High-fidelity patient simulation in physiotherapy education

Advice-giving skills in pre-registration physiotherapy training

BACKGROUND

With increased emphasis on self-management in healthcare, clinicians need outstanding skills in offering advice and empowering patients to attain an optimal outcome.

OBJECTIVES

This study explores how undergraduate physiotherapists acquire knowledge, skills, and confidence to offer advice to patients in clinical practice.

METHODS

Convenience sampling was used to recruit 50 BSc and MSc pre-registration physiotherapy students across all years of study in one university in southern England, UK. Semi-structured interviews were conducted for first year BSc students (n = 13). Six focus groups of mixed BSc and MSc students were conducted, three groups (n = 15 students) were mid-training, and three groups (n = 22 students) were in their final year.

RESULTS

Thematic analysis identified 6 themes: advice content; a patient-centered approach; delivery; acquisitions; perceptions; and uptake of advice. Students placed high value on advice-giving, drawing upon multiple learning opportunities, however they felt under-prepared to deliver this skill in practice. Furthermore, perceptions of their student status, and pressures to perform on graded placements were reported to influence the advice they offered to patients.

CONCLUSIONS

Developing high-level skills in promoting self-management is essential in physiotherapy, this study highlights the challenges for students to develop these skills. Academic and practice educators must explicitly enable and support students to develop the knowledge and skills to confidently offer high-quality advice to patients.

Student Perceptions of Simulation to Enhance Clinical Readiness for Assessment and Management of Adults With Voice Disorders

BACKGROUND

Simulation is a safe, supported, and accessible learning method for students to gain skills and experience, especially in difficult to access range of practice areas such as voice.

OBJECTIVE

The study aimed to explore change in students' perceptions of knowledge, confidence, anxiety, and clinical readiness for assessment and management of an adult with a voice disorder after participation in simulation-based learning activities.

METHODS

Participants (N = 113) were students enrolled in a mandatory course dedicated to the voice and voice disorders. Students completed 32 hours of academic coursework which included lectures and tutorials and two 30-minute simulation-based learning activities with a standardized patient playing the role of an adult with a voice disorder. The impact of the simulation-based learning activities on student perceptions of their knowledge, confidence, anxiety, and clinical readiness for work within the area of voice were surveyed at three time points: (1) pre lectures, (2) post lectures but pre simulation, and (3) post simulation. Change across time was analyzed using repeated measures analysis of variance with post hoc Bonferroni adjustment.

RESULTS

All students perceived significant (P ≤ 0.001) positive changes in knowledge and confidence across time points for all activities, except for writing an assessment report. Anxiety related to the management of a client with a voice disorder fluctuated significantly (P ≤ 0.001) throughout the program. Overall, the majority (>90%) of students agreed or strongly agreed that the simulation-based learning activities were useful and helped them to develop clinical skills, apply content taught in lectures, and gain confidence and interest in voice.

CONCLUSION

This study supports incorporation of simulation-based learning as part of students' clinical preparation for the assessment and management of voice disorders.

A rollercoaster of emotions: An integrative review of emotions and its impact on health professional students' learning in simulation-based education

AIM

Simulation-based education establishes a specific learning environment capable of activating emotions before, during and after the task. Research has identified stress and anxiety related to simulation. However, the role of various emotional experiences in a simulation that favour learning is still unclear. This review describes, interprets and synthesizes the current research findings on health professional students' experience of emotions and the effects on student learning in simulations.

DESIGN

This study design was guided by integrative review method.

METHODS

Databases were systematically searched for articles. 9,323 records were screened and 16 studies met the inclusion criteria. The study protocol was reported in Prospero.

RESULTS

Three themes emerged from the analysis: (a) simulation as a fearful and stressful situation, (b) variability in emotions experienced during simulation as a rollercoaster of emotions and (c) emotions wide-ranging effects on students' learning in the simulation.

