June

14

Simulated Learning Technologies in Undergraduate

Curricula:
An Evidence Check review for HETI

D Nestel, J Harlim, C Smith, K Krogh, M Bearman

HealthPEER, Faculty of Medicine, Nursing & Health Sciences
Monash University

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Table of Contents
The project team.................................................................................................................. 4
Executive summary............................................................................................................. 5
Introduction.......................................................................................................................... 9
Operational definitions............................................................................................................... 9
Simulation.................................................................................................................................................... 9
Simulators or simulation modalities..................................................................................................... 9
Simulation educators................................................................................................................................. 9
Graduate outcomes.................................................................................................................................. 10
Methods............................................................................................................................... 11
Results................................................................................................................................. 12
Search results............................................................................................................................. 12
Summary of selected reviews.................................................................................................. 12
Review question 1...................................................................................................................... 16
Strong evidence........................................................................................................................................ 16
Moderate evidence.................................................................................................................................. 16
Enablers for successful outcomes....................................................................................................... 18
Barriers to successful outcomes.......................................................................................................... 19
Review question 2...................................................................................................................... 20
Research papers........................................................................................................................ 21
Common themes and summary of selected papers.......................................................................22
Gaps in the evidence................................................................................................................. 22
The NSW context...................................................................................................................... 23
Strengths and limitations of the review................................................................................. 24
Conclusions........................................................................................................................ 26
Recommendations............................................................................................................. 27
References.......................................................................................................................... 29
Box 1: Search terms used in databases................................................................................. 33
Box 2: Search strategy for review.......................................................................................... 34
Box 3: Reasons for excluding reviews and papers..............................................................35
Box 4: Themes from the national research agenda from the 2013 Research Summit of
the Australian Society for Simulation in Healthcare..........................................................36
Appendix I: List of simulators or simulation modalities and their descriptions........37
Appendix II: Data display table of graduate outcomes for eleven eligible health
professions.................................................................................................................................. 39
Table 1: Summary of data extracted from eligible reviews..............................................66
Table 2: Summary of data extracted from eligible papers................................................76
Table 3: Number of papers by respondent group............................................................232
Table 4: Number of papers by simulation modality........................................................233
Table 5: Number of papers by study design...................................................................... 234
Table 6: Number of papers by quality rating.................................................................... 235

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3
The project team
The project team was comprised of:
 Professor Debra Nestel (DN)
 Dr Kristian Krogh (KK)
 Dr Jennifer Harlim (JH)
 Dr Cathy Smith (CS)
 Associate Professor Margaret Bearman (MB)
DN undertook the database search.
DN and KK offered additional contributions of reviews and papers.
JH and DN sourced the graduate outcomes documents.
JH prepared the thematic analysis of graduate outcomes.
DN and JH created the tables summarising the review papers.
MB and DN analysed the review papers to answer the questions posed by HETI.
KK, CS, JH and DN created the table that summarise the research papers.
DN and JH analysed the research papers to identify examples relevant to NSW.
DN took overall responsibility for writing the Report.
All authors reviewed the final version of the Report.

The authors all have experience in undertaking reviews, work in the field of healthcare simulation and have
extensive experience in supporting health professional students and clinicians with simulation-based education.
Four authors have been involved in the NHET-Sim Program1 as faculty (DN, KK, CS, MB) and two in the
Victorian Simulated Patient Network2. MB is Director of the Graduate Certificate in Clinical Simulation, Monash
University. Three authors are based in Victoria (DN, MB, JH), one in Denmark (KK) and one in Canada (CS)
although all are familiar with the landscape of simulation education in Australia.

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Executive summary
This Report on the use of simulated learning technologies in undergraduate health professions
education was prepared for NSW Health Education and Training Institute (HETI) as an Evidence
Check Review. Simulation is widely used in training individuals to work in high reliability industries
such as aviation. Here, our focus is healthcare and undergraduate education for 24 eligible professions.

Two questions were addressed: What is the evidence for the effectiveness of simulated learning
technologies for core graduate outcomes in the accredited undergraduate curricula for eligible
professions? In which settings are simulated learning technologies most effective?

We defined simulated learning technologies as activities that provide students with an opportunity to
rehearse skills or elements of practice that they will be required to perform as part of their future
professional roles. This includes activities that use simple to complex technologies and low to high
fidelity and that may take place in learning, simulated or real clinical settings. That is, we adopted a
definition that included a breadth of simulated learning technologies.

