Running head:SIMULATION-BASED EDUCATION

ULATION-BASED EDUCATION

Introduction

Simulation-based learning is a widely used method for enhancing the clinical expertise of medicine and

nursing students. Clinical situations are generated for the nursing, medicine and pharmacy students by the use of

mannequins, simulated patients, part-task trainer, and computer-generated simulations. ( Weller et al, 2012).

Simulation-based learning provides the students with the opportunity to learn and practice clinical skills

without the use of live patients. Simulation makes it easier for the learner to receive professional feedback. This

also brings opportunities for repetition.

Theoretical Underpinning

Experimental Learning

In Kolb’s Experimental learning theory, knowledge is generated through the experiences which are

transformed. Kolb’s learning theory is consist of four phases. Each of these phases has a significant role in

simulation-based education. According to the Kolb, learner learns from the experience, such as in the

simulation. The student exposure to the simulation, where the clinical situation is generated and the student

learns by the experience of the simulated based clinical situation. The student reflects on this experience in the

future for clinical situations and uses his knowledge built through experience to improve future outcomes. For

example, Kolb experimental learning is integrated to improve simulation-based interprofessional education to

improve communication and collaboration among healthcare professionals. The students have the opportunity

to share their ideas and belief with each other during the simulation practices. The greater the number of

simulation-based activities students participate in, the greater the development of communication and

collaboration skills.IPE facilitates collaboration and communication through teamwork among the healthcare

professionals that leads to improving patient safety, healthcare outcomes and quality of life. ( Poore et al, 2014).
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Simulation provides the firm experience, which enables the educator to identify the knowledge gaps, upon

which the learner can act. Sometimes the experience is stressful and challenging, but an optimally designed

simulation-based education provides with the meaningful reflection rather than the stressful which impede the

learning process. Debriefing makes the leaner to reflect on his own performance. Educators by providing a

clinical view of the learner activity can facilitate the reflective observation. Video-enhanced debriefing is useful

for this process. ( Zigmont et al, 2011).

Knowles Adult learning theory (Andragogy)

Simulation-based education requires the educator to have a better understanding of the adult learning

theory and experimental learning. The use of pediatric medication is because the children respond differently

than adults. Similarly, the mental process of adults are different, they require different attention and education

technique than the children. The Knowles explain this in his adult learning theory. Adult learner learns what is

needed to learn and what time it is required. Adult learn are intrinsically motivated and know that the outcomes

of simulation-based learning will be practical. The simulation-based education built the self-efficacy and self-

confident in the students because it allows the experimental practice of the skill. It promotes the community and

increases autonomy and competence, which promotes the adult to learn. A self-effacing and ancillary

environment is created by the educator in simulation, which protects the confidentiality of the learner and

maintains his motivation towards simulation-based education. Unlike lecture-based education, confidentiality is

the major factor of simulation-based learning as the whole procedure performed by the learner is watched and

observed by the group. An important element of simulation-based education is briefing. Briefing allows trust,

respect, and support. The educator must introduce all the individuals in the group, elaborate the course outline

including the rules for participation in the scenario, preparation of the confidentiality agreement which protects

the individual performance and issues raised during the group discussions. Experiences serve as a catalyst for
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learning. The debriefing is the main component of the simulation-based learning that follows the experience

( Zigmont et al, 2011).

Deliberated Practice in Simulation-based Education

The use of team-based skills in simulation-based education to improve patient safety and healthcare

outcomes is widely practiced now. The members of a team must be skilled enough in their profession. The

deliberate practice provides a way for skill improvement and professional capabilities. It improves learner skills

beyond the current level. There are different components of the deliberated practice which improves the clinical

skills of the learner including reflection, ongoing reflection. Reflection makes the learner to learn the new skill,

with a feeling that he does not know the skill properly. This reflection makes the learner improve his skill

performance in a safe optimal environment to improve clinical skill. In ongoing reflection, the learner evaluates

and evaluate the performance held in his memory. In simulation-based learning, simulation facilitator helps the

learner individually and team to improve the existing skill and practice by incorporating the reflection and

ongoing reflection components of the deliberated learning. Educator design the deliberate practice to improve

the skill the learner used rarely or is afraid of using or dislike to practice. (Clapper & Edgren , 2012).An

example of the deliberated practice is the use of the portable cardiopulmonary resuscitation manikin with

automated feedback built in. This manikin was used for 15 weeks by the 420 staff members. This lead to

improved in CPR skills as compared to the infrequent training. (Niles et al, 2009).

Healthcare simulation is a useful tool education tool which facilitates learning for clinicians and

improves healthcare outcomes and patient safety. In order to improve simulation-based education for the

learner, the educator needs to understand the learner, his experience and environment for his working. (Zigmont

et al, 2011)
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Peyton Four-Step Approach

Skill lab training is used nowadays as a methodological teaching approach in medical faculties. It allows

the students to practice on mannequins, or the patient simulators prior to performing on real patients. Peyton

four-step approach consist of four instructional steps:

Demonstration: In the demonstration step, the educator demonstrates the skill to the learners.

