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

2. 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).

3. 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

4. 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)

5. 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)

6. 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

7. 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

8. Simulation in Action!

9. 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

10. 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”

11. 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

12. 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

13. 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

14. 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

15. Questions
References available from