An exploratory study considering the potential impacts of high-fidelity simulation based education on self-evaluated confidence of non-respiratory physiotherapists providing an on-call respiratory physiotherapy service: a mixed methods study

Introduction

Physiotherapists working on-call to provide emergency respiratory services report stress and lack of confidence in on-call scenarios. Simulation-based education (SBE) is a potential solution to improve confidence and reduce stress of on-call physiotherapists. In physiotherapy, use of SBE is sporadic. The aim of this study was to evaluate the addition of SBE to an on-call training programme on non-respiratory physiotherapists' self-evaluated confidence. Additionally, the study aimed to evaluate if SBE facilitates identification of learning needs.

Methods

This cohort study took a mixed methods approach. Participants were recruited from staff providing on-call respiratory physiotherapy services at a UK hospital. Participants received traditional on-call training over 1 year, with SBE added the subsequent year, in a pre-post analysis design. Self-evaluated confidence was assessed with the Association of Chartered Physiotherapists in Respiratory Care Acute Respiratory/On-call Physiotherapy Self-evaluation of Competence (ACPRC) questionnaire. Two focus groups were conducted post-SBE.

Results

There were 10 participants. Thematic analysis of focus groups indicated participants found SBE provided coping strategies for on-call working. Using coping strategies taught in SBE reduced stress levels and increased confidence of non-specialist on-call physiotherapists. ACPRC questionnaire scores significantly improved following the addition of SBE (median change 5.5%, p=0.034, r=0.57). SBE assisted in identification of learning needs through recognition of unconscious incompetence and reinforcement of conscious and unconscious competence.

Conclusions

SBE may improve self-evaluated confidence of non-specialist on-call physiotherapists. SBE assists in learning needs identification. SBE could enhance training of physiotherapists providing on-call respiratory services. Further larger trials investigating optimal methods of on-call physiotherapy postgraduate education are warranted.

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

OBJECTIVE

Simulation-based learning experiences (SBLEs) are widely used in education for health professionals, but this literature has not yet been synthesized for dietetics. The aim of this study was to describe presupervised practice SBLEs using simulated patients within programs credentialing dietitians.

METHODS

A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 8 databases were searched (MEDLINE by EBSCO HOST, CINAHL Plus with Full Text, Web of Science, PsycINFO, Scopus, ERIC ProQuest, Embase, and ProQuest Education) for studies published up to November 2, 2018 with the terms "dietitian," "standardized patient," "student," and their synonyms.

RESULTS

Fourteen out of 740 studies were identified. Most focused on development/assessment of communication and counseling skills. Learning outcomes were measured in 12 studies with 8 different tools.

CONCLUSIONS AND IMPLICATIONS

The dietetics profession needs robust and consistent reporting methods to enable the development of a high-quality body of evidence on SBLEs. The quality and quantity of SBLE research need to improve to ensure that simulations are pedagogically sound and are accompanied by measures of quality and impact on learning.

Simulation-based education improves student self-efficacy in physiotherapy assessment and management of paediatric patients

BACKGROUND

The Australian Physiotherapy Council mandates that physiotherapy clinical education be sufficient to produce graduates who are competent to practice across the lifespan. Due to a lack of opportunities for paediatric clinical placements, there is a risk of graduates not having the opportunity to develop competency in paediatric physiotherapy. To address this risk, simulation-based education (SBE) has been proposed as an educational strategy to address the placement shortfall. Despite encouraging evidence for its use in physiotherapy education, there is limited evidence supporting its use specifically in paediatric populations. The aims of this research were to investigate the effect of SBE on student self-efficacy in the physiotherapy assessment and management of paediatric clients, and to determine student satisfaction with SBE as a learning strategy.

METHODS

Three interactive SBE sessions were run during the undergraduate paediatric physiotherapy unit at the campus of one Australian university. Self-efficacy was surveyed before and after each session, to determine confidence in clinical skills, clinical decision-making, treatment preparation and planning, communication skills; evaluating and modifying interventions, and interprofessional practice. Student satisfaction with SBE as a learning strategy was surveyed after the final SBE session.

