Learning After the Simulation Is Over: The Role of Simulation in Supporting Ongoing Self-Regulated Learning in Practice

Virtual patients in undergraduate psychiatry education: a systematic review and synthesis

Virtual patients are increasingly used in undergraduate psychiatry education. This article reports on a systematic review aimed at providing an overview of different approaches in this context, describing their effectiveness, and thematically comparing learning outcomes across different undergraduate programs. The authors searched PubMed, PsycInfo, CINAHL, and Scopus databases for articles published between 2000 and January 2021. Quantitative and qualitative studies that reported on outcomes related to learners' knowledge, skills, and attitudes following an intervention with virtual patients in undergraduate psychiatry education were reviewed. Outcomes were thematically compared, and a narrative synthesis of the different outcomes and effectiveness was provided. Of 7856 records identified, 240 articles were retrieved for full-text review and 46 articles met all inclusion criteria. There were four broad types of virtual patient interventions: case-based presentation (n = 17), interactive virtual patient scenarios (n = 14), standardized virtual patients (n = 10), and virtual patient videogames (n = 5). The thematic analysis revealed that virtual patients in psychiatry education have been used for learners to construe knowledge about symptomatology and psychopathology, develop interpersonal and clinical communicative skills, and to increase self-efficacy and decrease stigmatizing attitudes towards psychiatric patients. In comparison with no intervention, traditional teaching, and text-based interventions, virtual patients were associated with higher learning outcomes. However, the results did not indicate any superiority of virtual patients over non-technological simulation. Virtual patients in psychiatry education offer opportunities for students from different health disciplines to build knowledge, practice skills, and improve their attitudes towards individuals with mental illness. The article discusses methodological shortcomings in the reviewed literature. Future interventions should consider the mediating effects of the quality of the learning environment, psychological safety, and level of authenticity of the simulation.

Principles of Effective Simulation-Based Teaching Sessions in Medical Education: A Narrative Review

A challenge for medical educators is to provide learning opportunities that allow students to develop technical and non-technical skills as set by the clearly defined learning objectives within their relevant institutions. This is particularly relevant in clinical education, which encompasses a vast majority of medical education. Specifically, clinical education is highly variable, with numerous distractions, interruptions and variability in learning experience and quality of clinical educators which often result in underprepared medical students by the time they transition into clinical practice. Simulation-based teaching (SBT) has been a key pedagogical approach that has been implemented into curriculum design to assist with addressing some of these educational challenges. However, their implementation is highly variable, and research into evidence-based best practice considerations in SBT design and implementation is fundamental to their success in medical student development. A narrative review was performed following a computer-assisted search on electronic databases Medline, Embase and Google Scholar. Relevant papers that explored the role of SBT in medical education were considered for this review. SBT is an important pedagogical approach to support the education of medical students. Their use has the benefit of providing a standardised and safe environment that mimics 'real life' as a means of allowing students to hone key skills with respect to clearly defined learning outcomes. The role of debriefing and feedback is crucial to the development of efficacious SBT programs, and therefore the upskilling and training of educators is a key aspect of evidence-based SBT design. Despite this, medical educators must be cognisant of the limitations of SBT. These include the cost and resources required to develop and implement SBT sessions, the effort and conceptualisation required to standardise and ensure these programs reflect real-life situations as well as the degree of training for facilitators to ensure they can best deliver and achieve learning outcomes and provide effective debriefing and feedback for students. Understanding the educational frameworks and the evidence-based best practice principles for SBT design and implementation is highly necessary for medical educators given the resource demands of SBT programs.

Three perspectives on learning in a simulated patient scenario: a qualitative interview study with student, simulated patient, and teacher

INTRODUCTION

Patient simulation can be useful for medical students in developing communication skills for vulnerable situations. Three participants are primarily involved in the patient simulation activities: the student, the simulated patient (SP), and the teacher. We here aimed to explore these participants' perceptions of learning in a patient simulation scenario.

