design: qualitative, quantitative, and mixed method studies were identified in a single search, analysed separately, and integrated throughout synthesis and presentation. PRISMA and Extension for Scoping Reviews: RISMA-ScR and Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidance were followed. CINAHL Cumulative Index, Medline, British Nursing Index and Google Scholar were searched for eligible studies published between January 2010 and September 2023.

Results:

Thirty-three studies, spanning 17 qualitative studies, 12 quantitative studies and 4 mixed method studies were included. Quantitative evidence highlights the potential benefits afforded to students in terms of developing confidence, competence, knowledge, and skills in the clinical setting. However, qualitative evidence suggests that multiple factors can affect the student’s learning experience, which could consequently limit the transfer of taught knowledge and skills from SBE to clinical practice.

Discussion:

Although there is a consensus that SBE promotes learning transfer, much of the evidence is based on students’ perceptions of their abilities to utilise learning from SBE in the clinical setting. Few studies have explored the processes involved in learning transfer between the two learning environments. Further research is needed to explore the processes by which learning transfer occur¹, including the impact of SBE on student’s clinical performance and patient safety and patient outcomes [1].

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. Hussein M, Harvey G, Bell N. the influence of nursing simulation on patient outcomes and patient safety: a scoping review. Clinical Simulation in Nursing. 2022;70:37–46.

Whilst predominantly informed by research from international education systems, Simulation-Based Learning (SBL) is becoming increasingly present within the curriculum of UK Pre-registration Physiotherapy degree programmes [1]. However, due to variability in reporting of study methodology little is known about ‘How, Why and When?’ SBL is being used within these programmes [2]. This scoping review aimed to identify trends around ‘How, Why and When?’ SBL is being used, in an effort to clarify current practice and provide a UK focused perspective to the current evidence base.

Methods:

Considered the most appropriate research method for addressing the aims of the study, a scoping review was undertaken. The databases AMED, British Education Index, CINAHL Complete, ERIC, Medline, Pro-Quest Nursing & Allied Health, and Sports Medicine & Education Index were searched using a combination of words and synonyms representing the review Population (Physiotherapy Students), Concept (Simulation-Based Learning) and Context (Pre-registration Education). All peer-reviewed primary research studies undertaken from 2013-2023, published in English and concerning UK-based Physiotherapy educational practice were included.

Results:

Of the 475 studies identified from the databases, only 10 met the criteria for review on screening. Of these, only 5 were available as full text and so eligible for full review, Figure 1-A84. These studies were published between 2016 and 2023, with a predominantly qualitative study design. ‘How?’ SBL was used varied in modality, fidelity and structure, with limited detail provided, especially in relation to pre-and debrief activities. ‘Why?’ SBL was used was mostly in pursuit of a combination of clinical knowledge and technical/ non-technical skills. ‘When?’ SBL was used ranged across the academic levels (First to Final year); only one study provided data on programme of study i.e. BSc (Hons). Three studies did however provide contextual background information in relation to previous educational experiences, to suggest where participants were in their academic journey.

Figure 1-A84.

Discussion:

The limited number of studies that met the review criteria, variability in reporting of study methodology (‘How’ & ‘When’), and the variety of research aims (‘Why’) prevents a clear consensus being achieved as to the current use of SBL in UK Pre-registration Physiotherapy degree programmes at this time. Whilst recognising weaknesses in the sensitivity of this review’s search strategy [3], the outcome suggests that a more active research agenda within UK Physiotherapy education, one that promotes the publication of studies examining the role of SBL in pre-registration programmes, is currently needed.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. Heneghan NR, Radones M, Herbland A. Simulation in pre‐registration physiotherapy education: a scoping review. HSK Research Conference. University of Hertfordshire. 2022.

2. Roberts F, Cooper K. Effectiveness of high fidelity simulation versus low fidelity simulation on practical/clinical skill development in pre-registration physiotherapy students: a systematic review. JBI Evidence Synthesis. 2019;17(6):1229–1255.

3. Peters MD, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, McInerney P, Godfrey CM, Khalil H. Updated methodological guidance for the conduct of scoping reviews. JBI Evidence Synthesis. 2020;18(10):2119–2126.

Simulated practice learning is simulation-based education (SBE) that must adhere to the Nursing and Midwifery Council (NMC) Standards for Pre-Registration Nursing programmes including the Standards for Student Supervision and Assessment [1]. The use of SBE aids the development of clinical knowledge, skills and practice in students and increases the possibility of applying the acquired knowledge and skills into clinical practice. Unlike clinical practice, where the needs of the patient are the main priorities, simulation exercises are centred upon the needs of the student and can be tailored to meet required learning outcomes. This systematic review evaluates the effectiveness of using SBE to teach clinical practice-based patient care skills to nursing students compared to clinical practice-based and/or patient-based teaching on the same topic.

