La pédagogie par la simulation clinique haute-fidélité (SCHF) est de plus en plus utilisée dans la formation des étudiantes en sciences infirmières. Au cours des dix dernières années, plusieurs chercheurs ont tenté d’évaluer l’efficacité de la SCHF en évaluant les connaissances des étudiantes en sciences infirmières. Cependant, il existe un manque de connaissances relativement à l’effet de cette pédagogie sur les connaissances des étudiantes en pédiatrie. La présente étude quasi expérimentale avec post-tests avait pour objectif d’explorer l’effet de la SCHF sur l’acquisition et la rétention des connaissances des étudiantes francophones en soins infirmiers pédiatriques. Après une séance de SCHF pédiatrique, deux tests de connaissances ont été administrés dans un intervalle de 2 semaines à deux groupes d’étudiantes: un groupe témoin (1er post-test n= 17; 2e post-test n = 6) et un groupe expérimental (1er post-test n=8; 2e post-test n=5). Les deux groupes d’étudiantes ont participé à la SCHF pédiatrique. Cependant, les participantes du groupe expérimental ont aussi vécu une expérience réelle similaire au scénario de SCHF impliquant des soins à au moins un nourrisson durant leur stage clinique en pédiatrie. Les résultats du test U de Mann-Whitney suggèrent qu’il n’y a pas de différence significative (p = 0,63) entre les scores obtenus au 1er post-test pour les étudiantes des deux groupes. Quant aux résultats du test MANOVA, ceux-ci semblent indiquer qu’il n’y a pas de différence significative entre les scores obtenus au 1er et au 2e post-test des étudiantes, lorsque les deux post-tests sont considérés simultanément (p= 0,90) et séparément (1er post-test p= 0,94; 2e post-test p= 0,74). L’absence de différence significative entre les deux groupes de participantes aux deux post-tests pourrait démontrer que toutes les étudiantes ont acquis et retenu autant de connaissances, qu’elles aient vécu ou non une expérience réelle similaire au scénario de SCHF impliquant des soins à au moins un nourrisson durant leur stage clinique en pédiatrie. Les résultats de l’étude suggère que la SCHF est une pédagogie efficace pour former les étudiantes en sciences infirmières. Ainsi, la SCHF pourrait être utilisée pour remplacer quelques heures de stages cliniques en pédiatrie, ce qui pourrait aider à compenser le manque de disponibilité de stage en milieu pédiatrique. De plus, cette étude a pu expliquer l’effet de la SCHF sur l’acquisition et la rétention des connaissances des étudiantes à l’aide d’un cadre de référence inspiré du cognitivisme et socioconstructivisme. Bien que la SCHF semble avoir un effet positif sur l’acquisition et la rétention des connaissances des étudiantes en pédiatrie, des recherches additionnelles dans ce contexte de soins sont nécessaires.

This thesis explores the support of learning through reflection, in the context of medical students and practitioners, working through a series of simulated consultations involving the diagnosis and management of chronic illness. A model of the medical consultative process was defined, on which a web-based patient simulation was developed. This simulation can be accessed over the Internet using commonly available web-browsers. It enables users to interact with a virtual patient by taking a history, examining the patient, requesting and reviewing investigations, and choosing appropriate management strategies. The virtual patient can be reviewed over a number of consultations, and the patient outcome is dependant on the management strategy selected by the user. A second model was also developed, that adds a layer of reflection over the consultative process. While interacting with the virtual patient users are asked to formulate and test their hypotheses. Simple tools are included to encourage users to record their observations and thoughts for further learning, as well as providing links to web-based library resources. At the end of each consultation, users are asked to review their actions and indicate whether they think their actions were critical, relevant, or not relevant to the diagnosis and management of the patient in light of their current knowledge. Users also have the opportunity to compare their activity to their peers or an expert in the case under study. Three formal cycles of evaluation were undertaken during the design and development of the software. A number of clinicians were involved in the initial design to ensure there was an appropriate structure that matched clinical practice. Formative evaluation was conducted to review the usability of the application, and based on user feedback a number of changes were made to the user interface and structure of the application. A third, end user, evaluation was undertaken using a single case concerning the diagnosis and management of hypertriglyceridaemia in the context of Type 1B Glycogen Storage Disease. This evaluation involved ten medical students, five general practitioners and two specialists. The evaluation involved observation using a simplified think-aloud, as well as administration of a questionnaire. Users were engaged by the simulation, and were able to use the application with only a short period of training. Usability issues still exist with respect to the processing of natural language input, especially when asking questions of the virtual patient. Until such time that natural language recognition is able to provide satisfactory performance, alternative, list-based, methods of interaction will be required. Evaluation involving medical students, general practitioners, and specialist medical practitioners demonstrated that reflection can be supported and encouraged by providing appropriate tools, as well as by judiciously interrupting the consultative process and providing time for reflection to take place. Reflection could have been further enhanced if users had been educated on reflection as a learning modality prior to using SIMPRAC. Further work is also required to improve the simulation environment, improve the interfaces for supporting reflection, and further define the benefits of using this approach for medical education and professional development with respect to learning outcomes and behavioural change.

