Mills Brennen W, Carter Owen B J, Rudd Cobie J, Mills Jodie K, Ross Nathan P, Ruck Joanne D
Office of the Pro-Vice-Chancellor (Health Advancement), Edith Cowan University, Perth, Western Australia, Australia.
School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Ballarat, Victoria, Australia.
BMJ Simul Technol Enhanc Learn. 2015 May 13;1(1):24-28. doi: 10.1136/bmjstel-2015-000040. eCollection 2015.
A reported advantage of simulation-based learning environments (SLE) over clinical placements (CPs) is that the former can provide a greater number and breadth of opportunities to practice level-appropriate clinical skills compared with the random patient presentations provided during the latter. Although logical and widely accepted as fact, we find no published evidence to demonstrate the magnitude, nor indeed veracity, of this assumption. We therefore sought to quantify the clinical skills practiced by entry-level paramedicine students attending a well-selected CP compared with an equal dosage of SLE.
N=37 first-year paramedicine students completed activity diaries during 3 days of CP and 3 days of SLE. Opportunities to practice clinical skills were quantified and coded as either: level-appropriate, beyond-level or of non-discipline relevance.
During SLE, the average student was exposed 226 times to 11 level-appropriate clinical procedures. During CP the average student was exposed 48 times to 24 clinical procedures, the majority relevant to paramedicine (63%), but a minority level-appropriate (38%). Students' opportunities for supervised, 'hands on' practice represented only 10% of exposures in either SLE or CP but in terms of raw numbers of level-appropriate opportunities, SLE provided more than CP (n=23 vs 2).
Our results confirm that SLE provides substantially more opportunities than CP for students to practice level-appropriate skills and is therefore more appropriate for repetitive practice. However, CP is likely to remain useful to students for practicing interpersonal skills and contextualisation of knowledge within the broader health system. Educators should therefore carefully articulate learning objectives before choosing between SLE and CP.
据报道，基于模拟的学习环境（SLE）相对于临床实习（CP）的一个优势在于，与后者提供的随机患者情况相比，前者能够提供更多数量和更广泛的机会来练习符合水平的临床技能。尽管这一观点合乎逻辑且被广泛视为事实，但我们并未找到已发表的证据来证明这一假设的程度，甚至其真实性。因此，我们试图量化参加精心挑选的CP的入门级护理专业学生与等量SLE的学生所练习的临床技能。
37名护理专业一年级学生在3天的CP和3天的SLE期间完成了活动日记。练习临床技能的机会被量化并编码为：符合水平、超出水平或与专业无关。
在SLE期间，平均每名学生有226次机会接触11项符合水平的临床操作。在CP期间，平均每名学生有48次机会接触24项临床操作，其中大多数与护理专业相关（63%），但符合水平的操作占少数（38%）。学生接受监督的“实践操作”机会在SLE和CP中仅占接触机会的10%，但就符合水平的机会原始数量而言，SLE提供的比CP更多（分别为23次和2次）。
我们的结果证实，SLE为学生提供的练习符合水平技能的机会比CP多得多，因此更适合重复性练习。然而，CP对于学生练习人际交往技能以及在更广泛的卫生系统中进行知识情境化可能仍然有用。因此，教育工作者在选择SLE和CP之前应仔细阐明学习目标。