Methods:

Included were comparative studies published between January 2000 and January 2024 where outcomes were externally verified exams, proficiencies or competencies for both groups. Searches were conducted in 10 databases (platforms): MEDLINE (OVID), Embase (OVID), Maternity and Childcare (OVID), CINAHL (EBSCO), PsycINFO (EBSCO), Central (Cochrane Library), Scopus, Science Citation Index (Web of Science), ERIC (EBSCO), and Assia (ProQuest). Citation checking, data extraction and quality assessment were in duplicate, and Revman (5.4) used for meta-analysis, using standardised mean differences (SMD).

Results:

Included were 42 studies: 19 RCTs, 2 randomised crossover trials, 4 cohort and 17 case control studies. Student numbers varied from 12 to 847. Twenty-eight studies compared SBE to clinical teaching, eleven compared SBE plus clinical teaching to clinical teaching only and three compared more versus less SBE in the course. Twenty-one studies (n=2,329 participants) of SBE vs clinical teaching were meta-analysed (SMD=0.96 (95%CI=0.63-1.30)) and all eleven studies (n=918 participants) comparing SBE plus clinical teaching to clinical teaching only (SMD=0.96 (95%CI=0.55-1.37)).

Discussion:

Meta-analysis results show that SBE is as good or better than clinical teaching only to teach clinical practice-based patient care skills to nursing students. Replacement of hospital placements with SBE is viable but is resource-intensive and requires strategic planning. Future research could assess the cost effectiveness of SBE to teach undergraduate nursing students.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. Nursing and Midwifery Council (NMC). Part 2: Standards for student supervision and assessment. 2018. Available from: https://www.nmc.org.uk/globalassets/sitedocuments/standards/2023-pre-reg-standards/new-vi/printer-friendly/standards-for-student-supervision-and-assessment-print-friendly.pdf.

Acknowledgments:

Project commissioned and funded by NHS England (NHSE) and Council of Deans of Health (CoDH).

Currently, 1.7 million CYP are living with chronic illness in the UK [1]. The growing pressures on the National Health Service (NHS) call for a rethink in the planning and delivery of healthcare to foster inclusivity and empowerment of both healthcare professionals (HPs) and primary caregivers (PCGs). Empowering PCGs to initiate lifesaving interventions in emergencies in the community could lessen the burden on the NHS primary care, ensure optimum outcomes, and facilitate Patient and Family-Centred Care (PFCC) for these children and young people (CYP).

Simulation-based education (SBE) as a modality for medical education has immense benefits but the evidence is skewed towards HP [2, 3]. This position paper explores the potential role of simulation in enhancing the education of PCGs for CYP with chronic illnesses by highlighting its benefits, challenges, and future implications. It proposes that PCGs being adult learners like HPs could experience similar benefits from SBE if learning activities are appropriate.

Methods:

This paper evaluates the benefits and drawbacks of using SBE for PCGs education under three educational outcomes: Knowledge Acquisition for early detection of clinical deterioration; Technical Skills Acquisition for confidence to initiate home management; and Non-Technical Skills Acquisition for management in the community.

Based on these outcomes, a literature review was conducted across three online databases (PubMed, University of Edinburgh Library [DiscoverED], and Google scholar). Relevant articles were explored under these outcomes and conclusive opinions were drawn. Anticipated challenges to this intervention were highlighted and recommendations for implementation were proffered.

Results:

In the context of CYP, 6 studies demonstrated increment in knowledge acquisition for PCGs following SBE whilst 1 study showed no difference in this regard.

For Technical Skills Acquisition and Confidence, 5 studies showed positive impact and no study was found of contrary opinion. Unfortunately, no study was found that explored Non-Technical Skills Acquisition in this context. Proposed challenges for SBE implementation in PCGs education included funding, fidelity logistics, and psychological safety concerns.

Discussion:

Despite the paucity of evidence in this regard, available evidence showed that the experiential learning opportunities provided by SBE can equip PCGs with the knowledge, skills, and confidence needed to deliver high-quality care in diverse community settings. Additional benefits of SBE in this context include reduction of parental anxiety management, interprofessional collaborations, and peer-to-peer learning.

Successful implementation of this intervention requires cross-organizational partnerships and a robust funding scheme. This Investment in PCG education would decrease healthcare system pressures, drive PFCC, and improve outcomes for these CYP.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. NICE [Internet]. Managing long-term conditions in the community, NICE. 2024. Available from: https://www.nice.org.uk/about/what-we-do/into-practice/measuring-the-use-of-nice-guidance/impact-of-our-guidance/niceimpact-children-and-young-peoples-healthcare/ch2-managing-long-term-conditions-in-children#:~:text=There%20are%201.7%20million%20children,pressure%20on%20emergency%20hospital%20services. [Accessed 20 April 2024].

2. Sharma R. et al. Modalities and essentials of simulation facility for facilitation of clinical skills to medical and nursing students: Need for the present era. Journal of Surgical Specialties and Rural Practice. 2022;3(1):1.

3. Barghi-Shirazi F, Moslehi S, Masoumi G. Benefits of simulation-based education in hospital emergency departments: A systematic review. Journal of Education and Health Promotion. 2022;11(1):40.