This thesis explores the support of learning through reflection, in the context of medical students and practitioners, working through a series of simulated consultations involving the diagnosis and management of chronic illness. A model of the medical consultative process was defined, on which a web-based patient simulation was developed. This simulation can be accessed over the Internet using commonly available web-browsers. It enables users to interact with a virtual patient by taking a history, examining the patient, requesting and reviewing investigations, and choosing appropriate management strategies. The virtual patient can be reviewed over a number of consultations, and the patient outcome is dependant on the management strategy selected by the user. A second model was also developed, that adds a layer of reflection over the consultative process. While interacting with the virtual patient users are asked to formulate and test their hypotheses. Simple tools are included to encourage users to record their observations and thoughts for further learning, as well as providing links to web-based library resources. At the end of each consultation, users are asked to review their actions and indicate whether they think their actions were critical, relevant, or not relevant to the diagnosis and management of the patient in light of their current knowledge. Users also have the opportunity to compare their activity to their peers or an expert in the case under study. Three formal cycles of evaluation were undertaken during the design and development of the software. A number of clinicians were involved in the initial design to ensure there was an appropriate structure that matched clinical practice. Formative evaluation was conducted to review the usability of the application, and based on user feedback a number of changes were made to the user interface and structure of the application. A third, end user, evaluation was undertaken using a single case concerning the diagnosis and management of hypertriglyceridaemia in the context of Type 1B Glycogen Storage Disease. This evaluation involved ten medical students, five general practitioners and two specialists. The evaluation involved observation using a simplified think-aloud, as well as administration of a questionnaire. Users were engaged by the simulation, and were able to use the application with only a short period of training. Usability issues still exist with respect to the processing of natural language input, especially when asking questions of the virtual patient. Until such time that natural language recognition is able to provide satisfactory performance, alternative, list-based, methods of interaction will be required. Evaluation involving medical students, general practitioners, and specialist medical practitioners demonstrated that reflection can be supported and encouraged by providing appropriate tools, as well as by judiciously interrupting the consultative process and providing time for reflection to take place. Reflection could have been further enhanced if users had been educated on reflection as a learning modality prior to using SIMPRAC. Further work is also required to improve the simulation environment, improve the interfaces for supporting reflection, and further define the benefits of using this approach for medical education and professional development with respect to learning outcomes and behavioural change.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 4 uppsatser.

abstract: The purpose of this study was to investigate the use of the design characteristics component of the Jeffries/National League for Nursing Framework for Designing, Implementing, and Evaluating Simulations when developing a simulation-based approach to teaching structured communication to new graduate nurses. The setting for the study was a medium sized tertiary care hospital located in the southwestern United States. Participants in the study were an instructional designer (who also served as the researcher), two graduate nursing education specialists, one unit based educator, and 27 new graduate nurses and registered nurses who had been in practice for less than six months. Design and development research was employed to examine the processes used to design the simulation, implementation of the simulation by faculty, and course evaluation data from both students and faculty. Data collected from the designer, faculty and student participants were analyzed for evidence on how the design characteristics informed the design and implementation of the course, student achievement of course goals, as well as student and faculty evaluation of the course. These data were used to identify the strengths and weaknesses of the model in this context as well as suggestions for strengthening the model. Findings revealed that the model generally functioned well in this context. Particular strengths of the model were its emphasis on problem-solving and recommendations for attending to fidelity of clinical scenarios. Weaknesses of the model were inadequate guidance for designing student preparation, student support, and debriefing. Additionally, the model does not address the role of observers or others who are not assigned the role of primary nurse during simulations. Recommendations for strengthening the model include addressing these weaknesses by incorporating existing evidence in the instructional design of experiential learning and by scaffolding students during problem-solving. The results of the study also suggested interrelationships among the design characteristics that were not previously described; further exploration of this finding may strengthen the model. Faculty and instructional designers creating clinical simulations in this context would benefit from using the Jeffries/National League for Nursing Model, adding external resources to supplement in areas where the model does not currently provide adequate guidance. / Dissertation/Thesis / Ph.D. Educational Technology 2011

