Background
Clinical placements provide rich learning environments for health professional pre-registration education, but are often accompanied by significant workload pressure and capacity issues for clinical departments. Advances in simulation approaches mean that many aspects of students’ clinical learning can be undertaken in the academic environment. There is, however, limited data identifying the specific benefits of provided by simulation compared to clinical placement. This study measured the impact of a comprehensive integrated simulation placement on student clinical skill acquisition.
The challenge
The clinical environment is undoubtedly an unparalleled source of learning opportunities however, there are a number of factors that present a challenge to the implementation and support of clinical learning experiences. Therapeutic radiography departments face increasing workloads with high numbers of patients, strict targets, reduced staff levels, alongside training and implementation challenges with complicated equipment and techniques. There is also an increasing need for more trained therapeutic radiographers in the UK. There are therefore potential benefits in in optimisation of the clinical placement experience through effective simulation-based placements, outside ofthe clinical environment.
Whilst the value of simulation for learning has been recognised within a range of health science disciplines, the majority of previous research in this area has focused on student self-reported outcomes and confidence levels. This study aimed to address this gap in quantitative data demonstrating the specific educational value of simulation interventions.
Our research
A virtual department was developed using a range of simulation equipment and software, with actors and service users providing a range of simulated patients for students to engage with.
A cohort of 29 first year undergraduate therapeutic radiography students were randomly assigned to either simulated or conventional clinical placement. Both cohorts of students swapped placements at the end of the study to ensure parity of experience.
The simulation group undertook a two-week integrated simulation placement, which was based at the radiotherapy simulation facility on campus. This comprised a full timetable of simulated activities using a range of dedicated simulation equipment in combination with actors, service users, clinical staff and academic facilitators. Activities were developed with service user, clinical partner and student representative input. Realistic cases including notes, images and plans were used as a focus and students were expected to comply with all usual clinical protocols; including attendance criteria, professionalism and uniform policy.
Following the initial two-week placement, clinical skills assessment scores, provided by a blinded assessor, were compared between the simulated and conventional placement cohorts. Mean overall assessment scores for each cohort were within 3% of each other. The simulation cohort had over 10% higher ‘communication’ scores than the traditional group (p=0.028). The ability to gain both technical and interpersonal skills simultaneously improved learning compared to clinical placement. Students valued the structured approach of the simulated placement and the opportunity to practice techniques in a safe unpressured environment.
Research with impact
This work has resulted in a shift in how simulation is used nationally to support clinical training and increase capacity. Rather than used sporadically as part of module teaching, departments across the UK and beyond are now using extended simulation placements to prepare students for practice and to increase their training capacity.
The research highlighted that simulated placements can help students to achieve clinical learning outcomes and lead to improved communication skills development. The data from the randomised study confirmed that therapeutic radiography students were able to gain relevant clinical skills from an extended simulated placement. The equivalence of performance in a blinded clinical assessment demonstrated that students were not disadvantaged by working on a simulated placement. More significantly, their improved communication skills scores suggest that simulated placements should play a major role in training students for patient interactions within therapeutic radiography.
Within the University of Liverpool, these results have allowed us to improve integration of simulation activities within our modules, to enable students to acquire technical, procedural and interpersonal skills in a simulated environment which reflects real-world scenarios. This facilitates improved preparation of students for the demands of the clinical environment, and has paved the way for a reduction in overall clinical placement time and departmental training burden.