Method
In May 2014, statements of graduate outcomes were sourced from eligible health professions
associations (as defined by HETI) and thematically analysed. The search terms related graduate
outcomes with simulation. Searches were undertaken of the OvidMedline, Cochrane, PsychInfo, and
Informit databases. We also searched the collections and libraries of Best Evidence Medical Education
and the Joanna Briggs Institute respectively and sought recommendations from simulation education
experts. Inclusion criteria focused on undergraduate health professions education, simulation, published
in 2005 to present and in English language.

Results
The Report is based on 27 reviews. We also extracted data from 439 research papers relevant to the
NSW context. In undergraduate health professions education, simulation is most often used to support
learning of commonly performed skills and procedures and for management of acutely ill (and
deteriorating) patients. However, learning is often out of context because of limited access to simulated
learning environments. Simulation is also used for transitions including those for entering new clinical
environments. This includes orientating students to practices on clinical placements and for entry to
registered practice. Simulation is widely used for assessments of skills, especially in the Objective
Structured Clinical Examination.

Question 1: What is the evidence for the effectiveness of simulated learning technologies for core
graduate outcomes in the accredited undergraduate curricula for eligible professions?
From the reviews, there is strong evidence for simulated learning technologies leading to increased

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knowledge and improved skills under specific conditions for several core graduate outcomes in
undergraduate curricula, when compared with no intervention. This includes the development and
application of clinical knowledge and, of clinical skills such as assessing and examining patients,
communicating with patients, performing procedural skills and clinical reasoning. There is also
moderate evidence of increased knowledge and practice of these clinical skills and patient safety,
teamwork and professionalism. The specific conditions include the choice of simulator, which must be
appropriate for the graduate outcomes, the educational design, the learner characteristics and the
simulation educator. From the research papers, there is strong evidence that simulation can in part
(25%) replace clinical placements without compromising graduate outcomes.

Question 2: In which settings are simulated learning technologies most effective?

Simulated learning technologies have relevance in all undergraduate health professions education.
Although high technology learning environments are not essential for effective simulation practice,
efforts must be made for learning of procedures and skills to be contextualised. That is, students have
the opportunity to integrate whole procedures and skills with the people and settings that resemble
those in which they will be expected to practice. Simulation facilities need to be accessible for students
across their undergraduate education and reflect the varied environments in which they will eventually
work. Learning technologies such as audio-visual capture are now relatively inexpensive and easily
integrated into non-specialised environments. There is moderate evidence for the value of video-
assisted debriefing.

Simulation modalities have different degrees of relevance across health professions. Simulated patients
have value in all health professions. Task trainers are highly relevant in procedure-oriented health
professions. Manikins are essential for recognising and managing deteriorating patients and can be
enhanced by adding simulated patients to scenarios. Virtual patients assist the development of clinical
reasoning but can be unhelpful for empathic communication.
Not using simulation (or using it ineffectively) in undergraduate education may result in greater costs
in the longer term to the health and social care services.

Summary
There are ethical imperatives for the use of simulation in health professions education. The first
imperative is to minimise risks to patients by ensuring health professional students are prepared for
integrated work learning (clinical placements) and for transition to professional practice. The second
imperative is to students where strong evidence exists for the benefits of learning in simulation, they
should be afforded this opportunity.

Recommendations
Based on the evidence, the resources and expert opinion, recommendations for implementing effective
simulated learning technologies in undergraduate health professions education include:
1. Ensuring sound design of simulation-based education programs that are integrated with

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 broader curriculum activities.
a. Theoretical underpinning of simulation-based education programs.
b. Explicit learning objectives.
c. Feedback and debriefing processes to optimise student learning.
d. Provision of multiple opportunities to practise and rehearse using simulation.
e. Access to a wide range of simulators (including simulated patients, manikins, task
trainers etc.). For example, establish a simulated patient database, training program
and network (as part of a simulation educator network). Increase access to a wide
range of simulators through distributed models supported by appropriate technology
such as EdWISE. Commission the development of new simulator task trainers
appropriate to specific professions whose needs are currently not met.
f. Access to scenarios including a database that include profession specific and
interprofessional resources that are graded by task difficulty and map to graduate
outcomes
g. Access to simulated learning environments where undergraduate programs are
offered.
h. Assessment methods in simulation that reflects curriculum goals and real clinical
practice.
2. Using simulation to prepare students for clinical placements.
3. Using simulation to transition from student to professional.
4. Providing professional development opportunities for faculty involved in simulation
education.
5. Supporting professional networks for simulation educators to share experiences and resources
by establishing/maintaining state-wide/regional or local simulation educator networks to
facilitate exchange of experience, ideas and resources.
6. Implementing quality improvement processes.
a. Develop research skills of simulation educators or fund educational researchers to
work with simulation educators to conduct multi-site studies on healthcare
simulations.
b. Develop a state-based research strategy in healthcare simulation.