METHODS

We conducted individual interviews with eight students, three teachers, and one SP at a psychiatry placement of a Medical Doctor Program (5th year). During the interviews we asked the participants to watch a video of their participation in a patient simulation session. Thus, we obtained three perspectives on each of the eight recordings. We analysed our data with qualitative content analysis.

RESULTS

Three themes were generated: identity formation, collaborative learning, and learning intentions. This highly emotional scenario forced students out of their comfort zone, to the intersection of their roles as private person and professional. The SP perceived the collaborative creation of the scenario as significant learning. The teacher took a professional position and perceived the learning in the perspective of a future colleague.

CONCLUSIONS

The mutually created emotionally loaded scenario was found to be important from all three perspectives, forcing the students to identify unexpected ways of communicating. This possibly enhanced their professional identity development. Implications for future research can be to explore the process of skills transfer.

Ticket to perform: an explorative study of trainees' engagement in and transfer of surgical training

BACKGROUND

Research suggests that simulation-based surgical skills training translates into improved operating room performance. Previous studies have predominantly focused on training methods and design and subsequent assessable performances and outcomes in the operating room, which only covers some aspects of training engagement and transfer of training. The purpose of this qualitative study was to contribute to the existing body of literature by exploring characteristics of first-year trainees' engagement in and perceptions of transfer of surgical skills training.

METHODS

We conducted an explorative study based on individual interviews with first-year trainees in General Surgery, Urology, and Gynaecology and Obstetrics who participated in a laparoscopic skills training program. Informants were interviewed during and two months after the training program. A thematic cross-case analysis was conducted using systematic text condensation.

RESULTS

We interviewed 12 informants, which produced 24 transcripts for analysis. We identified four main themes: (1) sportification of training, (2) modes of orientation, (3) transferrable skills, and (4) transfer opportunities. Informants described their surgical training using sports analogies of competition, timing, and step-by-step approaches. Visual orientations, kinaesthetic experiences, and elicited dialogues characterised training processes and engagement. These characteristics were identified in both the simulated and the clinical environment. Experiences of specific skills transfer included ambidexterity, coordination, instrument handling, and visuospatial ability. General transfer experiences were salient in informants' altered training approaches. Informants considered the simulation-based training an entry ticket to perform in the operating room and mentioned supervisor-trainee relationships and opportunities in the workplace as critical conditions of transfer.

CONCLUSIONS

Our findings elucidate characteristics of surgical training engagement that can be interpreted as self-regulated learning processes that transcend surgical training environments. Despite appreciating the immediate skills improvements resulting from training, trainees' narratives reflected a struggle to transfer their training to the clinical setting. Tensions existed between perceptions of transferable skills and experiences of transfer within the clinical work environments. These results resonate with research emphasising the importance of the work environment in the transfer process. Our findings provide insights that may inform the development of training programs that support self-regulated learning and transfer of training from the simulated to the clinical environment.

On embedding assessments of self-regulated learning into licensure activities in the health professions: a call to action

How well have healthcare professionals and trainees been prepared for the inevitable demands for new learning that will arise in their future? Given the rapidity with which 'core healthcare knowledge' changes, medical educators have a responsibility to audit whether trainees have developed the capacity to effectively self-regulate their learning. Trainees who engage in effective self-regulated learning (SRL) skillfully monitor and control their cognition, motivation, behaviour, and environment to adaptively meet demands for new learning. However, medical curricula rarely assess trainees' capacity to engage in these strategic processes. In this position paper, we argue for a paradigm shift toward assessing SRL more deliberately in undergraduate and postgraduate programs, as well as in associated licensing activities. Specifically, we explore evidence supporting an innovative blend of principles from the science on SRL, and on preparation for future learning (PFL) assessments. We propose recommendations for how program designers, curriculum developers, and assessment leads in undergraduate and postgraduate training programs, and in licensing bodies can work together to develop integrated assessments that measure how and how well trainees engage in SRL. Claims about lifelong learning in health professions education have gone unmatched by responsive curricular changes for far too long. Further neglecting these important competencies represents a disservice to medical trainees and a potential risk to the future patients they will care for.