Deconstruction: In deconstruction step, the educator repeats the steps and elaborate the sub-steps.

Comprehension: In the comprehension step, the learner explains the step to the educator.

Performance: In the performance step, the Learner performs the clinical skill on his own, without any

external help.

These steps help in the simulation-based learning as the educator explaining the steps to the learner, the

learner is memorizing the steps, and then repeat the demonstration as done by the educator and then by

performing the steps, he practices them and get memorize. The Peyton model involves learning through

observation, action, teaching, and repetition (Nikendi et al, 2014).

I have designed the Peyton four-step approach for the measurement of blood pressure. The third-year

medical students were included in the Peyton four-step approach. I have used a patient simulator for this

study.

Importance of Patient simulator

The use of patient simulator has been increased in medicine, nursing, and pharmacy education. Using

a patient simulator for the blood pressure measuring is the part of the curriculum of the University. Patient

simulators are used to learn complex clinical situations. It allows the learner to focus on procedure,

providing them with the opportunity of learning as much as needed. As the environment is safe, so the

learner can fail in performing a function, and can learn from that failure as compare to real patients where

there is no chance of failure and put stress on the learner, he is unable to test his capabilities on a real

patient. The feedback provided by the simulator is also useful for learner performance. Another importance

of using patient is that learner is uncomfortable with the use of the live animal as sometimes use in

pharmacological studies or deceased patients as used in surgical experiences. ( Good, 2003)

Peyton Approach for Blood Pressure measurement

Demonstration:

In the demonstration step, the educator explains all the necessary step to the learner. As here im

using the patient simulator, so the educator explain these steps while using the patient simulator.

Deconstruction:

In deconstruction step, the teacher demonstrates all the necessary steps to the students. In this

step, all the sub-steps are also performed. The teacher demonstrates to the students the procedure for

measuring blood pressure for the patient simulator. It involves the use of sphygmomanometers. The teacher

elaborate to the students to wrap the cuff around the arm of the simulator patient. The cuff's lower edge

should be one inch above the antecubital fossa. The cuff was inflated to 180mmHg .The rate at which the air

is realased from the cuff was 3mm/sec.. ( Seybert & Barton, 2007).
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Comprehension: The learner repeats the steps demonstrated by the educator. This step allows the learner to

interpret what he has observed in the demonstration and deconstruction.

Performance: This step is actually the action performed by the leaner on the basis of observation and

memorization of the blood pressure measuring steps on the patient simulator.

Pendleton model used for feedback

Pendleton model is used to give feedback in the clinical education. It can be given at first hand or by

the videos. The feedback is important as it allows the students to improve his clinical practice and fulfills

the gap. Feedback can be made parallel to effective debriefing in the simulation. The individual receptivity

to the feedback can vary, but it is important for the assessment of the clinical performance. Feedback is

actually the information provided to the learner about the gap between the performance and the standard.

debriefing and feedback are parallel in clinical education and can be said as two sides of the same coin.

( Stephan & Rose,2015).

References

1. Good., M., L.(2003). Patient simulation for training basic and advanced clinical skills, Medical

Education,37(1), 14–21.

2. Nikendei., C., Huber., J., Stiepak., J.,….Krauttar., M.(2014). Modification of Peyton’s four-step

approach for small group teaching – a descriptive study, BMC Medical Education,14(68),1-10.
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3. Niles, D., Sutton, R., Donoghue, A., Kalsi, M., Boyle, L., Nishisaki, A., et

al. (2009). ‘‘Rolling refreshers’’: A novel approach to maintain CPR

psychomotor skill competence. Resuscitation, 80, 909-912.

4. Poore., J., Cullen., D., & Schaar., G.(2014). Simulation-Based Interprofessional Education

Guided by Kolb’s Experiential Learning Theory, Clinical Simulation in Nursing, (10), 241-247.

5. Stephan., V., & Rose., H.(2015). Debriefing and Feedback: Two Sides of the Same Coin?,  The

Journal of the Society for Simulation in Healthcare, 10(2),67-68.

6. Seybert., A., L/. & Barton., C., M.(2007). Simulation-based learning to teach blood pressure

assessment to the doctor of pharmacy students, American Journal of Pharmaceutical Education, 71

(3),1-5.

7. Weller., J., Nestrel., D., Marshall., S., Brook., P & Conn., J.(2012). Simulation in clinical

teaching and learning, Medical Education,196(9),1-6.

8. Zigmont., J ., Kappus., L & Studikoff., S.(2011). Theoretical foundations of learning through

simulation, Seminars in Perinatology,47-50.