Simulation-Based Learning Experiences in Dietetics Programs: A Systematic Review

An exploration of Irish nutrition educators' experiences of competency-based assessment in nutrition science education

BACKGROUND

Competency-based assessment (CBA) supports the development and attainment of skills required for the workforce. Little is known about educators' experience in developing or implementing CBA in nutrition science education or their opinions on how well it captures a student's preparedness for the workforce. The objective of this study was to explore educators' experience of CBA in nutrition education in Ireland.

METHOD

Grounded in interpretivism, in-depth, semi-structured, audio-recorded interviews were conducted with 13 educators from five of the ten undergraduate honours degree nutrition programmes across Ireland. Interviews explored experiences of CBA and perception of students training to prepare for the workforce. A reflexive thematic analysis approach was implemented whereby the data were transcribed, inductively coded, and themes identified.

RESULTS

A clear divide was evident between participants who were confident in their understanding of CBA and those who were unsure or had no knowledge of the term. Those with a clear understanding were more involved in programme development and evaluation. Three themes were identified: 'Assessment process' including intended learning outcomes, assessment design, and grading systems, 'Student-centred approach to assessment' focusing on work-based assessment and preparation for the workforce, and 'Upskilling educators' to equip educators with the skills and knowledge for professional development and to foster student success.

CONCLUSION

The importance of CBA as a student-centred approach, supporting them to meet standards expected to practice as a nutrition professional, was the key experience of educators. Training in CBA and inclusion of more authentic assessment may better prepare students for the workforce.

An Investigation into Student Dietitians' Professional Development through Video-Mediated Communication Training on Patient Counselling

The aim of the study is to describe a student dietitian's professional development process in a video-mediated communication skills training cycle designed for undergraduate nutrition and dietetics education and including activities such as simulated and real patient counseling, feedback, and reflection. The design of the training cycle is inspired by (reflective) interventionist Conversation Analysis (CA) through researcher and trainer collaboration, and the data comes from the screen-recordings of video-mediated meetings. CA is used to analyze the video-mediated interactions on a moment-by-basis and trace the student dietitian's interactional change over time. CA examination of the data showed that the trainer identified listenership in simulated sessions as an improvable practice (i.e. due to repetitive overlaps and cutoffs) and used it as the basis for the intervention. In the post-intervention period, the student dietitian observably improved her listenership both in simulated and real patient counseling sessions. The video-mediated, interventionist, reflective, and data-led cycle played a role in the development of the interactional and professional practice of the student dietitian in ways transferrable to real patient counseling. The training cycle with evidence-based lectures, data-led interventions, and simulated/real patient counseling can be integrated to dietetics education curricula both for clinical communication training and preparing for future teleconsultation practices.

Perception of faculty in the community health sciences colleges towards simulation-based education in clinical nutrition undergraduate practical courses

BACKGROUND

Simulation now is widely used for training and education in different fields including healthcare education. Medicine and healthcare students can be trained in a secure, efficient, and engaging setting by Simulation-based Education (SBE). Therefore, this study aimed to assess the perception of faculty members in the community health departments towards SBE to be used in practical subjects for clinical nutrition undergraduate courses.

METHOD

This cross-sectional survey was conducted among community health sciences faculty members. The perception was assessed using a self-administered questionnaire that included three sections.

RESULTS

This questionnaire was completed by 125 faculty members, of whom 36 (28.8%) were male and 89 (71.2%) were female. Overall, faculty members had positive perceptions, with a mean score of 3.86 ± 0.74, but a high level of anxiety toward SBE, with a mean score of 3.42 ± 0.75. There was a statistically significant difference between the responses of the faculty members based on the training they received in simulation (P = 0.001).

CONCLUSION

The study results indicate that community health sciences faculty members' perception of SBE in Saudi Arabia is generally positive. However, the results show high levels of anxiety among faculty members toward SBE.

Teaching and assessment of communication skills in dietetics: a scoping review

BACKGROUND

Communication is a core element of dietetic practice, and although communication skills are a prominent feature of dietetic curricula, research suggests a need for more consistent approaches. The evidence on how communication skills are taught and assessed in dietetics has not been synthesised leaving uncertainty about best practice. This scoping review aimed to examine and map the research literature relating to the teaching and assessment of communication skills in dietetics.

METHODS

The review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. Five electronic databases, two theses databases and eight conference proceedings were systematically searched for research on how communication skills are taught and assessed in dietetics. The search had no geographical or time limits. Studies were independently screened by two authors, summarised thematically using the Kirkpatrick Model and narratively synthesised.

