Abstract
Simulation to train and assess pre-registration students and health professionals has grown in popularity and use over the last few decades. After its beginnings in aviation with the first flight simulator developed in 1929, simulation has rapidly grown in sophistication and capabilities. Simulation now offers academics in the healthcare professions opportunities to train and assess their students in ways that can enhance patient safety and student readiness, prior to the students progressing to the real world and commencing contact with patients. Across the professions many forms of simulation have been implemented, such as, high fidelity patient simulators, part-task trainers, and simulated patients, many of which have large costs involved. Medicine and nursing are leading the way in researching the impact that simulation has on education of their students, whereas allied health professions, such as, physiotherapy have focused on areas like replacing clinical placement hours with simulation. Rather than focusing on using simulation to replace part of work-integrated learning, the aim of this thesis is to increase the knowledge around, and evidence for, the use of simulation in preparing physiotherapy students prior to commencing work-integrated learning placements, where they will be required to interact with real patients.This thesis consists of three studies across five pieces of work. Study one aimed to gain an understanding of the true extent that simulation was being implemented across Australian and New Zealand universities as this was unclear in 2017. This audit revealed that most universities were using simulation, but also acknowledged the limited evidence to support simulation in physiotherapy specifically. This lack of high-quality evidence meant that universities were often completing isolated evaluations to determine the effectiveness of their simulation programmes. The results from this audit helped to inform the subsequent simulation-based educational studies, investigating both classroom-based simulation for learning and a simulation-based assessment, with the aim of improving the evidence base for the use of simulation in physiotherapy education.
Study two investigated whether classroom-based simulation could better prepare physiotherapy students for work-integrated learning. Two pieces of work were produced during study two. In this randomised cluster trial at an Australian university, we explored whether classroom-based simulation, in the form of MASK-EDTM Simulation, could improve students’ performance on work-integrated learning. MASK-EDTM Simulation involves an academic donning a silicon mask to play the role of a patient that aligns to the specific teaching required for a unit. In accordance with a rigorous methodological approach, the protocol for this randomised cluster trial was published and is detailed in Chapter 3 of this thesis. Chapter 4 is the published results of this study. Although MASK-EDTM Simulation showed no better student results than usual teaching of practising on peers, it was deemed to be enjoyable and showed a trend towards assisting those students with lower grade point averages. Given, it is important that students are prepared to commence work-integrated learning, part of this process needs to include rigorous classroom-based assessment to determine students’ readiness.
Study three endeavoured to improve the evidence-base for using simulation-based assessments to determine readiness and predict performance during work-integrated learning. This study is broken into two pieces of work, found in Chapter 5 and 6 of this thesis. Part a (Chapter 5) of this study looked at the feasibility of a low-cost simulation method, peer simulation, whereby senior students were trained to play the role of the patient for junior students’ practical examinations. Part b (Chapter 6) investigated whether the peer patient practical examination was able to predict performance on a future work-integrated learning placement. The peer simulation practical examination was found to be feasible, enjoyable, helped to develop the junior and senior students’ professional identity, and was able to predict which students were more likely to fail their work-integrated learning placement.
In summary, simulation is being used by many physiotherapy academics across Australia and New Zealand, with many stating that they would like to increase how often they were using it; however, barriers were common, such as cost, and time. Students like and enjoy being involved in classroom-based simulation, both for learning and assessment. Although students found MASK-EDTM enjoyable, the frequency and amount of exposure was no more useful in preparing students for work-integrated learning. Peer simulation shows great promise in areas such as determining readiness for work-integrated learning and predicting which students may benefit from remediation prior to commencing work-integrated learning. Overall, simulation is a beneficial learning and assessment modality that healthcare academics should be aiming to incorporate into their curricula, especially with the onus on protecting the safety of patients encountered by students on clinical placement. Academics should follow evidence-based educational principles, however, there is also a need for ongoing robust educational research to continue to grow the evidence-base to inform simulation in healthcare education.
| Date of Award | 2025 |
|---|---|
| Original language | English |
| Supervisor | Elisabeth PRESTON (Supervisor) & Bernie BISSETT (Supervisor) |