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Introduction
Simulated learning technologies in undergraduate curricula are the focus of this Evidence Check. The
Report provides a summary of reviews and highlights key research papers, offers expert opinion on the
quality and strength of the findings, describes effective practices and identifies gaps in the evidence.
Simulated learning technologies are here to stay3 and we have an obligation to use them optimally in
supporting health professional students in meeting the needs of the health care workforce.

Operational definitions
Simulation
We drew on two commonly used definitions of healthcare simulation. That is, simulation is defined as:
 “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”4
 “a technique - not a technology - to replace or amplify real experiences with guided
experiences that evoke or replicate substantial aspects of the real world in a fully interactive
manner”.5
We defined simulated learning technologies as activities that provide students with an opportunity to
rehearse skills or elements of practice that they will be required to perform as part of their future
professional roles. This includes activities that use simple to complex technologies and of low to high
fidelity and that may take place in learning, simulated or real clinical settings. That is, we adopted a
definition that included a breadth of simulated learning technologies.

Simulators or simulation modalities

We limited the study to those simulators or simulation modalities listed in Appendix I. That is,
anatomical models, cadaveric models, computer based simulations (e.g. virtual patients, virtual worlds
– Second Life, virtual reality – haptic with 2D and 3D visualisation), task trainers, simulated
(standardised) patients (SPs), hybrid simulations (two or more simulation modalities blended),
manikins (low, medium and high fidelity), Objective Structured Clinical Examinations (OSCEs) and
role-play.

Simulation educators
We refer to anyone offering simulation as an educational method as a simulation educator. They may
be clinicians or subject specialists and may function as a teacher, instructor or facilitator. For ease of
reading, we have not distinguished simulation technicians from educators although practically there is
often a difference in their roles.

Graduate outcomes
Graduate outcomes refer to competencies or standards expected of new graduates. We thematically
analysed the published outcomes of ten from the 24 eligible health professions defined by HETI 6.
These include: i) Medicine; ii) Nursing; iii) Midwifery; iv) Dentistry; v) Physiotherapy; vi) Aboriginal

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Health; vii) Occupational Therapy; viii) Dietetics; ix) Paramedicine; and x) Psychology. Common
themes were theoretical knowledge (including biomedical science, therapeutics, other theories
underpinning practice etc.), clinical skills including communication, patient assessment skills, physical
examination skills, clinical reasoning/decision-making, patient safety, teamwork, professionalism
(including law and ethics), reflection, self-awareness, self-care, organisational skills, cultural
understanding and research skills (Appendix II).

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Methods
We adopted the search strategy detailed in Boxes 1 and 2. In summary, we searched four databases
Cochrane, Medline, PsychInfo and Informit. The first three as set out in the Contract and the fourth to
capture studies originating from Australia. We conducted a limited search of the grey literature
including government reports (e.g. Health Workforce Australia), the Joanna Briggs Institute and the
Best Evidence Medical Education collaborative and sought recommendations from simulation
education experts. Only publications since 2005 and in English were included. Review papers were
considered in full while data was extracted from abstracts of research papers. Reasons for exclusion of
reviews and papers are listed in Box 3.
Quality assessments ranged from the highest - large systematic meta-analyses, followed by moderate -
narrative, integrative, critical and best practice reviews none of which had pooled data. Research papers
using randomised control trials (RCT’s) were rated as very strong through single post-test only studies
as very weak.

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Results
Search results
3277 papers were retrieved from the initial search. On reading review abstracts, 37 remained in the
pool while data was extracted from abstracts of 425 papers. Additionally, 13 reviews and 14 papers
were included after grey literature search and consultation with experts. After further consideration the
Report is based on 27 reviews and 439 papers.