RESULTS

The 45 included studies were organised thematically into three categories: (i) the inclusion of communication skills education in dietetics, suggesting that dietitians have variable experiences; (ii) approaches to teaching communication skills in dietetics, characterised predominantly by a move away from didactic approaches in favour of experiential opportunities for learning such as simulation; and (iii) assessment of communication skills in dietetics, including the use of both dietetic-specific and generic tools.

CONCLUSIONS

The included studies demonstrate that although a variety of teaching strategies are used in the development of communication skills in dietetics, there is potential for more robust evaluation and more diverse approaches to support dietetic educators to prepare the dietetic workforce.

The impact of moulage on learners' experience in simulation-based education and training: systematic review

BACKGROUND

Moulage is a technique used to simulate injury, disease, aging and other physical characteristics specific to a scenario, often used in health and emergency worker training, predominantly for simulation-based learning activities. Its use in allied health fields is unclear. Previous work has explored moulage as an adjunct for authentic simulations, however there is opportunity for broadening its scope.

AIM

To explore the effects of moulage interventions in simulation-based education and training, for learner experience. A secondary aim was to understand which pedagogical frameworks were embedded in moulage interventions.

METHOD

Four electronic databases (PubMed, CINAHL, EmBase, Proquest Central) were systematically searched to December 2022 for studies utilising moulage in simulation-based education experiences. Outcomes were focused on learner satisfaction, confidence, immersion, engagement, performance, or knowledge. Study quality was assessed using the Mixed Methods Appraisal Tool.

RESULTS

Twenty studies (n = 11,470) were included. Studies were primarily conducted in medicine (n = 9 studies) and nursing (n = 5 studies) and less frequently across other health disciplines. The findings demonstrated greater learner satisfaction, confidence, and immersion when moulage was used against a comparator group. Minimal improvements in knowledge and performance were identified. One study underpinned the intervention with a pedagogical theory.

CONCLUSION

Moulage improves learner experience in simulation-based education or training, but not knowledge or clinical performance. Further research utilising moulage across a broader range of professions is needed. Interventions using moulage should be underpinned by pedagogical theories.

Determining current approaches to the evaluation of the quality of healthcare simulation-based education provision: a scoping review

Background: With an increase in simulation being used in healthcare education, there is a need to ensure the quality of simulation-based education is high. This scoping review was conducted to answer the question: What are the current approaches to the evaluation of the quality of health-care simulation-based education provision? Methods: Databases PubMed, Cochrane, ERIC, CINAHL and Medline were searched in March 2023 to retrieve peer-reviewed healthcare research and review articles written in the English language within the last 20 years. All data were extracted from six studies, themed and presented in the main text and in tabular form. Results: Two scoping reviews, one systematic review and three research articles were included. Three main themes were found: adherence to existing design frameworks, lack of validation of these frameworks and lack of evaluation frameworks, and a proposed evaluation framework. Many of the excluded articles focussed on gaining participant feedback to evaluate simulation activities, rather than evaluating the quality of the design and implementation of the simulation. Conclusions: Benchmarking of current United Kingdom (UK) healthcare simulation against UK and international simulation standards is required to increase its quality, therefore, an agreed UK template framework to evaluate simulation packages is recommended.

The effect of a virtual simulation-based educational application on nursing students' belief and self-efficacy in communicating with patients about complementary and alternative medicine

BACKGROUND

Simulation-based learning that focuses on the development and assessment of communication and counseling skills can help nursing students achieve better skill performance and gain self-confidence with decision-making ability. It is unknown whether virtual simulation as an instructional design significantly improves educational outcomes than a traditional lecture with low-fidelity simulation in students.

OBJECTIVES

The aim was to explore the effect of a virtual simulation-based educational smartphone application on nursing students' beliefs and self-efficacy in communicating with patients about complementary and alternative medicine (CAM) use.

DESIGN

A quasi-experimental study with pretest-posttest nonequivalent control group design.

SETTINGS AND PARTICIPANTS

A total of 101 nursing students, who were in their second or third-year nursing program at a Southern Taiwan university volunteered to participate in the academic year 2020-2021. Participants were assigned to an experimental or control group in an elective course.

METHODS

All participants received a 4-hour lecture that included an in-class lecture with low-fidelity simulation (paper-based scenarios) about the risk-benefit assessment of a patient's CAM use. The experimental group received a series of 13 virtual simulation exercises with clinical scenarios by means of a smartphone application. Data from belief and self-efficacy scales were collected at the beginning and end of the course from September 2020 to February 2021. Descriptive and inferential statistics were analyzed using the IBM® SPSS® version 23.0.

