A Systematic Review of the Evidence for Using Simulation to Replace Clinical Experience for Paramedic Students

This is the authors' abstract. We don't add key points for this paper.

Background In health professions education there is a shortage of clinical training opportunities and an increasing demand for workers, creating a need for alternative methods to clinical placements. One alternative method to replace clinical experience is simulation-based education. Currently, the efficacy of simulation as a clinical replacement in paramedicine is unknown. To understand the current state of evidence for substituting clinical experience with simulation in paramedic education, provide implications for SBE implementation, and direct further research in this area a systematic review, following the PRISMA checklist guide, was conducted. Methods Five databases were searched. Primary source studies of all designs investigating replacing clinical experience in paramedicine were included, with eight articles assessed for eligibility screening. Three studies were selected for final inclusion, quality assessment and critical appraisal. Results Inter-rater reliability was good for the quality assessment and quality appraisal ratings were moderate to strong, though the articles were of low levels of evidence. None of the studies directly addressed whether simulation-based education can be used as a clinical replacement, though both learners and program directors found value in simulation and felt a combination of simulation and clinical time was best. Communication skills and high-acuity low-frequency situations were identified as most appropriate for simulation substitution. Discussion The findings of the systematic review indicate a willingness to engage in simulation to replace some clinical experience and certain skill areas that could be suitable for simulation, but no practical recommendations can be made due to the low level of study design based on the levels of evidence and lack of evidence for direct clinical substitution. Simulation as a replacement for clinical experience has support in other health professions, but further research is needed in paramedicine to investigate its efficacy and to inform future educational practice.