Telling it like it is: What do we really know about replacing clinical practice with simulation?

Telling it like it is: What do we really know about replacing clinical practice with simulation?

Background
Simulation based education has emerged as an essential element of pre-licensure education for health care students. It provides engaging and authentic learning opportunities during realists simulated clinical experiences. With the rapid increase in simulation scholarship, we sought to substantiate current knowledge for substitution of clinical practice hours with simulation across the health disciplines using the best available evidence.

Objectives
1. To examine the levels, quality of evidence, measures and outcomes when simulation is substituted for clinical placement;
2. To identify the optimal proportions, ratios, durations of simulation replacement and;
3. To explore how this evidence impacts on professional education standards.

Methods
A systematic review of primary studies in which simulation was used to replace clinical practice hours. Elements of interest were carefully extracted and the quality of each study was assessed using the MERSQI1.

Results
We identified 10 primary studies (six RCTs, three quasi-experimental designs and one observation-analytic design) in nursing (n=7), physiotherapy (n=2) and medicine (n=1) and the methodological quality was moderate to high. A total of 1972 students participated in the studies and outcomes measured students’ reaction, learning and behaviour. There were no clear findings in relation to proportion, ratio or duration of replacement and, the evidence is not clearly translated into professional program accreditation standards.

Conclusion
Best available evidence supports the substitution of clinical practice with simulation although the evidence is unclear regarding the appropriate ‘dose’ and studies were notable in their heterogeneity. We provide recommendations for simulation-based research to contribute to a stronger evidence base and higher impact research translation.

References
1. Reed, D.A., Beckman, T.J., Wright, S.M. (2009) An assessment of the methodological quality of medical education research studies published in the American Journal of Surgery. The American Journal of Surgery, 198: 442-4.