Summary of selected reviews

Reviews included in the study are summarised in Table 1. Before answering the two questions posed,
we highlight selected reviews most relevant to the NSW context. We also draw attention to the reports
commissioned by Health Workforce Australia (HWA) in 2010 as a scoping exercise on Simulated
Learning Environments (SLE) in undergraduate health professions education. Although we have
included just three of these reports7-9 (physiotherapy, dentistry, social work) in our review, most offered
valuable contextual and profession specific insights. The summaries are in alphabetical order.

Carey JA, Madill A, Manogue M. Communication skills in dental education: a systematic research
review. Eur J Dent Educ. 2010;14(2):69-7
Carey et al10 reviewed communication skills training in dental education. The level of evidence was
very weak although all interventions were in a positive direction with respect to improved
communication skills. Training addressed pre- and post-operative rather than intra-operative
communication. SPs and role-play were the commonly reported simulation modality and video replay
was reported to be valuable by faculty and students. Peer observation and feedback was widely used.
Interventions appeared to be integrated with other curriculum activities. Some interventions were
distributed across the curriculum while others were confined to the early years of dental education.
Outcome measures were based on observations in practice or in simulations (e.g. OSCEs). One study
developed a rating tool to address communication skills in the context of dental education. The authors
noted the minimal contribution of real patients in the development, implementation and evaluation of
communication skills training. Programs were feasible and students reported value and satisfaction
with them. The settings and cost effectiveness were largely unreported.

Cook, D.A., et al., Technology-enhanced simulation for health professions education: a

systematic review and meta-analysis. JAMA. 2011. 306(9): p. 978-88.

This is an important study since it is the only meta-analysis in the reviews. The authors sought to
summarise the outcomes of technology-based simulation training for health professionals (and
students) compared with no intervention. The study did not include simulated patients. Pooled effect
sizes were large for knowledge, skills, and behaviours. The authors conclude that, “technology-
enhanced simulation training is associated with improved outcomes in comparison with no
intervention for health care professionals across a range of clinical topics and outcomes, including

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large effects on clinician behaviours and moderate effects on patient care.” The authors propose that
future research should focus on when and how to use technology-based simulation most effectively
and cost-efficiently.

Flanagan B, Clavisi O, Nestel D. Efficacy and effectiveness of simulation-based training for

learning and assessment in healthcare, 2007, Department of Human Services (Victoria):
Melbourne.

In 2007, the Department of Human Services (Victoria) commissioned a report on the current state of
simulation in health care in relation to specific topics: transferability of skills learned via simulation
to real patient care; clinical skills; decision-making; communication with patients; teamwork,
leadership and cost effectiveness of simulation compared with earning in real clinical settings. The
search differed to this review in that it also included studies of clinicians and did not restrict
time frame. The authors included 458 papers. Most papers were related to the medical profession.
There were gaps in the literature for every topic by profession. The authors concluded that overall,
simulation makes a valuable contribution to learning for students, trainees and clinicians. It enables
learning of routine and non-routine procedures and management of patients. However, the level of
evidence is low using conventional approaches 11 to measuring quality. There is substantial
evidence for simulation-based activities at Levels 1 and 2 of the modified Kirkpatrick’s
framework12,13, some evidence at Level 3 and a small number of studies at Level 4 where there was
clear evidence of direct benefit to patients. Most studies report high levels of participant
satisfaction. There were almost no studies on cost effectiveness.

Leigh, G.T., High-fidelity patient simulation and nursing students' self-efficacy: a review of the
literature. International Journal of Nursing Education Scholarship, 2008. 5: p. Article 37.
Leigh et al (2008) conducted a literature review examining the effects of high fidelity human patient
simulation (manikins) on undergraduate nursing student's self-efficacy and confidence 14. They
conclude that high fidelity manikins are effective when used with sound educational practices. The
quality of evidence ranged from very weak to very strong with respect to improved confidence, clinical
knowledge and skills (e.g. critical thinking, leadership, decision-making, problem-solving,
prioritisation). Studies with very strong evidence used randomisation of participants and observed
measures of skills (in simulations). Most studies used perceived rather than actual skills. The review
did not find conclusive evidence for the impact of high fidelity manikins on nurses’ self-efficacy when
compared with other methods. From students’ perspectives, high fidelity manikins were valuable to
learn to apply knowledge to clinical practice, to learn from their mistakes, to learn from peers and to
identify gaps in their knowledge. The use of manikins appeared most beneficial when the students
believed the scenarios to be legitimate, authentic and realistic. Faculty believed that manikins prepared
students to perform in real clinical settings and that the experiences in the simulation environment
transfer to clinical practice. Multiple studies revealed students and educators perceptions that
simulation improves clinical performance. Nursing students believed manikins improved both critical
thinking skills and confidence. Students rate debriefing and direct feedback as a major advantage of