RESULTS

For the 164 participants included in this study, self-efficacy survey response rate varied from 77 to 96% for each session. Significant increases in mean student self-efficacy were recorded for all questions (p <  0.001). A total of 139 (85%) responded to the learning reactionnaire with 78.6% indicating they were very satisfied with SBE as a learning strategy. Written comments from 41 participants identified 'experience' as the primary theme.

CONCLUSION

SBE had a significant positive effect on student self-efficacy in the physiotherapy assessment and management of paediatric patients. Students also perceived SBE to be a valuable learning experience. Future research is needed to investigate whether the improvement in self-efficacy achieved through SBE translates into improved student performance during workplace-based clinical placements.

Student perceptions of two simulated learning environments in paediatric audiology

Objective: To determine audiology student perceptions of two simulated learning environments (SLE) in paediatric audiology.Design: A one-shot case study design.Study sample: Fifteen audiology students who completed questionnaires after participating in two SLEs, one simulating auditory brainstem response (ABR) assessments of neonates in a hospital ward and one simulating visually reinforced orientation audiometry (VROA) assessments of young children in an audiology clinic.Results: The students responded positively to 11/11 areas of audiometric testing and client interaction in both SLEs, to 7/7 aspects of their interactions with the mannequins in both SLEs, and to 8/8 aspects of their interactions with fellow students playing the role of parent in the ABR SLE and 7/8 of these aspects in the VROA SLE. The students reported low levels of anxiety towards both SLEs but rated the ABR SLE more highly than the VROA SLE in areas of preparedness, effectiveness, realism, pre-SLE training, reinforcement of lecture content, and overall usefulness.Conclusions: The participating students responded positively to almost all aspects of both SLEs. Further research is warranted using research designs capable of determining if these SLEs directly improve student abilities as they transition from academic settings to clinical placements in paediatric audiology.

Combining medical, physiotherapy and nursing undergraduates in high-fidelity simulation: determining students’ perceptions

High-fidelity simulation (Hi-Fi SIM) is increasingly used to provide undergraduate interprofessional education (IPE). Although research has reported positive student feedback, studies have predominantly involved medical and nursing specialties. The present study sought to further explore this area by determining the perceptions of medical, physiotherapy and nursing students participating in the same simulation session. A total of 145 medical, physiotherapy and nursing undergraduate students jointly participated in a novel Hi-Fi SIM IPE programme. Immediately before and after their session, students completed the KidSIM ATTITUDES questionnaire where statements were rated regarding simulation, IPE and human factors. A high score indicated a more positive attitude. Physiotherapy students reported the lowest level of previous Hi-Fi SIM experience. Students from each specialty had more positive attitudes related to simulation, IPE and human factors following their simulation. Physiotherapy students had predominantly less positive attitudes compared with nursing and medical students. Participation in an IPE Hi-Fi SIM session positively impacted on the perceptions of medical, physiotherapy and nursing students regarding the relevance of simulation, IPE and the importance of human factors. Such findings support the use of this learning modality for the provision of IPE in a range of specialties.

Preparing Physiotherapy Students for Clinical Placement: Student Perceptions of Low-Cost Peer Simulation. A Mixed-Methods Study

INTRODUCTION

Simulation is increasingly used in health care education, yet the organizational and financial costs can be prohibitive. This study aimed to investigate whether peer simulation is perceived by third-year undergraduate physiotherapy students as valuable for clinical placement preparation.

METHODS

Third-year undergraduate physiotherapy students participated in a 9-week peer simulation program, using each other as patients, and were invited to complete two surveys evaluating perceptions of the program. The program consisted of weekly patient interactions during which students were required to assess and treat a "patient" under strict simulation guidelines and in accordance with stated learning objectives. Items rated included self-perceived skills, confidence, time management, and clinical placement readiness and included collection of qualitative responses. Surveys were released at commencement and completion of the simulation program.

RESULTS

Of 79 third-year students, 63% completed survey 1 and 66% completed survey 2. Students had high expectations of the program and these were consistently met. Peer simulation rated highly for all items, including identifying knowledge and skill deficits, and improving confidence, clinical reasoning, time management, and communication. Simulation was considered safe, supportive, engaging, and valuable for clinical placement preparation. Students identified some lack of authenticity when working with peers.