RESULTS

Although both groups significantly improved their belief and self-efficacy scale scores, the experimental group had significant differences in overall self-efficacy in communicating with patients about CAM use compared with the control group, specifically the CAM perceptions and self-confidence scores.

CONCLUSIONS

Although both in-class and virtual simulation improved nursing students' belief and self-efficacy, the virtual simulation-based educational app is effective as an adjunct learning tool in significantly increasing nursing students' self-efficacy in communicating with patients about CAM use to help minimize their risks.

Dietetics Students' Perceptions of Academic and Health Impacts of the COVID-19 Pandemic

This study examined dietetics students' perceptions of coronavirus disease-2019 (COVID-19) pandemic impacts on academics and mental and physical health. Data were collected via a cross-sectional online survey in February to March 2021 from undergraduate dietetics students across the United States. Among the 526 students who participated, during the fall 2020 semester, 87% experienced increased stress, 64% reported mental health concerns, and 32% reported disordered eating. Sixty-two percent agreed their program met educational needs; however, 62% also agreed COVID-19 negatively impacted the quality of education and 49% agreed to learning less than normal. Pandemic impacts are critical to consider as students enter dietetic internships and start careers.

Communication skills in dietetic practice: a scoping review protocol

OBJECTIVE

This scoping review aims to examine and map the evidence regarding communication skills in dietetic practice and the education strategies used to develop them. Specifically, the review will address usage in practice, perceptions, and experiences, as well as the teaching and assessment of communication skills in student dietitians and dietitians.

INTRODUCTION

Communication skills are a key element of practice for dietitians. Dietetic practice is evolving, and there is a need to explore the breadth of literature on communication skills for contemporary practice and how these skills are taught.

INCLUSION CRITERIA

This scoping review will consider empirical research on dietitians' or nutritionists' communication skills. This will include skills used in dietitian-patient communication, in communication interactions in different employment contexts, and diverse forms of communication (verbal, written, technological). We will consider the views of student dietitians, dietitians, and patients, as well as evidence regarding how communication skills are taught and assessed in dietetics. Sources may include experimental, quasi-experimental, observational, and qualitative studies.

METHODS

The following electronic databases will be searched: MEDLINE, Embase, CINAHL, ERIC, and PsycINFO. There will be no date limits. Reference lists of eligible studies will be back-searched. Google Scholar will be used for forward citation tracking. Conference proceedings from the previous five years will be searched for eight conferences of the professional associations of dietetics and health care education. ProQuest Dissertations and Theses, and WorldCat Dissertations and Theses will be searched for unpublished literature. The findings will be summarized in tabular format and a narrative synthesis.

Developing and piloting a simulated placement experience for students

COVID-19 and rising student numbers are affecting healthcare education, particularly access to clinical placements. As healthcare education is increasingly supported by technology and non-traditional teaching methods, educational experiences gained through clinical placement also require new approaches. This article explores and discusses the use of a simulated clinical placement for a dietetic student cohort. During this virtual placement, students were able to explore and experience a virtual clinical setting and immerse themselves in a placement experience. A vast range of virtual resources were linked to the online placement portal, including statutory and mandatory training, dietetic resources, patient journeys and interprofessional communication. Advantages of this approach include that all students experience a given situation, unlike in traditional placements where workloads, variety and engagement vary; there is also no risk to patient safety. The aim is to enhance the learning experience to create effective, efficient clinicians. This virtual placement for dietetics is part of a bigger project to develop and evaluate the use of a virtual placement framework in a range of professions. The concept of virtual placement may have been brought forward by the COVID-19 crisis but was inevitable with the move to more technology-enhanced learning tools.

A virtual simulation-based educational application about complementary and alternative medicine: A pilot study of nurses' attitudes and communication competency

BACKGROUND

Conventional healthcare professionals have insufficient knowledge about complementary/alternative medicine (CAM) and often lack competencies to overcome attitudinal barriers to communicate effectively with patients about CAM. Interacting with a virtual simulation-based educational application program may help nurses learn current evidence and acquire communication skills when consulting with patients.

OBJECTIVES

The aim of this pilot study was to evaluate nurses' attitudes towards patients' CAM use and their competency in communicating with patients about CAM after interacting with a virtual simulation-based educational app.

DESIGN

A quasi-experimental study with one-group, pretest-posttest design.

METHODS

A total of 49 nurses volunteered to participate in the study. Participants interacted with a virtual simulation software app on a smartphone that included audiovisual presentations about CAM, 13 exercises, and a risk-benefit decision assessment. Data about nurses' attitudes and communication competency were collected at baseline and after completing the 13 exercises. Descriptive and comparative statistics were analyzed using the IBM® SPSS® version 22.0.

