An integrative review of computer-based simulation in the education process

A Novel Training Modality for Providers in the Emergency Department Using a Computer-Based Scenario: A Pilot Study

OBJECTIVES

Individuals with substance use disorders (SUDs) are increasingly admitted in emergency departments (EDs) nationwide. However, ED providers often have limited knowledge about and lack confidence in treating SUDs. This limited knowledge often results in poor treatment outcomes among patients with SUD in the ED setting. The aims of this pilot study were to (a) assess the desirability, applicability, and acceptability of a computer-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) education scenario and (b) examine changes in SUD knowledge scores among ED providers before and after engaging in the computer-based SBIRT education scenario.

METHODS

A tailored computer-based education scenario was developed based on the SBIRT framework for ED providers in an academic medical center. Participants (N = 15) evaluated the desirability, applicability, and acceptability of the education tool. Also, a single-group pre-/post-design was used to examine changes in participants' SUD knowledge and proficiency scores.

RESULTS

Participants rated the computer-based SBIRT education scenario as desirable, applicable, and acceptable based on 4.0/5.0 or greater evaluation scores for each component. Overall knowledge scores increased from 3.5 to 3.8, albeit non-significantly. Proficiency score percentages increased by 25%.

CONCLUSION

Computer-based SBIRT education scenario training may be acceptable by ED providers and may improve proficiency in addressing SUD for patients. Future studies should evaluate this training method with a larger sample size.

A guide to prompt design: foundations and applications for healthcare simulationists

Large Language Models (LLMs) like ChatGPT, Gemini, and Claude gain traction in healthcare simulation; this paper offers simulationists a practical guide to effective prompt design. Grounded in a structured literature review and iterative prompt testing, this paper proposes best practices for developing calibrated prompts, explores various prompt types and techniques with use cases, and addresses the challenges, including ethical considerations for using LLMs in healthcare simulation. This guide helps bridge the knowledge gap for simulationists on LLM use in simulation-based education, offering tailored guidance on prompt design. Examples were created through iterative testing to ensure alignment with simulation objectives, covering use cases such as clinical scenario development, OSCE station creation, simulated person scripting, and debriefing facilitation. These use cases provide easy-to-apply methods to enhance realism, engagement, and educational alignment in simulations. Key challenges associated with LLM integration, including bias, privacy concerns, hallucinations, lack of transparency, and the need for robust oversight and evaluation, are discussed alongside ethical considerations unique to healthcare education. Recommendations are provided to help simulationists craft prompts that align with educational objectives while mitigating these challenges. By offering these insights, this paper contributes valuable, timely knowledge for simulationists seeking to leverage generative AI's capabilities in healthcare education responsibly.

Digital games and virtual reality applications in child abuse: A scoping review and conceptual framework

Child abuse refers to any form of maltreatment, including physical abuse, sexual abuse, emotional abuse, and neglect that occurs to children under 18 years of age. Digital games and virtual reality (VR) can be used as beneficial solutions for dealing with child maltreatment concerns. This study aimed to present a conceptual framework for showing the applications of these technologies in managing child abuse. The framework is developed in two stages: (1) a scoping review to gather digital games and VR applications for child abuse issues through the search in PubMed, Ovid (APA PsycInfo), Scopus, Web of Science, ProQuest, Institute of Electrical and Electronics Engineers (IEEE), Cochrane Database of Systematic Reviews, and grey literature and (2) developing a conceptual framework based on the review results and validating it by 12 experts. The proposed conceptual framework shows that digital games and VR have been used for six main topics: (1) medical education, (2) prevention, (3) screening, (4) diagnosis, (5) treatment, and (6) forensic medicine in response to child abuse issues. Studies have more focused on child sexual abuse prevention, behavioral monitoring of sexual offenders in forensic medicine, and knowledge or performance assessment of students in medical education. Serious games (SGs), computer simulation, and immersive VR were common technologies for children, students, and forensic medicine, respectively. The experts believe the combination of immersive features of VR with SGs can further encourage user engagement. It appears that digital games and VR can play a positive role in child abuse management. Given the extensive capabilities of these technologies, further studies are needed to show all their potential applications for child abuse problems.

Using the DiCoT framework for integrated multimodal analysis in mixed-reality training environments

Simulation-based training (SBT) programs are commonly employed by organizations to train individuals and teams for effective workplace cognitive and psychomotor skills in a broad range of applications. Distributed cognition has become a popular cognitive framework for the design and evaluation of these SBT environments, with structured methodologies such as Distributed Cognition for Teamwork (DiCoT) used for analysis. However, the analysis and evaluations generated by such distributed cognition frameworks require extensive domain-knowledge and manual coding and interpretation, and the analysis is primarily qualitative. In this work, we propose and develop the application of multimodal learning analysis techniques to SBT scenarios. Using these analysis methods, we can use the rich multimodal data collected in SBT environments to generate more automated interpretations of trainee performance that supplement and extend traditional DiCoT analysis. To demonstrate the use of these methods, we present a case study of nurses training in a mixed-reality manikin-based (MRMB) training environment. We show how the combined analysis of the video, speech, and eye-tracking data collected as the nurses train in the MRMB environment supports and enhances traditional qualitative DiCoT analysis. By applying such quantitative data-driven analysis methods, we can better analyze trainee activities online in SBT and MRMB environments. With continued development, these analysis methods could be used to provide targeted feedback to learners, a detailed review of training performance to the instructors, and data-driven evidence for improving the environment to simulation designers.

Innovations in Behavioral Intervention Preparation for Paraprofessionals Working with Children with Autism Spectrum Disorder

Given the empirically validated success of behavioral intervention based on applied behavior analysis for individuals with autism spectrum disorder and other developmental disabilities, the demand for knowledgeable and skilled paraprofessional teaching staff is very high. Unfortunately, there currently exists a widely recognized shortage of such practitioners. This paper describes the development of an online training program aimed at preparing paraprofessionals for face-to-face training and supervision, as part of a solution to the growing demand. The focus of the program has been on moving beyond traditional online pedagogy, which has limited interactivity. Instead, the approach to teaching fundamental knowledge and implementation skills in behavioral intervention methods incorporates first-person simulations, typical of live mentor/mentee training. Preliminary program evaluation data are also described.

Learning style impact on knowledge gains in human patient simulation

INTRODUCTION

Human patient simulation (HPS) is a widely used method of teaching in nursing education. While it is believed that a student's learning style impacts knowledge gains in HPS, there is little evidence to support this. This study sought to determine the impact of learning style on knowledge gains after a heart failure (HF) simulation experience in pre-licensure nursing students.

METHODS

A convenience sample of four cohorts of prelicensure nursing students (n=161) were recruited from three Baccalaureate Schools of Nursing at the same point in their curriculum (age 25.7±6.6 years; gender=85.5% female) and participated in HPS using a HF simulation on a high-fidelity manikin. Learning style was assessed by the Kolb Learning Style Inventory (LSI) and pre- and post-HPS knowledge measured by parallel, validated, knowledge tests. The LSI identifies 4 learning styles, (Assimilating Diverging, Accommodating, and Converging). In some cases, learners present a balanced learning profile-an emphasis of all four equally. Statistical analysis consisted of t-tests and ANOVA.

RESULTS

HF knowledge scores post-HPS compared to pre-HPS scores revealed a mean improvement of 7 points (p<0.001) showing evidence of learning. Within group score increases between the pre-test and post-test were seen for the Assimilating (66.68±20.87 to 83.35±12.59; p=0.07), Diverging (61.95±11.08 to 69.86±12.33; p<0.01) and balanced profiles (64.4±12.45 to 71.8±10.14; p<0.01), but not for Converging or Accommodating profiles (73% of sample). Post-hoc paired t-tests revealed a large effect size for the Assimilators (0.91) and moderate effect sizes for both the Divergers and balanced profiles (0.67 and 0.65, respectively).

CONCLUSION

These findings confirm that knowledge gains occur with HPS and provide evidence that HPS is an effective teaching methodology for nursing students identifying with most types of learning styles.

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 the 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.

High-fidelity simulation and legal/ethical concepts

Students in an undergraduate legal and ethical issues course continually told the authors that they did not have time to study for the course because they were busy studying for their clinical courses. Faculty became concerned that students were failing to realize the value of legal and ethical concepts as applicable to clinical practice. This led the authors to implement a transformational learning experience in which students applied legal and ethical course content in a high-fidelity human simulation (HFHS) scenario. A preliminary evaluation compared the new HFHS experience with in-person and online student groups using the same case. Based on both student and faculty perceptions, the HFHS was identified as the best of the three approaches for providing a transformational learning experience regarding legal and ethical content.

Predictors of knowledge gains using simulation in the education of prelicensure nursing students

Gains in knowledge and self-efficacy using human patient simulation (HPS) in the education of prelicensure nursing students have been reported. However, the predictors of improved learning outcomes using this teaching methodology are not known. Using a two-group (participated in HPS, did not participate in HPS), repeated-measures, experimental design, we examined the predictors of higher scores on a Knowledge Questionnaire in 162 students (age = 25.7 ± 6.6, gender = 85.5% female) from four prelicensure cohorts at three nursing schools. Statistical analysis consisted of t-tests, ANOVA and stepwise logistic regression. Covariates included age, gender, learning style, baseline critical thinking, baseline self-efficacy, group membership (control or experimental), and school. Membership in the experimental group was the only statistically significant independent predictor (P < .001) of knowledge gains among the covariates entered into the regression analysis. Members of the control group were two times less likely than those in the experimental group to be in the higher scored group (P < .001), yet this changed once the control group participated in HPS. Our findings show that HPS can independently improve test scores. This study provides evidence that HPS; is an effective teaching methodology for prelicensure nursing students regardless of age, learning style, or critical thinking ability.

FIRST2ACT: educating nurses to identify patient deterioration - a theory-based model for best practice simulation education

Delayed assessment and mismanagement of patient deterioration is a substantial problem for which educational preparation can have an impact. This paper describes the development of the FIRST(2)ACT simulation model based on well-established theory and contemporary empirical evidence. The model combines evidence-based elements of assessment, simulation, self-review and expert feedback, and has been tested in undergraduate nurses, student midwives and post-registration nurses. Participant evaluations indicated a high degree of satisfaction and substantial self-rated increases in knowledge, confidence and competence. This evidence-based model should be considered for both undergraduate and post-registration education programs.

The role of simulation in nurse education

This descriptive survey evaluates the role of medium to high fidelity simulation in the preparation for clinical nursing practice, from the perception of third year undergraduate students. A questionnaire was distributed to 153 Adult Branch undergraduate nursing students from one Higher Education Institution. Quantitative data was collected through use of Likert scales, whilst a comment box permitted the compilation of qualitative remarks. A 60% (n=93) response rate was achieved. Findings indicate that simulation using high fidelity simulators is perceived to be a valuable method of learning, which should positively impact on the clinical effectiveness of nursing students approaching the transition to registered nurses. Furthermore participants believed that their experience with high fidelity simulators enhanced the safety of their practice. This study has strengthened the case for using high fidelity simulators as a means of assisting linkage of theory to practice. Whilst there are limitations to the realism of high fidelity simulators, the majority of subjects considered simulation an authentic learning experience. New knowledge from this research suggests that high fidelity simulators may contribute significantly to the preparation for nursing students' final key stage management assessment prior to entry to the Nursing and Midwifery Council (NMC) register. Although engagement with the high fidelity simulators can be anxiety provoking, this may precede perceived augmentation of learning, skill and confidence.

The who and where of clinical skills teaching: a review from the UK perspective

Over the years, the debate on clinical skill acquisition in Nursing is one that has been subject to constant scrutiny within educational settings, locally and globally. Indeed, the Nursing and Midwifery Council (NMC) have endeavoured to provide some clarity with the publication of the Essential Skills Cluster statements [NMC, 2006. Advance Information Regarding Essential Skill Clusters for Preregistration Nursing Programmes (NMC Circular 35/2006). NMC, London] and the recently updated Standards to Support Learning and Assessment in Practice [NMC, 2008. Standards to Support Learning and Assessment in Practice: NMC Standards for Mentors, Practice Teachers and Teachers, second ed. NMC, London]. In this paper, we seek to provide a review of the evidence and debate produced thus far surrounding skills acquisition in general and the role of the nurse lecturer in particular from a UK perspective.

Development and performance usability testing of a theory-based, computerized, tailored intervention

Technology offers innovative and promising methods of delivering health messages to provide knowledge and potentially facilitate improved health behaviors. Theory was foundational to the development of a new intervention using a tailored Web site and a handheld computer. A performance usability study was conducted to determine if women could use this newly developed intervention delivered via a Web site and pocket computer accurately and in a timely manner in real-world settings. A convenience sample of 15 women between 35 and 55 years of age were observed as they used "Complete a Task" and "Talk Aloud" performance usability methods. Results identified several problems affecting the ability of participants to use the Web site and handheld computer.

Evaluation of the Virtual Physiology of Exercise Laboratory program

The Virtual Physiology of Exercise Laboratory (VPEL) program was created to simulate the test design, data collection, and analysis phases of selected exercise physiology laboratories. The VPEL program consists of four modules: 1) cardiovascular, 2) maximal O(2) consumption (Vo(2max)), 3) lactate and ventilatory thresholds, and 4) respiratory exchange ratio. The purpose of this investigation was to compare student learning from the VPEL program with that from traditional "hands-on" exercise physiology laboratory activities. Student participants from the spring 2009 Integrated Fitness Programming course were randomly assigned to either experimental group 1 or group 2. Group 1 completed a hands-on version of a typical Vo(2max) laboratory activity, whereas group 2 completed the VPEL Vo(2max) module. Both groups then completed the same assessment to evaluate their understanding of Vo(2max) laboratory concepts. Group 1 then completed the VPEL lactate and ventilatory threshold module, whereas group 2 completed a hands-on version of that same activity. Both groups then completed the same assessment to evaluate their understanding of lactate and ventilatory threshold laboratory concepts. Mean Vo(2max) assessment scores were 86.39 +/- 4.13 and 85.64 +/- 6.72 and mean lactate and ventilatory threshold assessment scores were 85.50 +/- 8.05 and 86.15 +/- 6.45 for groups 1 and 2, respectively. These findings lend additional support to the following conclusion of similar investigations (2, 4, 6): that virtual laboratories instruct students as effectively as hands-on laboratories.

Graduating nurses' self-evaluation of information technology competencies

Using a standardized instrument, graduating baccalaureate nurses reported moderate information technology skills. The students were most confident in their Internet, word processing, and systems operations skills; the students' rated themselves lowest on care documentation and planning, valuing informatics knowledge, skills development, and data entry competencies. Exposure to the latest informatics systems was a priority. Students want fair access to informatics and technology-rich clinical settings; more realistic informatics and technology simulations; enthusiastic and capable faculty; and better hardware, software, and literature-searching support in agencies, classrooms, laboratories, and residences. Nursing programs, clinical agencies, and policy makers need to recognize that students are advancing beyond acquiring informatics skills to integrating health information literacy into practice. To facilitate current and future skills attainment and innovation, nursing informatics education and evaluation must keep pace.

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.

Computer-assisted instruction for novice nurses in critical care

The current worldwide nursing shortage is having the greatest effect on the critical care areas as novice nurses enter these specialty areas in unprecedented numbers. Massive healthcare restructuring, a rapidly aging nursing work force, and high nursing turnover and absenteeism rates have all contributed to a healthcare environment that is struggling to care for critically ill patients. Computer-assisted instruction in the form of interactive computer programs may be used as an adjunct educational resource for these novice practitioners. These programs have the potential to bridge the gap between theory and practice, which may assist the novice nurse in achieving safe, competent clinical practice.

Promoting Collaboration in Nursing Education: The Development of a Regional Simulation Laboratory

This article describes a collaboratively developed plan for a regional patient simulation laboratory for nursing education. The Western North Carolina Regional Simulation Laboratory will be located at the Enka Campus of the Asheville-Buncombe Technical Community College at the Department of Nursing of Western Carolina University (Candler, NC). A proactive collaborative consortium has been established to help meet the demand for nursing education in the 13 most rural mountain counties of western North Carolina. Through a 2-year process with regional networking, the nursing administration of Western Carolina University, Mission Hospitals, Asheville-Buncombe Technical Community College, and affiliated community colleges, consortium hospitals, and emergency care services developed a vision and a proposal for an innovative program for the nursing education of the future. The consortium proposed the establishment of a 3-year integrated educational program utilizing state-of-the-art simulation manikin technology. Financial resources were obtained from a charitable grant from The Duke Endowment (Charlotte, NC). Sustainability of funding will be ensured through university, hospital, and community college collaboration.