CONCLUSIONS

Peer simulation was perceived by students as valuable in preparing them for clinical placement, despite a perceived lack of realism. These findings support the use of peer simulation as an alternative to the use of more formalized standardized patients in an undergraduate physiotherapy program. Further investigation is required to establish a detailed cost analysis of the program and to determine the amount of realism required to optimize the benefits of this promising educational strategy.

Simulation Experiences in Canadian Physiotherapy Programmes: A Description of Current Practices

Purpose: Although health care professional education programmes around the world are increasingly using sophisticated simulation technology, the scope of simulation use in Canadian physiotherapy programmes is currently undefined. The current study explores the definitions of simulation, its current use, and the perceived benefits and barriers in Canadian entry-to-practice physiotherapy programmes. Method: Using a qualitative, descriptive study approach, we contacted Canadian physiotherapy programmes to identify faculty members with simulation experience. Using a semi-structured interview format, we asked participants to discuss their perspectives of simulation in their physiotherapy programmes. Interviews were audio recorded, transcribed, and analyzed for themes. Results: Of 13 eligible Canadian physiotherapy programmes, participants from 8 were interviewed. The interviews revealed three major themes: (1) variability in the definition of fidelity in simulation, (2) variability in simulation use, and (3) the benefits of and barriers to the use of simulation. Conclusions: Variability in the definition of fidelity in simulation among Canadian physiotherapy programmes is consistent with the current literature, highlighting a spectrum of complexity from low fidelity to high fidelity. Physiotherapy programmes are using a variety of simulations, with the aim of creating a bridge from theoretical knowledge to clinical practice. This study describes the starting point for characterizing simulation implementation in Canadian physiotherapy programmes and reflects the diversity that exists across the country.

Simulation in Occupational Therapy Curricula: A literature review

BACKGROUND/AIM

Simulated learning experiences are increasingly being used in health-care education to enhance student engagement and provide experiences that reflect clinical practice; however, simulation has not been widely investigated in occupational therapy curricula. The aim of this paper was to: (i) describe the existing research about the use and evaluation of simulation over the last three decades in occupational therapy curricula and (ii) consider how simulation has been used to develop competence in students.

METHODS

A literature review was undertaken with searches of MEDLINE, CINAHL and ERIC to locate articles that described or evaluated the use of simulation in occupational therapy curricula.

RESULTS/FINDINGS

Fifty-seven papers were identified. Occupational therapy educators have used the full scope of simulation modalities, including written case studies (22), standardised patients (13), video case studies (15), computer-based and virtual reality cases (7), role-play (8) and mannequins and part-task trainers (4). Ten studies used combinations of these modalities and two papers compared modalities. Most papers described the use of simulation for foundational courses, as for preparation for fieldwork, and to address competencies necessary for newly graduating therapists. The majority of studies were descriptive, used pre-post design, or were student's perceptions of the value of simulation.

CONCLUSION

Simulation-based education has been used for a wide range of purposes in occupational therapy curricula and appears to be well received. Randomised controlled trials are needed to more accurately understand the effects of simulation not just for occupational therapy students but for longer term outcomes in clinical practice.

Impact of providing case-specific knowledge in simulation: a theory based study of learning

Background

Simulation-based education (SBE) has been lauded for its ability to help students recognise and react appropriately to common and rare circumstances. While healthcare professions have started to implement SBE into their curriculum, there is no evidence to suggest which educational theory is best for implementation. This study explores the usage of cognitive load theory (CLT) and the unified theory of emotional learning (UTEL).

Study design

A mixed methods ordered-allocation cohort study.

Methods

23 patient management teams were allocated into 2 groups. The first group received prior information about the simulation scenario; the second group did not. Each team had 1 student assigned to the role of doctor. The scenarios were filmed at time 1 (T1), time 2 (T2) and follow-up (F/U). The ‘doctor’ role was then graded with a validated checklist by a three-judge panel. The scores were evaluated to determine if prior information enabled better performance. Secondary analysis evaluated the role of gender on performance and also evaluated anxiety at the onset of the simulation.

