University of the Sunshine Coast, Sippy Downs, Queensland, Australia.
The University of Queensland, St Lucia, Queensland, Australia.
J Clin Nurs. 2019 Nov;28(21-22):3759-3775. doi: 10.1111/jocn.14965. Epub 2019 Aug 13.
To extract, examine and report the highest available levels of evidence from healthcare disciplines in the use of simulation-based education as substitution for clinical placement in prelicensure programmes.
Simulation is widely employed across prelicensure health professional education to create safe, realistic clinical learning experiences for students. Whether simulation can be employed to substitute for actual clinical placement, and if so, in what proportion, replacement ratio and duration, is unclear.
A systematic review and quality appraisal of primary studies related to prelicensure students in all health disciplines, guided by the PRISMA checklist.
Ten primary studies were included, representing 2,370 students from three health disciplines in four countries. Nine studies were experimental and quasi-experimental and methodological quality was assessed as moderate to high with good to very good inter-rater agreement. Direct substitution of simulation for clinical practice ranged from 5% to 50%. With one exception, replacement ratios were 1:1 and duration of replacement ranged from 21 hr-2 years. Levels of evaluation included measures of reaction, knowledge and behaviour transfer; no negative outcomes were reported. We appraised practicalities for design of substitution, design limitations and knowledge transfer to accreditation standards for prelicensure programmes.
This review synthesised highest levels and quality of available evidence for substitution of simulation for clinical placement in health professional education. Included studies were heterogenous in simulation interventions (proportion, ratio and duration) and in the evaluation of outcomes. Future studies should incorporate standardised simulation curricula, widen the health professions represented and strengthen experimental designs.
Current evidence for clinical educational preparation does not appear to be translated into programme accreditation standards governing clinical practice experience for prelicensure programmes in relevant jurisdictions. Overall, a stronger evidence base is necessary to inform future curricula and policy development, to strengthen clinical practice in health.
从医疗保健学科中提取、检查和报告最高水平的证据，以了解模拟教育在预许可课程中替代临床实习的应用。
模拟在预许可卫生专业教育中被广泛应用，为学生创造安全、真实的临床学习体验。模拟是否可以替代实际的临床实习，如果可以，替代的比例、替代的时间和替代的时长是多少，目前还不清楚。
本系统评价根据 PRISMA 清单，对所有健康学科的预许可学生的初级研究进行了系统评价和质量评估。
纳入了 10 项初级研究，代表了来自四个国家三个健康学科的 2370 名学生。9 项研究为实验性和准实验性，方法学质量评估为中等到高度，组内一致性良好至非常好。模拟直接替代临床实践的比例从 5%到 50%不等。除了一个例外，替代比例都是 1:1，替代时长从 21 小时到 2 年不等。评估的水平包括反应、知识和行为转移的衡量标准；没有报告负面结果。我们评价了替代设计的实用性、设计局限性以及向预许可课程认证标准的知识转移。
本综述综合了替代健康专业教育中临床实习的模拟的最高水平和现有证据的质量。纳入的研究在模拟干预（比例、比例和时长）和结果评估方面存在差异。未来的研究应该纳入标准化的模拟课程，扩大所代表的卫生专业，并加强实验设计。
目前的临床教育准备证据似乎并没有转化为相关司法管辖区管理临床实践经验的许可课程认证标准。总的来说，有必要建立一个更强大的证据基础，为未来的课程和政策制定提供信息，以加强卫生保健的临床实践。
