Effectiveness of simulation on health profession students' knowledge, skills, confidence and satisfaction

BACKGROUND: Despite the recent wave of interest being shown in high-fidelity simulators, they do not represent a new concept in healthcare education. Simulators have been a part of clinical education since the 1950s. The growth of patient simulation as a core educational tool has been driven by a number of factors. Declining inpatient populations, concerns for patient safety and advances in learning theory are forcing healthcare educators to look for alternatives to the traditional clinical encounter for skill acquisition for students. OBJECTIVE: The aim of this review was to identify the best available evidence on the effectiveness of using simulated learning experiences in pre-licensure health profession education. INCLUSION CRITERIA: Types of studies: This review considered any experimental or quasi-experimental studies that addressed the effectiveness of using simulated learning experiences in pre-licensure health profession practice. In the absence of randomised controlled trials, other research designs were considered for inclusion, such as, but not limited to: non-randomised controlled trials and before-and-after studies. TYPES OF PARTICIPANTS: This review included participants who were pre-licensure practitioners in nursing, medicine, and rehabilitation therapy. Types of intervention(s)/phenomena of interest: Studies that evaluated the use of human physical anatomical models with or without computer support, including whole-body or part-body simulators were included. TYPES OF OUTCOME MEASURES: Student outcomes included knowledge acquisition, skill performance, learner satisfaction, critical thinking, self-confidence and role identity. SEARCH STRATEGY: Using a defined search and retrieval method, the following databases were accessed for the period 1995-2006: Medline, CINAHL, Embase, PsycINFO, HealthSTAR, Cochrane Database of Systematic Reviews and ERIC. METHODOLOGICAL QUALITY: Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the standardised critical appraisal instruments for evidence of effectiveness, developed by the Joanna Briggs Institute. Disagreements were dealt with by consultations with a third reviewer. DATA COLLECTION: Information was extracted from each paper independently by two reviewers using the standardised data extraction tool from the Joanna Briggs Institute. Disagreements were dealt with by consultation with a third reviewer. DATA SYNTHESIS: Due to the type of designs and quality of available studies, it was not possible to pool quantitative research study results in statistical meta-analysis. As statistical pooling was not possible, the findings are presented in descriptive narrative form. RESULTS: Twenty-three studies were selected for inclusion in this review including partial task trainers and high-fidelity human patient simulators. The results indicate that there is high learner satisfaction with using simulators to learn clinical skills. The studies demonstrated that human patient simulators which are used for 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. CONCLUSION: At best, simulation can be used as an adjunct for clinical practice, not a replacement for everyday practice. Students enjoyed t he 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.