RESULTS

Both the nurses' attitudes about patients' CAM use and communication competency improved significantly following the completion of the 13 exercises. The risk-benefit decision scores correlated significantly with the increase in nurses' attitudes and their communication competency.

CONCLUSIONS

Using a virtual simulation-based educational app may help nurses not only increase their attitudes towards CAM but also increase their communication competency in consulting with patients about CAM use.

Perceived Benefits of a Standardized Patient Simulation in Pre-Placement Dietetic Students

The purpose of this study was to evaluate the effect of a simulation-based learning (SBL) experience on perceived confidence in monitoring and evaluation, as part of the delivery of nutrition care of pre-placement dietetic students, and to describe their perceived value of the learning experience post-placement. A mixed method explanatory sequential study design was used. A confidence appraisal scale was developed and completed by students before (n = 37) and after (n = 33) a low fidelity simulation using a volunteer patient in an acute care setting. Two semi-structured focus group discussions with post-placement students (n = 17) were thematically analysed, grounded in phenomenology. Overall perceived confidence in monitoring and evaluating, as part of nutrition care, improved after the simulation [pre-SBL: 74 (62–83) vs. post-SBL: 89 (81–98.5), p = 0.00]. Two factors emerged to modulate confidence, namely (i) structure and (ii) authentic learning. Structure in turn was modulated by two key factors; safety and process. A low fidelity simulation using a standardised patient can improve students’ perceived confidence in monitoring and evaluation, and a well-structured authentic learning experience was valued and positively perceived by most dietetic students.

Simulation in Exercise Science and Physiology—No Longer a Luxury but a Necessity

The depreciation in placement opportunities has placed pressures on university academics for some time now. Today, the coalescence of this supply issue and the global health pandemic have forced the consideration of alternative placement options. Simulation-based learning experiences (SBLEs) is one such approach, providing students with a diverse range of clinical experiences in a safe and well-placed manner. The documented effectiveness of these experiences in preparing the future health care workforce has been strong, but exists largely in medicine and nursing spheres. SBLEs have been recognized in Australia as providing a commensurate education experience to that of a traditional practicum hour resulting in a portion of total practicum hours being accrued by this activity. In March of this year, the Exercise & Sports Science Australia, accrediting body for exercise science, exercise physiology, and sports science, has lifted the restriction on mandated hours that can be apportioned to simulation-based placement. This “green light” will enable more academics to explore the opportunities within simulation-based learning, although the question regarding being able to deliver quality educational experience remains. This commentary provides an overview of key peer-reviewed literature and simulation design recommendations. Despite being founded on nursing simulation best practice standards, the lessons learned could help direct simulation designers in exercise science and physiology curricula as they strive to meet a rapidly changing practicum placement landscape while maintaining quality teaching and learning environments.

Using simulation-based learning to provide interprofessional education in diabetes to nutrition and dietetics and exercise physiology students through telehealth

BACKGROUND

Current workforce demands require new graduates to competently work within health care teams and often in remote settings. To better prepare students for this work, universities have spent much time developing interprofessional education (IPE) activities. The body of literature supporting IPE of allied health students is growing. Simulation-based learning with simulated patients is one platform through which IPE can be implemented in a dedicated, supported environment and potentially at scale. This study describes an interprofessional simulation-based learning experience with nutrition and dietetics and exercise physiology students. The common practice area of interacting with patients who have type 2 diabetes was targeted, and the simulation was delivered in partnership with simulated patients via a telehealth platform to allow interprofessional teams to work collaboratively in remote locations.

METHODS

Ten nutrition and dietetics and 13 exercise physiology students participated in a simulation module in which students observed and collaborated in the development and delivery of an interprofessional treatment plan for patients with diabetes. Learning outcomes were measured according to the first two levels of Kirkpatrick's (1994) model for training evaluation (i.e. reaction and learning), as well as the perceived impact on behaviour.

RESULTS

The students' confidence in communication, assessment, management and ability to work with another health professional significantly increased (p < 0.05) post-activity. Students perceived that the simulation-based learning would have a positive impact on their clinical skills and ability to work with other health professionals. Students reported that the most effective aspects of the simulation module were learning from and about each other, the opportunity for experiential learning and the supportive learning environment. However, the telehealth platform audio clarity and delay had negative impact on the learning experiences for students.

CONCLUSION

The overall positive results demonstrate the potential of simulation-based learning activities for preparing allied health students for working in interprofessional teams. Although remote access was possible, the telehealth platform was identified as a limiting factor to this simulation-based learning experience. However, videoconferencing technology has advanced considerably since this study. Hence, there is an opportunity to employ more reliable technology for future simulations.