During the 2021 International Meeting on Simulation in Healthcare (IMSH) virtual simulation conference weekly lecture series, “Bringing Simulation Research To Life,” the presentation “How Research is Advancing Healthcare Practice” was given by Gabriel Reedy, PhD, CPsychol, FSSH of King’s College in London. Dr. Reedy examined the relationship between clinical simulation, healthcare practice and simulation research, identifying some recent research which links the three fields together. The presenter noted that research is a systematic process with a clearly defined goal to understand more about a particular system or subject. In other words, research answers questions.
He continued that research is a rigorous activity where data is collected, analyzed and interpreted in light of existing evidence in order to add to the body of knowledge. This process should always be open to public scrutiny. According to academic John W. Creswell (1998), research has defined a number of distinct steps: identifying a research problem, completing a literature review, defining a purpose, generating data, analyzing data, interpreting data, and reporting and evaluating results.
Dr. Reedy related research to healthcare simulation by using The Research Compass developed by Ringsted et al. (2011). He noted that research, including that related to medical education, can take on different forms which are identified by different names but are all related to one another. The compass consists of four points:
Justifying Involves observational studies which seek to understand and predict how the world works. Predicting Translational studies which seek to understand the ways in which ideas are implemented. Implementing Explorative studies which seek to identify different ways of doing things and what happens when we implement new ideas. Modelling Experimental studies which seek to model or justify a particular way of doing things.
Dr. Reedy believes that clinical simulation research will provide a deeper and better understanding of learning and teaching. Ultimately, research will improve and even generate ways to use sim to enhance the clinical practices of ourselves and others. Further, researchers are like masons building a wall, brick by brick. Each brick is the result of a piece of research. Each completed brick must be checked to see how it fits in the wall and likewise, research must be checked against existing data. As the wall grows, it needs to be evaluated for dimensions and functionality. Likewise, healthcare simulation research needs to be evaluated for its use value in improving clinical practice and patient outcomes.
The second half of the lecture was devoted to identifying common themes in recent healthcare simulation research articles published by three prominent clinical simulation research journals: Clinical Simulation in Nursing (INACSL), Advances in Simulation (SSH) and BMJ Simulation and Technology Enhanced Learning. The four main themes identified are listed below along with articles related to the themes.
Simulation in New Domains of Healthcare: Helping to train people using simulation to do activities they have not previously been trained to do. Boruff, R. (2020, August). Preparing Nursing Students for Enhanced Communication With Minority Populations via Simulation. Clinical Simulation in Nursing 45(C), 47-49. A cross-discipline healthcare simulation bringing together nursing students and language learners to create a learning environment for both groups. The language learners assumed the role of interpreters for patients in underserved communities. Akber, B.A. et al. (2021). Simulated Learning in Rural Community Environment: pushing the boundary. Advances in Simulation. 6-5. Describes the setup of a simulated rural village within a clinical simulation center. The researcher’s goal was to use simulation to prepare HCW to take care of people from rural communities. Without clinical simulation, medical students would have no training in treating patients in a rural setting. Our Learners Matter: Simulation research allows educators to observe what learners do and obtain feedback about their learning experience. These studies may be qualitative and/or quantitative in nature. Naismith, L et al. (2020). Participant Perspectives on the Contributions of Physical, Psychological, and Sociological Fidelity to Learning in Interprofessional Mental Health Simulation. Sim Healthcare 15: 141-146. This study explores the concept of fidelity in mental healthcare education. The authors seek to identify how important clinical fidelity is to learners and how it affects the learner’s experience. The COVID-19 pandemic has affected fidelity by eliminating much in-person healthcare simulation. The study indicated that both psychological and sociological aspects of healthcare simulation were most important to learners; however, the learners still found the clinical simulation helpful even if the sociological aspects did not match their clinical experience. Stokes-Parish, J. et al. (2020). How Does Moulage Contribute to Medical Students' Perceived Engagement in Simulation? A Mixed-Methods Pilot Study. Advances in Simulation, 5-23. This study investigated whether the intensity of moulage affected learner engagement. Senior medical students participated in various mountain bike trauma simulations which were identical except for the level of moulage. The three levels of moulage were: no moulage (only verbal descriptions), minimal moulage and extensive moulage. Overall, the learners reported that moulage was not a significant factor for their engagement. The authors suggested that these higher-level students had received extensive training and were therefore experienced in focusing on their learning beyond the moulage. However, the authors determined from other components of the study that this may not be true for new medical students and thus concluded, ”Within the context of undergraduate medical students, the use of authentic moulage may provide more consistent patterns of engagement, as compared to no or poor-quality moulage in clinical simulation.” The authors also suggested that moulage may provide a more realistic process of prioritizing care, thereby contributing to deep learning. Well-being of HC professionals matters: this aspect of healthcare was highlighted during the COVID-19 pandemic where practitioners were often fatigued and stressed. Pollard, C. et al. Managing Student Workload in Clinical Simulation: A Mindfulness-Based Intervention. BMJ Simulation and Technology Enhanced Learning 6:356-359. This study concluded that short mindfulness activities for learners given during pre-briefing sessions affected the learners' perceptions of workload. For example, the learners who participated in the mindfulness activity felt less time pressured than those learners who did not. Allen, M. et al. (2020). Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. Clinical Simulation in Nursing 39, 1-6. This study investigated factors which help to create a sense of well-being in clinical simulation. Well-being was measured at three different times in healthcare simulation: prior to, immediately after and later on following debrief. An effective debrief was found to enhance the learners' feelings of well-being. The Patient Perspective Matters. Sagalowsky, S. et al. (2020). Lessons Learnt from Piloting Paediatric Patient-Focused and Family-Focused Simulation Patients and their families were invited into the planning phase of OSCEs for medical students. The authors suggest that patients and families can make a huge contribution to learners' communication skills. The following are examples of areas where families felt learners needed to communicate more: informing patients about what they are doing during an assessment and why they are doing it, using age appropriate language with pediatric patients, including the family members in the conversation and being considerate of a patient’s privacy. Learners may have implicit biases particularly towards sexual orientation, changed character names, histories (disabilities) and skin color. Waxman, KT. et al. (2020). Using Simulation To Provide Culturally Competent Care To Transgender and Gender Nonconforming Patients. Identifies specific issues faced by these patients and notes the importance of including patient suggestions in scenario design. The study included detailed scenario scripts which could prove instrumental for others creating similar scenarios.
Healthcare simulation research is varied and has many different goals. Such research is both influenced by and influences healthcare practice and clinical simulation practice. Dr. Reedy points out that clinical simulation research literature, although often subjective, has value. He invites attendees to consider how they may contribute to simulation research and thus improve the body of knowledge related to the effectiveness of healthcare simulation.
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