Results

23 doctors were evaluated. There was no difference between groups in performance (t=1.54, p=0.13). Secondary analysis indicated that gender did not play a role. There was no difference in anxiety between groups at baseline (t=0.67, p=0.51).

Conclusions

Trends were observed, suggesting that when students enter a simulation environment with prior knowledge of the event they will encounter, their performance may be higher. No differences were observed in performance at T2 or F/U. Withholding information appeared to be an inappropriate proxy for emotional learning as no difference in anxiety was observed between groups at baseline. All trends require confirmation with a larger sample size.

Simulated Patients in Physical Therapy Education: Systematic Review and Meta-Analysis

BACKGROUND

Traditional models of physical therapy clinical education are experiencing unprecedented pressures. Simulation-based education with simulated (standardized) patients (SPs) is one alternative that has significant potential value, and implementation is increasing globally. However, no review evaluating the effects of SPs on professional (entry-level) physical therapy education is available.

PURPOSE

The purpose of this study was to synthesize and critically appraise the findings of empirical studies evaluating the contribution of SPs to entry-level physical therapy education, compared with no SP interaction or an alternative education strategy, on any outcome relevant to learning.

DATA SOURCES

A systematic search was conducted of Ovid MEDLINE, PubMed, AMED, ERIC, and CINAHL Plus databases and reference lists of included articles, relevant reviews, and gray literature up to May 2015.

STUDY SELECTION

Articles reporting quantitative or qualitative data evaluating the contribution of SPs to entry-level physical therapy education were included.

DATA EXTRACTION

Two reviewers independently extracted study characteristics, intervention details, and quantitative and qualitative evaluation data from the 14 articles that met the eligibility criteria.

DATA SYNTHESIS

Pooled random-effects meta-analysis indicated that replacing up to 25% of authentic patient-based physical therapist practice with SP-based education results in comparable competency (mean difference=1.55/100; 95% confidence interval=-1.08, 4.18; P=.25). Thematic analysis of qualitative data indicated that students value learning with SPs.

LIMITATIONS

Assumptions were made to enable pooling of data, and the search strategy was limited to English.

CONCLUSION

Simulated patients appear to have an effect comparable to that of alternative educational strategies on development of physical therapy clinical practice competencies and serve a valuable role in entry-level physical therapy education. However, available research lacks the rigor required for confidence in findings. Given the potential advantages for students, high-quality studies that include an economic analysis should be conducted.

The validity of a professional competence tool for physiotherapy students in simulation-based clinical education: a Rasch analysis

BACKGROUND

Despite the recent widespread adoption of simulation in clinical education in physiotherapy, there is a lack of validated tools for assessment in this setting. The Assessment of Physiotherapy Practice (APP) is a comprehensive tool used in clinical placement settings in Australia to measure professional competence of physiotherapy students. The aim of the study was to evaluate the validity of the APP for student assessment in simulation settings.

METHODS

A total of 1260 APPs were collected, 971 from students in simulation and 289 from students in clinical placements. Rasch analysis was used to examine the construct validity of the APP tool in three different simulation assessment formats: longitudinal assessment over 1 week of simulation; longitudinal assessment over 2 weeks; and a short-form (25 min) assessment of a single simulation scenario. Comparison with APPs from 5 week clinical placements in hospital and clinic-based settings were also conducted.

RESULTS

The APP demonstrated acceptable fit to the expectations of the Rasch model for the 1 and 2 week clinical simulations, exhibiting unidimensional properties that were able to distinguish different levels of student performance. For the short-form simulation, nine of the 20 items recorded greater than 25 % of scores as 'not-assessed' by clinical educators which impacted on the suitability of the APP tool in this simulation format.

CONCLUSION

The APP was a valid assessment tool when used in longitudinal simulation formats. A revised APP may be required for assessment in short-form simulation scenarios.

