Brady Susannah, Bogossian Fiona, Gibbons Kristen
The University of Queensland, School of Nursing and Midwifery, Herston Campus, Edith Cavell Building, Fourth Avenue, Herston, QLD 4029 Australia.
The University of Queensland, School of Nursing and Midwifery, Herston Campus, Edith Cavell Building, Fourth Avenue, Herston, QLD 4029 Australia; Mater Research Office, Mater Medical Research Institute, The University of Queensland, South Brisbane, QLD 4101, Australia.
Nurse Educ Today. 2015 Mar;35(3):524-9. doi: 10.1016/j.nedt.2014.11.005. Epub 2014 Nov 20.
Simulation as a pedagogical approach is used in health professional education to address the need to safely develop effective clinical skills prior to undertaking clinical practice, in complex healthcare environments. Evidence for the use of simulation in midwifery is largely anecdotal, and research evaluating the effectiveness of different levels of simulation fidelity is lacking.
To evaluate the effectiveness of varying levels of fidelity on simulated learning experiences and identify which best contributes to integrated and global clinical skills development in midwifery students.
Randomised three arm intervention trial.
Midwifery students who had yet to receive theoretical instruction in the performance of the clinical skill of vaginal examination.
Midwifery students (n=69) received theoretical instruction in the performance of vaginal examination following random allocation into one of three intervention arms. Participants were recorded performing the procedure using low fidelity (part task trainer only), medium fidelity (part task trainer and life sized poster of a pregnant woman) or progressive fidelity (part task trainer and a simulated standardised patient). Senior midwifery students were recruited to act in the role of standardised patients.
There was a statistically significant difference in the mean total Global Rating Scale score between at least two of the three groups (p=0.009). The progressive fidelity group revealed as different from both the low fidelity group (p=0.010) and medium fidelity group (p=0.048). There was a statistically significant difference in the mean total Integrated Procedural Performance Instrument score between at least two of the three groups (p=0.012). The progressive fidelity group revealed as different from both the low fidelity group (p=0.026) and medium fidelity group (p=0.026).
Progressive and medium fidelity simulation yields better outcomes than low fidelity simulation and where resources are constrained medium fidelity equipment, such as a life sized poster can produce effective learning experiences for midwifery students.
模拟作为一种教学方法，在卫生专业教育中被用于满足在复杂医疗环境中进行临床实践之前安全培养有效临床技能的需求。在助产领域使用模拟的证据大多是 anecdotal 的，并且缺乏评估不同模拟保真度水平有效性的研究。
评估不同保真度水平对模拟学习体验的有效性，并确定哪种水平最有助于助产专业学生综合和整体临床技能的发展。
随机三臂干预试验。
尚未接受阴道检查临床技能理论指导的助产专业学生。
69 名助产专业学生在被随机分配到三个干预组之一后，接受了阴道检查操作的理论指导。使用低保真度（仅部分任务训练器）、中保真度（部分任务训练器和孕妇真人大小海报）或渐进保真度（部分任务训练器和模拟标准化患者）记录参与者执行该操作的情况。招募高年级助产专业学生扮演标准化患者的角色。
三组中至少两组之间的平均全球评分量表总分存在统计学显著差异（p = 0.009）。渐进保真度组与低保真度组（p = 0.010）和中保真度组（p = 0.048）均不同。三组中至少两组之间的平均综合程序表现工具总分存在统计学显著差异（p = 0.012）。渐进保真度组与低保真度组（p = 0.026）和中保真度组（p = 0.026）均不同。
渐进保真度和中保真度模拟比低保真度模拟产生更好的结果，并且在资源受限的情况下，中保真度设备，如真人大小的海报，可以为助产专业学生带来有效的学习体验。
