Siobhán Smyth and Evelyn Byrne Psychiatric Students’ Evaluation of Learning in a Simulated Environment Siobhán Smyth and Evelyn Byrne

Aim To ascertain students’ perspective of a simulated mental health ward prior to internship using the METI™ Simulation Effectiveness Scale To enable students draw on prior knowledge and clinical experience while caring for patients (actors) under the supervision of experienced clinicians, lecturers and service user METI™ Simulation Effectiveness Scale- Calculated Chronbach’s alpha (.93) from a multi-site investigation indicated that the 13-item SET is reliable instrument and shows promise for measuring simulation effectiveness. They has been a lack of reliable and valid instruments to measure its effectiveness (Kardong-Edgren, Adams on, and Fitzgerald, 2010).

Context The transition to practice causes great anxiety; the level of stress newly qualified nurses experience influences their ability to function effectively in their new role The complexity of today’s healthcare system requires nurses to be Critical thinkers Provide safe, timely, appropriate & effective care

What is Simulation? According to Ker and Bradley (2007)“the narrow, popularist view of simulation is that of advanced technologies recreating the clinical experience, such as those found in virtual reality and advanced computer - controlled human patient simulators. But simulation does not focus exclusively on technical or psychomotor performance; it encompasses a broad perspective, incorporating both cognitive and affective domains. Simulation may involve a wide range of techniques and approaches applicable to learners at all levels of seniority, from novice to expert, one of the major underlying drivers being to develop safe healthcare practitioners” (p. 164)

Benefits of Simulation A valuable approach for engaging students in their learning(Bland et al, 2010) Supports teachers --- integrate role play, questioning, reflection, & feedback to strengthen critical thought & problem solving capabilities, resulting in the construction of new knowledge Environment resembles clinical practice as closely as possible (Rauren, 2004) Present students with simple/complex patient scenarios - opportunity to integrate knowledge, skills, attitude – enhance critical thinking (Guhde, 2011) Supports students learning (Baxter et al. 2009), “think on their feet, not in their seat” (Rauen, 2001), increase students’ confidence (Cant & Cooper , 2010)

Limitations of Simulation Does not replace learning in the real work Long term benefit of simulation unproven Significant costs Personnel; low student-teacher ratio Equipment, annual maintenance, consumables Physical infrastructure Time consuming Planning and preparation Developing case scenarios

Students’ Prior Exposure 1st exposure – before 1stclinical placement Baseline assessment of patient during OPD review 2nd exposure – 3rd year Ward simulation 3rd exposure – 4th year Drug round

Simulation in Action!

Quantitative Evaluation   Statement Strongly Agree (4) Agree (3) Disagree (2) Strongly Disagree (1) The instructor’s questions helped me to think critically. 14 2 I feel better prepared to care for patients. 9 7 I feel like it was OK to make a mistake. 8 I feel more confident in my decision making skills. I feel more confident determining what to tell the health care provider. 6 10 My assessment skills improved. I feel more confident in my ability to recognize changes in the patient. I feel more confident in my ability to predict changes in a real patient’s condition. I felt challenged in my critical thinking and decision-making skills. 13 3

Qualitative Evaluation What one thing did you like or appreciate the MOST from your simulation experience today? Realness of whole situation --- “excellent” Thinking on “my feet” Dealing with difficult situations/aggressive patient Cardiac arrest experience --- “wonderful” Chance to experience and learn great skills Opportunity to practice in a safe environment Learning about “my deficits” Encouraged to use “my current knowledge” Knowing what is expected as students Receiving immediate feedback from patient and assessor --- “excellent”, “very helpful”

Qualitative Evaluation contd Qualitative Evaluation contd.. What one thing did you like or appreciate LEAST from your simulation experience today? Anxiety provoking Stressful coping with “manufactured environment” “being watched” “not knowing what to do” Pressure Threatened with death Busyness --- dealing with interruptions

Qualitative Evaluation contd Qualitative Evaluation contd.. What can we do to improve the overall simulation experience? Provide regular and frequent simulations reduce anxiety increase confidence Create more clinical space avoid busy environment Clinical scenarios – dealing with difficult/challenging experiences and situations  

Conclusion Critical thinking was identified as a key factor: instructor’s questioning technique facilitated students’ critical thinking and enhanced decision-making skills Other facets students’ feeling better prepared to care for patients improvement in their assessment skills greater confidence in recognising and predicting changes in patients’ mental state

Finally Suggestions for improvement include integration of simulation throughout the program despite the stress the students experienced Challenge --- explore ways of increasing frequency of simulation in an already packed curriculum

Questions References available from siobhan.smyth@nuigalway.ie