International Journal of Healthcare Simulation

Background:

Annually, approximately 80 undergraduate physiotherapy and occupational therapy students participate in simulation-based learning, as part of a second-year module. The experience provides opportunities for students to achieve core module outcomes, such as developing communication skills, inter-professional practice and clinical reasoning. The simulation is supported by a small team of academic faculty and a professional actor, all trained in simulation and debriefing. The students are required to assess an older person at home as part of an emergency response team. They work in groups of up to eight students, are pre-briefed and given a profession-specific written brief of their role in the scenario. A two-pronged approach to debriefing is used; the origami approach, utilizes pauses to capture teachable moments ^[1], and the advocacy-inquiry approach, used to reflect on the experience ^[2]. The simulation itself is not assessed; the students write a reflective assignment through the simulation lens, discussing the concepts of effective collaborative practice.

Aim:

The aim of the study was to identify the mechanisms used in simulation-based education that support development of collaborative practice skills of undergraduate students.

Method:

The simulation-based learning scenario was iteratively developed, delivered and evaluated over 3 years. Staff reflection and content analysis of 3 years of feedback from anonymous evaluation questionnaires, and a sample of student assignments, were used to identify aspects of simulation delivery that supported students’ development of collaborative practice.

Results:

Although students consistently report anxiety about participating in the simulation, they also identify it as one of the most intense but helpful learning experiences of their on-campus degree programme. The use of trained, experienced actors, indistinguishable from service users maximizes student engagement. Effective pre-briefing reduces student anxiety and provides an opportunity to add complexity via the written brief. The student roles as observers and/or participants (in a familiar role) improve students’ experience and support students with diverse needs. Assigning clear staff roles improves delivery and cost-effectiveness. Combining the two approaches to debriefing students was necessary to allow reflection-in-action and -on-action. Thorough debriefing is essential, challenging and requires planning and practice.

Implications for practice:

Simulation is an effective pre-qualifying education tool. Adequate pre-briefing, effective debriefing styles, and clear assignment of staff roles aid in effective delivery. Simulation scenarios need to be carefully constructed and delivered to ensure that all students remain within their optimal learning zone and to support students with diverse needs.