Developing clinical skills in paediatric dysphagia management using human patient simulation (HPS)

PURPOSE

The use of simulated learning environments to develop clinical skills is gaining momentum in speech-language pathology training programs. The aim of the current study was to examine the benefits of adding Human Patient Simulation (HPS) into the university curriculum in the area of paediatric dysphagia.

METHOD

University students enrolled in a mandatory dysphagia course (n = 29) completed two, 2-hour HPS scenarios: (a) performing a clinical feeding assessment with a medically complex infant; and (b) conducting a clinical swallow examination (CSE) with a child with a tracheostomy. Scenarios covered technical and non-technical skills in paediatric dysphagia management. Surveys relating to students' perceived knowledge, skills, confidence and levels of anxiety were conducted: (a) pre-lectures; (b) post-lectures, but pre-HPS; and (c) post-HPS. A fourth survey was completed following clinical placements with real clients.

RESULT

Results demonstrate significant additive value in knowledge, skills and confidence obtained through HPS. Anxiety about working clinically reduced following HPS. Students rated simulation as very useful in preparing for clinical practice. Post-clinic, students indicated that HPS was an important component in their preparation to work as a clinician.

CONCLUSION

This trial supports the benefits of incorporating HPS as part of clinical preparation for paediatric dysphagia management.

Emulating Upper Limb Disorder for Therapy Education

Robotics not only contributes to the invention of rehabilitation devices, it can also enhance the quality of medical education. In recent years, the use of patient simulators and part-task trainers in the medical education field has brought meaningful improvements in the training of medical practitioners. Nevertheless, in the context of therapy training for upper limb disorders, trainee therapists still have to engage directly with the patients to gain experience of the rehabilitation of physical diseases. In this work, a high-fidelity part-task trainer that is able to reproduce the stiffness of spasticity and rigidity symptoms of the upper limb, such as those observed in post-stroke patients and Parkinson's disease patients, has been developed. Based on the evaluation carried out by two experienced therapists, the developed part-task trainer is able to simulate different patient cases and help trainee therapists gain pre-clinical experience in a safe and intuitive learning environment.

Simulation-based education (SBE) within postgraduate emergency on-call physiotherapy in the United Kingdom

BACKGROUND

The application and extent of simulation-based education use within cardiorespiratory physiotherapy postgraduate education (in-house/regional provisions) and emergency oncall services were previously unexplored.

OBJECTIVES

This survey aimed to investigate the extent to which simulation-based education is currently utilised by physiotherapy services in the UK.

DESIGN

A national postal questionnaire-based survey.

SETTING

All 280 National Health Service Critical/Intensive Care Units in England, Northern Ireland, Scotland and Wales, providing emergency on-call physiotherapy services were included in the survey.

PARTICIPANTS

Emergency on-call physiotherapy service leads.

METHOD

A self-administered 20-item postal questionnaire survey was designed to establish the extent to which simulation-based education was currently being used within cardio-respiratory physiotherapy post-registration training.

RESULTS

A useable response rate of 55% (155/280) was achieved, representing a range of respiratory and emergency on-call service leads. Sixty-one Trusts (39%) currently use simulation within acute respiratory or emergency on-call postgraduate training. The provision of simulation equipment varied with respect to type, fidelity and accessible to the physiotherapy service. Simulation-based education featured in emergency on-call induction, updates, competency assessment, assessment skills, treatment skills and scenarios (75, 92, 39, 28, 82, 48% respectively).

CONCLUSIONS

Simulation is currently used to teach a wide variety of cardio-respiratory physiotherapy skills relevant to the acute respiratory and on-call environments. Adoption was dependent upon local facilities, needs and training requirements. National inconsistencies in availability, fidelity and accessibility were identified. The evidence base surrounding the current use of simulation-based education within physiotherapy is limited and evidence of transferability to the practice arena remains relatively unknown. Future research is warranted to determine the education outcomes, impact on skill performance, competency, retention and patient safety when integrating SBE within EOC training activities.

On the ball with emergency on-call?

Emergency on-call physiotherapy has been defined by Gough and Doherty (2007) as: