Students' experience and perceived value of a clinical simulation centre

Aims

The study had two aims:

Methodology

This study, which took place from July 2016 to May 2017, used evaluation research with the iterative evaluation model (IEM) for improving online educational resources (Ooms and Garfield, 2008) as the theoretical framework. IEM is a validated evaluation model involving four components: learner engagement; perceived educational value; impact on attitudes, knowledge and skills; and sustainability (the ongoing ability for the resource to meet its intended goals).

The study was based around evaluation, so there was no need for Health Research Authority approval. The university's faculty research ethics committee decided this study did not require a full ethics review.

Results

Of the 187 paramedic students (100 BSc/87 FdSc) studying at the time, 33 completed the questionnaire, giving a response rate of 17.6%. Of the participants, 25% were enrolled in the FdSc programme and 75% in the BSc programme. More than 83% of them were direct entry and the remaining 17% were in service. While Van Mol (2017) suggests that an average response rate of 30% can be achieved for online surveys, recent studies have seen a diminishing return because of a number of design and human factors (Saleh and Bista, 2017). Nevertheless, clear themes emerged from the data which can be used to enhance the learners' experiences and improve the simulation centres.

The quantitative data demonstrated the effectiveness and impact of the three environments on students' development in the areas of knowledge, skills and practice (Table 2). To support this, data on the perceived learning opportunities and benefits were recorded (Table 3), and the following four core themes of access, engagement, support and sustainability were identified:

The qualitative data were aligned to both support and expand these quantitative themes. Following analysis of the open-ended questions, the following six themes emerged:

Discussion

With the introduction of simulation centres worldwide, the opportunities afforded to various clinical programmes have continued to grow. While these facilities offer a new environment to enhance the development of knowledge and a range of skills, their use must be appropriately integrated within the curriculum to fully engage students by improving the overall learning experience (Aebersold, 2018).

The data collected in this study have provided not only a greater level of understanding about the overall value and impact of simulation centres and their sustainability but also new insight into how students perceive their engagement with simulated learning and how this benefits their development and perceived levels of preparedness for their role.

In this setting, students thought that access to the PCSC was fairly good, allowing them to use it on a regular basis. The diverse nature of the facilities within it meant they could work independently or in small groups in a number of locations, undertaking a variety of learning activities and receiving peer or lecturer feedback as they progressed.

Students highly rated the SS because of its ability to mimic the environments and activities seen within their clinical work and placements. This is becoming more important as the number of health students requiring clinical placement hours has continued to rise and situations, such as those seen within the COVID-19 pandemic, meant fewer clinical placements were available (Williamson et al, 2020; Sani et al, 2020; Stout et al, 2021).

A common theme was around students wanting more access outside the normal 9:00–17:00 working day. This was previously discussed by Motola et al (2013) and Alshammari et al (2018), who identified the importance of creating an environment where students can optimise their performance while controlling their own development.

Irrespective of setting, being given the freedom to develop their knowledge and practice their skills in a safe, controlled environment at their own pace is important for students to build their confidence (Mortimer, 2018), but competent support is also vital to ensure that any simulated learning is effective (Caroll and Eaton, 2019).

The importance of support and an effective pre-briefing and debriefing process facilitated by trained staff was discussed by Sawyer et al (2016), So et al (2019) and Alinier and Oriot (2022), and demonstrated by Alshammari et al (2018) in their study of Asian nursing students. The present study supports this in relation to the IR, which students perceived as an ineffective learning environment when suitable faculty staff are not present. This absence of support often resulted in the room being used just as an open space, where students practised skills without using any enhanced immersion.

Support for and during learning within simulation was a recurring theme throughout this study, despite the various levels needed within the different rooms. Primarily concerned with clinical and academic support and less related to the use of equipment or technical devices, this was predominantly provided during planned sessions and as part of the taught day.

While the authors know that led, directed and non-directed learning took place in all the three rooms, they did not investigate how frequently each strategy was used. It was clear that any additional hours of supervision and guidance by faculty members was provided sporadically, such as during lunch or after the planned day had ended and was solely reliant on whether faculty staff were available. This support mechanism is an important factor, as a reduced structure and debriefing process can discourage students from accessing such facilities in the future (Motola et al, 2013; Carroll and Eaton, 2019).

Despite this issue, students' perceptions of simulation were very positive and echoed the findings of other studies that a good level of fidelity and communication are seen as essential to effective learning (Lemay et al, 2018; Bogossian et al, 2019). Students can see its potential benefits and can structure their studies accordingly.

It is imperative that the use of simulation centres is an integrated part of the curriculum rather than an add-on (Stefanidis et al, 2015; Aebersold, 2018). Currently, students perceive that simulation activities link well to their lectures allowing for a greater level of theory-to-practice transition and closing the theory-practice gap (Makransky et al, 2016; Brown et al, 2019). However, as Dudding et al (2018) discuss and the Unver et al (2018) study of Turkish nursing students shows, more needs to be done to fully integrate this style of learning into the wider curriculum. Through development of a suitable support system and provision of greater access and opportunities, students are more freely able to solidify their individual learning needs and engage to a greater extent (Humphreys, 2013; Sawyer et al, 2016; Chernikova et al, 2020).

Students by their very nature are always developing in both their knowledge base and the way in which they learn (Hu et al, 2021). Therefore, as Cadorin et al (2012) demonstrated in their study of Italian nursing and radiology students, diversity in terms of levels of knowledge, understanding and skills is varied and requires education that is tailored to their needs to be provided; all too often, certain students fall behind (Shin et al, 2019; So et al, 2019).

Presenting environments and situations that provide stimulating learning events is essential to increasing student engagement (Sadideen et al, 2012; Shin et al, 2019; So et al, 2019; Idris et al, 2021). In addition, providing activities and resources so students can excel beyond the expected objectives while giving them control of their own learning is critical to them achieving a positive outcome (Motola et al, 2013; Alshammari et al, 2018; Kennedy et al, 2019).

As curriculums develop and more health professionals are educated and trained, new ventures such as simulation centres are at risk of having a short lifespan and could easily become a selling point for an institution or course. This may result in their potential being wasted (Brandão et al, 2018; Delisle and Hannenberg, 2020).

It is therefore important to evaluate the use and impact of such educational facilities so that institutions can make evidence-based decisions on how best to incorporate their use within their curriculum. To this end, the paramedic faculty being studied has used available data such as that in this research and undertaken significant work to improve the use of simulation within the curriculum and engage students to a higher level, thereby maximising its overall impact and associated benefits.

Limitations

This study has a few limitations. First, it was undertaken at a single university and focused on a newly developed simulation centre.

Second, while its focus was on student perceptions of the PCSC, these facilities are clearly only part of what is needed to provide an efficient and effective learning environment. A greater understanding of the activities that are facilitated within and the full range of support accessible to students was not explored as part of this study.

Finally, the questionnaire had a low response rate, which limits the generalisability of the study results. The tailored design method was used to develop and administer the questionnaire with the aim of increasing response rates and minimising the burden on participants. However, reasons for low response rates are complex, with the length of the questionnaire being one factor. Fewer students responded to the questions near the end of the questionnaire, so it is likely that they became fatigued and their responses may potentially be less accurate. As a result, findings need to be interpreted with caution.

Future studies should consider modifying both recruitment and data collection strategies to engage more students with research. While participants did not have to answer every question, a shorter questionnaire or series thereof may facilitate greater engagement and strengthen the final data. Allocating a time slot within the student schedules or alternative data collection methods could be considered.

It is also important to note that while means are presented, given the small sample size, they can be used only to identify a trend in the data and need to be interpreted with caution.

Conclusion

With the greater use of simulation and introduction of simulation centres worldwide, the opportunities afforded to varying clinical programmes have continued to grow, and the decision to invest in simulation centres seems to have been the right one.

However, it is imperative that, while these facilities do offer a new environment in which students can develop knowledge and skills to maximise their impact and effectiveness, it is essential to fully integrate their use within the curriculum. As this study has demonstrated, simulation centres of this type are essential in enhancing the overall learning experience and development of students' confidence, knowledge and skills, as well as their overall ability to excel academically and professionally. Such centres do not work in isolation and an effective infrastructure with suitable support mechanisms and developmental opportunities available to all learners is imperative to maximise the overall impact of the learning environment.

This is something higher education institutions worldwide need to instil in their programmes as they learn to educate in line with the limitations associated with situations such as the COVID-19 pandemic.

Recommendations

Simulation as an additional pedagogical approach to learning has shown its worth in this and in previous studies. However, how simulation is used within the curriculum is not always as effective as it could be, and it is imperative that educators that provide education/training facilities understand the potential of simulation learning to complement the academic experience of students.

Simulation should be integrated to complement and expand the learning environment, so simulation rooms are used for their intended purpose, not just because they are available.

Having facilities that are not available when students want or need them most to practise their skills can create barriers to learning and motivation. Accessibility of facilities outside standard teaching hours, like access to the library, is desirable if not essential to offer students the ability to consolidate what they have learned through the day.

Finally, providing adequate academic support in simulation centres is essential. Practising alone and within groups is important as everyone learns differently, but the availability of a lecturer who can provide both a structured pre-brief and immediate debrief that facilitates guided reflection has a positive impact on the level of support perceived by students, as well as on their safety (Lane and Mitchell, 2013; Alinier and Heinrichs, 2019; Zhang et al, 2020; Schertzer and Waseem, 2021; Alinier and Oriot, 2022). Furthermore, it limits the likelihood of negative learning, where students develop misconceptions and poor practice when transitioning theory into practice.

Key Points

CPD Reflection Questions