1. Author(s) Naim Abdulmohdi
Title: The impact of a structured simulated experience on students’ clinical reasoning and decision making abilities
Author(s) Naim Abdulmohdi

2. Aims of the project
To assess the impact of human patient simulation and simulation design on clinical reasoning and decision making skills.

3. Simulation is a technique, not a technology. Gaba 2004, p2
“ ”
Simulation is a technique, not a technology. Gaba 2004, p2 .
an educational technique that allows interactive and, at times, immersive activity by recreating all or part of a clinical experience without exposing patients to the associated risks.
Human Patient simulator

4. Simulation design Scenario design Simulation design
WHO International Statistical Classification of Diseases (ICD)-10th
National and international consensus about clinical symptoms and management.
Checklist to guide the simulation progression to match the programmed trend.
Factors: person, task and context
Simulation design
Theory of decision making (DPT, CCT, SJT)
Cognitive errors
Teaching and learning theories
Cognitive, experiential learning, behaviourism

5. Simulation overview
Introduction
Overview on how to use the model, reminder of ABCDE and practicing thinking aloud
Step1: Simulation experience utilising the designed clinical reasoning model
Thinking aloud
Step 2: Debriefing: performance, typology of decision making- structured and video assist
Step 3: de-biasing: discuss the cognitive biases and strategies to reduce biases-

6. step 1: clinical reasoning model
Pattern recognition
Pattern formation
Repetition
Identify the problem
Include/exclude the context
Relate & infer
Act
Airway
Breathing
Circulation
Disability
Exposure
Interpret
Evaluate & reassess
Patient presentation
[simulation]
Collect

7. Method Design: Quasi-experiment : one group Data collection:
Health science reasoning test (HSRT),
Observations,
Follow up interview and satisfaction score
Sampling: convenient sampling / voluntary participation
Sample:
Third year nursing students
Successfully complete acute care module
Participated in traditional simulation experience before this project
38 students recruited but 23 completed the project
Data analysis: SPSS descriptive statistics and paired mean T-test

8. Descriptive Statistics Health Science Reasoning Test (HSRT)
Results
Descriptive Statistics
Health Science Reasoning Test (HSRT)
pretest HSRT overall score
Post test HSRT score N
Valid 23
Missing
Mean
18.39
20.52
Std. Error of Mean
.928
.838
Median
18.00
20.00
Mode 19 20
Std. Deviation
4.449
4.021
Range 17 16
Minimum 12 15
Maximum 29 31
Sum
423
472
Percentiles 25
15.00 50 75
19.00
23.00

9. Mean = 18.39 65% Moderate 15 Not Man. 3 Number HSRT Strong :39%
13%
Mean = 18.39
Std. Dev = 4.449
N= 23
65%
Moderate 15
Not Man. 3
Strong :3
Number
Superior: 2
HSRT

10. Mean = 20.52 Strong : 12 Strong :9 Number HSRT Std. Dev = 4.021 39%
52%
Strong : 12
Strong :9
Number
Superior: 2
HSRT

11. Strong Not Man. Moderate Mean = 7.04 Std. Dev = 1.637 N= 23 Number
Score
Mean = 7.43
Std. Dev = 1.59
N= 23
Number
Score

12. Strong Not Man. Moderate Mean = 4.35 Std. Dev = 2.442 N= 23 Number
Score
Mean = 4.35
Std. Dev = 2.442
N= 23
Number
Score

13. Strong Not Man. Moderate Mean = 3.04 Std. Dev = 1.492 N= 23

14. Strong Not Man. Moderate Mean = 3.74 Std. Dev = 1.054 N= 23

15. Strong Not Man. Moderate Mean = 4.61 Std. Dev = 1.076 N= 23

16. 95% Confidence Interval of the Difference
T-Test paired sample
Paired Samples Test
Paired Differences t df
Sig. (2-tailed)
Mean
Std. Deviation
Std. Error Mean
95% Confidence Interval of the Difference
Lower
Upper
Pair 1
Post test HSRT score - pretest HSRT overall score
2.130
3.622
.755
.564
3.697
2.821 22
.010
Pair 2
posttest induction - pretest induction score HSRT
.391
1.588
.331
-.295
1.078
1.182
.250
Pair 3
posttestdeduction - pretest deduction score
1.130
1.984
.414
.272
1.988
2.732
.012
Pair 4
postest analysis - pretest analysis score
.783
1.445
.301
.158
1.407
2.598
.016
Pair 5
posttest inference - pretest inference score
-.087
1.593
.332
-.776
.602
-.262
.796
Pair 6
postest evaluation - pretest evluation score
.217
1.380
.288
-.379
.814
.458

17. Pearson Bivariate correlation
Overall HSRT pretest and posttest
HSRT scale components for pretest and posttest
and
Years and type of clinical experience
Level of education
Learning difficulties
Age and gender
Number of hours of sleep before the test
Level of tiredness
First language
Finding:
No statistical significant correlation between above factors and HSRT score.
Students with learning difficulties have lower HSRT scores compare to others, but it was not statistically significant
Bilingual students with English as the first language have higher HSRT score compared to others, but that was not statistically significant.

18. Overall satisfaction score
Statistics
Overall_SS N
Valid 23
Missing
Mean
4.6776
Std. Error of Mean
.05614
Median
4.7500
Mode
4.88
Std. Deviation
.26925
Range
1.00
Minimum
4.00
Maximum
5.00
“to be methodological …. to get the whole picture and avoid anything that have been missed”
“not to assume and do your own assessment”
“You become more self-aware about your performance. Since the simulation you become more aware about this automatic decision and recall what we did to manage situation better”.
“Thinking more carefully as people gets into routines and automatically decision, oh this can go wrong, I do that a lot, so now I thinking more carefully”.
“It made me think broadly and carefully”
“It was very useful when you talk to me about the biases that I made and I can see that in the video, I though I know a lot, I am more careful with similar situations that I have in practice”.
“Reflection was very useful and sometimes I recall what we did in the study in practice”
“The thing I think I found most useful was we were looking about multiple issues in the same patient which is more applicable to practice compare to other scenarios we had in previous modules. Obviously, in module 7 we have one thing at time to learn it properly but this study was like how things happen naturally in practice, people come with many co-morbidities, I found this very helpful”.

19. Summary 39% of the participants had improved HSRT post the simulation.
Simulation could positively affect the clinical reasoning and decision making measures.
Students reported that simulation
increased their awareness about their biases,
led them to be more thoughtful and careful in their clinical decision.