Transfer of training from an internal medicine boot camp to the workplace: enhancing and hindering factors

BACKGROUND

The transfer of training to the workplace is the aim of training interventions. Three primary factors influence transfer: trainee characteristics, training design and work environment influences. Within medical education, the work environment factors influencing transfer of training remain underexplored. Burke and Hutchins' review of training transfer outlined five work environment influences: opportunity to perform, supervisor/peer support, strategic link, transfer climate and accountability. This study aimed to explore the ways in which work environment factors influence the transfer of training for medical trainees.

METHODS

Internal Medicine Training in Scotland includes a three-day boot camp involving simulation-based mastery learning of procedural skills, immersive simulation scenarios and communication workshops. Following ethical approval, trainees were invited to take part in interviews at least three months after following their boot camp. Interviews were semi-structured, anonymised, transcribed verbatim and analysed using template analysis. Member checking interviews were performed to verify findings.

RESULTS

A total of 26 trainees took part in interviews between January 2020 and January 2021. Trainees reported a lack of opportunities to perform procedures in the workplace and challenges relating to the transfer climate, including a lack of appropriate equipment and resistance to change in the workplace. Trainees described a strong sense of personal responsibility to transfer and they felt empowered to change practice in response to the challenges faced.

CONCLUSIONS

This study highlights barriers to transfer of training within the clinical workplace including procedural opportunities, a transfer climate with challenging equipment availability and, at times, an unsupportive workplace culture. Trainees are driven by their own sense of personal responsibility; medical educators and healthcare leaders must harness this enthusiasm and take heed of the barriers to assist in the development of strategies to overcome them.

Impact of palliative care simulation on nursing students' learning outcomes and reported use in hospital placement

Aim

Nursing students report emotional distress and feelings of inadequacy to the complexity of palliative care. This study aimed to examine nursing students’ attainment of learning outcomes in palliative care through simulation and hospital placement.

Design

A longitudinal, intervention study.

Methods

Fifty‐five second‐year bachelor nursing students participated. Three waves of assessments were performed: (1) pretest; (2) postsimulation test and (3) postplacement test after the completion of the placement. Non‐parametric Wilcoxon's signed‐rank test for paired samples was used to test for differences between assessments of knowledge, skills and competence before and after simulation, and between postsimulation and post hospital placement.

Results

The results showed positive differences between pre‐ and postsimulation, indicating that learning outcomes were attained through simulation. However, negative differences between the postplacement test and postsimulation test scores indicated that the participants had practiced learning outcome from the simulation to a small degree during placement.

The nature of learning from simulation: Now I know it, now I'll do it, I'll work on that

CONTEXT

Ongoing learning in complex clinical environments requires health professionals to assess their own performance, manage their learning, and modify their practices based on self-monitored progress. Self-regulated learning (SRL) theory suggests that although learners may be capable of such learning, they often need guidance to enact it effectively. Debriefings following simulation may be an ideal time to support learners' use of SRL in targeted areas, but the extent to which they are optimally fostering these practices has not been examined.

METHODS

A qualitative study informed by grounded theory methodology was conducted in the context of three interprofessional in situ trauma simulations at our level 1 trauma centre. A total of 18 participants were interviewed both immediately and 5-6 weeks after the simulation experience. Transcripts were analysed using an iterative constant comparative approach to explore concepts and themes regarding the nature of learning from and after simulation.

RESULTS

During initial interviews, there were many examples of acquired content knowledge and straightforward practice changes that might not require ongoing SRL to enact well in practice. However, even for skills identified as needing to be 'worked on,' SRL strategies were lacking. At follow-up interviews, some participants had evolved more specific learning goals and rudimentary plans for implementation and improvement, but suggested this was prompted by the study interview questions rather than the simulation debriefing itself.

CONCLUSIONS

Overall, participants did not engage in fulsome development of SRL plans based on the simulation and debriefing; however, there were elements of SRL present, particularly after participants were given time to reflect on the interview questions and their own goals. This suggests that simulation training can support the use of SRL. However, debriefing approaches might be better optimised to take full advantage of the opportunity to encourage and foster SRL in practice after the simulation is over.