Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacy Workforce Studies, The University of Manchester, Manchester, UK.
Med Educ. 2020 Oct;54(10):915-924. doi: 10.1111/medu.14182. Epub 2020 Jun 2.
Although there is much evidence to support the use of simulation-based education (SBE) in undergraduate education of health care professionals, less attention has been paid to how SBE, viewed as a complex intervention, is implemented and becomes embedded and sustained. This paper aims to explore factors that inhibited or promoted SBE becoming normal practice in undergraduate health care professional programmes.
Participants involved in the organisation, design and delivery of SBE in the north of England were recruited purposefully from higher education institutions (HEI) and National Health Service (NHS) Trusts through local networks for qualitative telephone interviews. Transcripts were analysed inductively using a hybrid approach involving simultaneous inductive open coding and deductive coding using normalisation process theory (NPT) as a theoretical lens.
A total of 12 NHS staff from 11 trusts and seven individuals from four HEIs were interviewed. There was considerable variation in the approach taken to implementation across organisations, which resulted in varying degrees of embeddedness. Implementation was challenged or enabled by organisational leadership, professional buy-in and the development and maturity of the strategic approach. Variation in understanding of the scope and pedagogical aims of SBE led to inequity between professions and organisations in investment and participation, as well as design and delivery of SBE.
Given the complexity of SBE, best practice in implementation should be considered fundamental to the successful delivery of SBE. The findings provide an explanation of how contextual factors can support or hinder implementation to maximise potential benefits and learning outcomes; this understanding can be used to better inform development of SBE strategies and highlight potential factors needed to navigate contextual barriers so that learning outcomes can be maximised.
尽管有大量证据支持在医疗保健专业人员的本科教育中使用基于模拟的教育（SBE），但对于 SBE 作为一种复杂干预措施，如何实施、嵌入和维持，关注较少。本文旨在探讨哪些因素会阻碍或促进 SBE 在本科医疗保健专业课程中成为常规实践。
通过当地网络，从英格兰北部的高等教育机构（HEI）和国民保健服务（NHS）信托机构中，有针对性地招募参与 SBE 的组织、设计和交付的参与者，进行定性电话访谈。使用规范过程理论（NPT）作为理论视角，通过同时进行归纳式开放编码和演绎式编码的混合方法对转录本进行分析。
共采访了来自 11 家信托机构的 12 名 NHS 工作人员和来自 4 所 HEI 的 7 名个人。各组织采取的实施方法存在很大差异，导致嵌入程度也存在差异。组织领导力、专业人员的认同以及战略方法的发展和成熟对实施起到了挑战或促进作用。对 SBE 的范围和教学目标的理解存在差异，导致各专业和组织在投资和参与度，以及 SBE 的设计和交付方面存在不平等。
鉴于 SBE 的复杂性，实施的最佳实践应被视为成功实施 SBE 的基础。研究结果解释了情境因素如何支持或阻碍实施，以最大限度地提高潜在收益和学习成果；这种理解可以用于更好地指导 SBE 策略的制定，并突出需要克服情境障碍的潜在因素，以最大限度地提高学习成果。
