Imms Christine, Froude Elspeth, Chu Eli Mang Yee, Sheppard Loretta, Darzins Susan, Guinea Stephen, Gospodarevskaya Elena, Carter Rob, Symmons Mark A, Penman Merrolee, Nicola-Richmond Kelli, Gilbert Hunt Susan, Gribble Nigel, Ashby Samantha, Mathieu Erin
School of Allied Health, Australian Catholic University, Fitzroy, Victoria, Australia.
School of Allied Health, Australian Catholic University, North Sydney, New South Wales, Australia.
Aust Occup Ther J. 2018 Dec;65(6):556-564. doi: 10.1111/1440-1630.12513. Epub 2018 Aug 31.
BACKGROUND/AIM: Professional practise placements in occupational therapy education are critical to ensuring graduate competence. Australian occupational therapy accreditation standards allow up to 200 of a mandated 1000 placement hours to include simulation-based learning. There is, however, minimal evidence about the effectiveness of simulation-based placements compared to traditional placements in occupational therapy. We evaluated whether occupational therapy students completing a 40 hour (one week block) Simulated Clinical Placement (SCP) attained non-inferior learning outcomes to students attending a 40 hour Traditional Clinical Placement (TCP).
A pragmatic, non-inferiority, assessor-blinded, multicentre, randomised controlled trial involving students from six Australian universities was conducted. Statistical power analysis estimated a required sample of 425. Concealed random allocation was undertaken with a 1:1 ratio within each university. Students were assigned to SCP or TCP in one of three settings: vocational rehabilitation, mental health or physical rehabilitation. SCP materials were developed, manualised and staff training provided. TCPs were in equivalent practice areas. Outcomes were assessed using a standardised examination, unit grades, the Student Practice Evaluation Form-Revised and student confidence survey. A generalised estimating equation approach was used to assess non-inferiority of the SCP to the TCP.
Of 570 randomised students (84% female), 275 attended the SCP and 265 the TCP (n = 540, 94.7% retention). There were no significant differences between the TCP and SCP on (i) examination results (marginal mean difference 1.85, 95% CI: 0.46-3.24; P = 0.087); (ii) unit score (mean (SD) SCP: 71.9 (8.8), TCP: 70.34 (9.1); P = 0.066); or (iii) placement fail rate, assessed using the Student Practice Evaluation Form-Revised (100% passed both groups).
Students can achieve equivalent learning outcomes in a 40 hour simulated placement to those achieved in a 40 hour traditional placement. These findings provide assurance to students, educators and professional accreditation bodies that simulation can be embedded in occupational therapy education with good effect.
背景/目的：职业治疗教育中的专业实习对于确保毕业生能力至关重要。澳大利亚职业治疗认证标准允许在规定的1000小时实习时间中，最多200小时可包含基于模拟的学习。然而，与职业治疗中的传统实习相比，关于基于模拟的实习效果的证据极少。我们评估了完成40小时（一周时间）模拟临床实习（SCP）的职业治疗专业学生，其学习成果是否不劣于参加40小时传统临床实习（TCP）的学生。
开展了一项实用、非劣效性、评估者盲法、多中心随机对照试验，涉及来自六所澳大利亚大学的学生。统计功效分析估计所需样本量为425。在每所大学内按1:1的比例进行隐蔽随机分配。学生被分配到三种环境之一的SCP或TCP中：职业康复、心理健康或身体康复。开发了SCP材料，进行了手册化并提供了人员培训。TCP在同等实践领域进行。使用标准化考试、单元成绩、修订后的学生实践评估表和学生信心调查来评估结果。采用广义估计方程方法评估SCP相对于TCP的非劣效性。
在570名随机分组的学生中（84%为女性），275人参加了SCP，265人参加了TCP（n = 540，保留率94.7%）。在以下方面，TCP和SCP之间无显著差异：（i）考试成绩（边际平均差异1.85，95%CI：0.46 - 3.24；P = 0.087）；（ii）单元分数（平均值（标准差）SCP：71.9（8.8），TCP：70.34（9.1）；P = 0.066）；或（iii）使用修订后的学生实践评估表评估的实习不及格率（两组通过率均为100%）。
学生在40小时的模拟实习中能够取得与40小时传统实习相当的学习成果。这些发现为学生、教育工作者和专业认证机构提供了保证，即模拟可以有效地融入职业治疗教育中。