Simulated Clinical Experience

Simulation with high-fidelity technology is an innovative and effective teaching strategy to address increasing student enrollment, faculty shortages, and limited clinical sites. This interactive learning method allows the educator to focus on desired content and teach multiple objectives. This study examines students' perceptions of a preterm labor simulated clinical experience as a method of instruction, emphasizing the importance of the educators' role in promoting positive student outcomes.

A blended learning experience for teaching microbiology

OBJECTIVES

To create a virtual laboratory system in which experimental science students could learn required skills and competencies while overcoming such challenges as time limitations, high cost of resources, and lack of feedback often encountered in a traditional laboratory setting.

DESIGN

A blended learning experience that combines traditional practices and e-learning was implemented to teach microbiological methods to pharmacy students. Virtual laboratory modules were used to acquire nonmanual skills such as visual and mental skills for data reading, calculations, interpretation of the results, deployment of an analytical protocol, and reporting results.

ASSESSMENT

Learning achievement was evaluated by questions about microbiology case-based problems. Students' perceptions were obtained by assessment questionnaire.

CONCLUSION

By combining different learning scenarios, the acquisition of the necessary but otherwise unreachable competences was achieved. Students achieved similar grades in the modules whose initiation was in the virtual laboratory to the grades they achieved with the modules whose complete or partial initiation took place in the laboratory. The knowledge acquired was satisfactory and the participants valued the experience.

An Obstetric Simulation Experience in an Undergraduate Nursing Curriculum

Educators face the dilemma of conveying didactic information in concise, creative ways that evoke critical thinking. In addition, high patient acuity, coupled with a growing nursing shortage, requires assimilation of didactic knowledge into sound clinical judgment in a timely manner. Human simulation offers a creative teaching modality that allows transference of textbook knowledge into a real-life situation where nursing students can function in their role without untoward effects to their clients. The author illustrates the use of a human birthing simulator, Noelle, in an undergraduate nursing program as a creative and effective teaching strategy.

Simulation-based training is superior to problem-based learning for the acquisition of critical assessment and management skills

OBJECTIVE

To determine whether full-scale simulation (SIM) is superior to interactive problem-based learning (PBL) for teaching medical students acute care assessment and management skills.

DESIGN

Randomized controlled trial.

SETTING

Simulation center at a U.S. medical school.

SUBJECTS

Thirty-one fourth-year medical students in a week-long acute care course.

INTERVENTIONS

After institutional review board approval and informed consent, eligible students were randomized to either the SIM or PBL group. On day 1, all subjects underwent a simulator-based initial assessment designed to evaluate their critical care skills. Two blinded investigators assessed each student using a standardized checklist. Subsequently, the PBL group learned about dyspnea in a standard PBL format. The SIM group learned about dyspnea using the simulator. To equalize simulator education time, the PBL group learned about acute abdominal pain on the simulator, whereas the SIM group used the PBL format. On day 5, each student was tested on a unique dyspnea scenario.

MEASUREMENTS AND MAIN RESULTS

Mean initial assessment and final assessment checklist scores and their change for the SIM and PBL groups were compared using the Student's t-test. A p < .05 was considered significant. The SIM and PBL groups had similar mean (PBL 0.44, SIM 0.47, p = .64) initial assessment scores (earned score divided by maximum score) and were deemed equivalent. The SIM group performed better than the PBL group on the final assessment (mean, PBL 0.53, SIM 0.72, p < .0001). When each student's change in score (percent correct on final assessment minus percent correct on the initial assessment) was compared, SIM group students performed better (mean improvement, SIM 25 percentage points vs. PBL 8 percentage points, p < .04)

CONCLUSIONS

For fourth-year medical students, simulation-based learning was superior to problem-based learning for the acquisition of critical assessment and management skills.

Human Patient Simulators: A New Face in Baccalaureate Nursing Education at Brigham Young University

Simulation has been used to augment learning in the health care professions. The human patient simulator (HPS) has been used primarily by medical students but is now being used by nursing students, as well. This study explored the benefits and limitations of using an HPS as a patient substitute for one day of actual clinical experience for junior nursing students. Learning outcomes included increased student knowledge, ability, and confidence in medication administration.