Human patient simulation (HPS) has been used for over 40 years in medical education. A human patient simulator is a life-like, anatomically correct, computer driven mannequin with physiologic responses that mimic real patients. Since the introduction of computerized HPS in 2000, its use by medical and nursing students has grown exponentially. Approximately 500 nursing schools are using human patient simulators in nursing education. Researchers have suggested that using HPS can assist in reducing the gaps between theory and practice by improving critical thinking, decision making and patient outcomes. An increase in recognition of medical errors has dictated the need to improve education by allowing students and clinicians to learn in an environment that permits errors and do not put real patients in danger. However, there is a dearth of research on the benefits, advantages and disadvantages of HPS as well as the learning experiences of students who used HPS in their nursing education. Therefore, the purpose of this qualitative study was to describe and analyze the learning experience of baccalaureate nursing students who used HPS during their education. Focus group interviews with HPS students were recorded and transcribed for content analysis in NVIVO, a qualitative analysis software program. The results of the analysis were categorized into four major themes: Structure, Environment, Instructor and Learning. The findings revealed that HPS students felt that structure was critical to optimize learning opportunities. Students wanted to be properly oriented to the environment of the HPS sessions, and they felt that the lack of realism of the simulators did not negatively affect their learning. Students wanted knowledgeable and competent instructors who had good interpersonal communication and interaction skills. Last, students expressed that there were benefits from acting as both the nurse and the observer during HPS. The opportunity to make mistakes without harming a patient and to experience different types of nurse-to-nurse reports were viewed as positive. The findings of the study suggested that further research about student perceptions of HPS learning experiences could provide valuable information for educators and policymakers to improve the implementation of HPS in nursing and medical education.

This article outlines a process for developing standardized patient cases. The initial step in the process is to define the educational goals of the exercise. Following this step the patient characteristics, setting for the interaction and clinical information are developed. Clinical information, in addition to history, may include elements of nonverbal communication, actual or simulated abnormal physical findings, and laboratory results. Guidelines for the standardized patient regarding disclosure of information to the student and providing feedback to the student enhance the value of the case. If the case is to be used as part of an examination, a grading system must be developed. Issues of cost, validity, and reliability are briefly addressed. .

This study addressed the use of simulation as an adjunct to experiential learning in nursing education. The purpose of this study was to determine the perceived needs of faculty required for successful incorporation of simulation in nursing curricula in associate degree nursing programs in the southern region of the United States. This study further explored experienced nursing faculty perceptions regarding how simulation can enhance or supplement specific components required in nursing curricula. The population was a convenience sample of faculty members teaching in public funded NLNAC accredited associate degree nursing programs in the southern region of the United States. Data were collected using the Barriers to Simulation Utilization scale, a demographic questionnaire, and a researcher developed question exploring the current use and perceived acceptable use of simulation in associate degree education. This study found that associate degree nursing faculty in the southern region of the United States perceive that adopter/innovation and organization/communication factors are facilitators of simulation. Organizational support, adequate training, faculty workload consideration, and the use of a technology or simulation coordinator were identified as factors that may facilitate the use of simulation in associate degree programs. Components of nursing curriculum were identified that could be taught using simulation. The results of this study are consistent with others and add to the body of knowledge related to faculty needs for successful incorporation of simulation in nursing curricula.

Book Summary: High Fidelity Patient Simulation in Nursing Education is a comprehensive guide to developing and implementing a high-fidelity patient simulation in a clinical setting. It is a necessary primer for administrators and nursing programs starting out with this technology. It includes examples for setting up a simulator program for nurses, developing and implementing this technology into particular clinical and laboratory courses, and setting up refresher courses in hospital settings. The text features appendices and case scenarios.

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