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high fidelity manikins. Challenges associated with this type of simulation included a “sense of
foreboding” that something was going to go happen. Studies consistently reported that students’
anxiety levels initially rose but this tended to decrease with repeated exposure to simulation. Although
team communication improved, communication with a manikin was not valued and may lead to
inappropriate communication styles. Studies reported logistical issues with large cohorts of students
and significant investment of faculty time and costs associated with facilities and their maintenance.

Murdoch, N., J. Bottorff, and D. McCullogh, Simulation education approaches to enhance

collaborative healthcare: A best practices review. International Journal of Nursing Education
Scholarship. 2013. 2013(10): p. 307-321.
This review was interesting in its focus on identifying best practices for interprofessional education for
undergraduate students15. Seventeen studies met the inclusion criteria. Key findings include that
learning objectives are not always made explicit, nursing students were involved in all studies, most
studies included convenience samples of less than 100 learners, group teaching sizes from three to ten.
Study outcomes did not seem related to teaching group size. Simulation centres were the most common
venue for activities. Although educational activities appeared to be underpinned by learning theories,
these were rarely described in papers. The most common modality was manikins (n=13), especially
high fidelity, SPs (n=8) and role-play (n=6). Learner satisfaction (n=17) and awareness of others’ roles
(n=11), knowledge (n=12), confidence and comfort in collaboration (n=10) were reported. Study
quality was diverse as judged by Beach et al (2004) rating scale (median 19, range 10 to 31.5/32) on a
scale of 32. On the modified Kirkpatrick framework two studies were at Level 3. The authors
cautiously conclude that learners were satisfied with interprofessional simulation education in
supporting the development of knowledge, skills and attitudes needed for collaborative practice. There
was less certainty about timing in the curriculum. Most of the studies occurred in the later years of the
undergraduate programs and this was considered effective.

McGaghie W, Issenberg B, Petrusa E, Scalese R. (2010). A critical review of simulation-based

medical education research: 2003-2009. Medical Education. 44(1), 50-63.
This paper by McGaghie et al (2010) is commonly cited in the literature and included studies of
undergraduate and qualified health professionals. The review extends earlier work16 identified twelve
features and best practices of simulation to maximise educational benefit. These include feedback,
deliberate practice, curriculum integration, outcome measurement, simulation fidelity, skill acquisition
and maintenance, mastery learning, transfer to practice, team training, high-stakes testing, instructor
training, and educational and professional context. For each of these features, the authors also
identified gaps in understanding. Additionally, they refer to a review by Salas et al 17on debriefing
practices conducted in the context of continuing professional development for medical teams (and so
excluded from this review). However, the practices may have relevance to undergraduate students. The
authors also draw on the work of Ericsson18 who has described the theoretical concept of deliberate
practice. This theory is especially relevant for the development of skills. Mastery learning is also
promoted as a rigorous approach to competency-based education and has some overlap with deliberate

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practice. Although not declared, the lead author has a strong personal stance for this approach. An
important advance from the earlier review is training for simulation educators. The authors argue that
there is a great need for a mechanism to educate, evaluate and certify simulation educators, teaching
with simulation is not intuitive, clinical experience is not a proxy for simulation instructor effectiveness
and simulation educators need not be from the same profession as the learners.

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Review question 1
What is the evidence for the effectiveness of simulated learning technologies for core graduate
outcomes in the accredited undergraduate curricula for eligible professions?
The direction of evidence is clear that simulation leads to improved knowledge and skills under
specific conditions for several core graduate outcomes in undergraduate curricula – in particular, for
application of theoretical knowledge, clinical skills including communication with patients, patient
assessment skills, physical examination skills, procedural skills and clinical reasoning, patient safety,
teamwork and professionalism. The following bullet points convey key areas for which there is
evidence. There are nuanced differences between the statements even though they appear similar. The
evidence is divided between strong and moderate. There was only one meta analysis19, a consequence
of the limited number of suitable studies meeting eligibility criteria. A challenge in synthesising the
outcomes relates to the broad range of simulation modalities, graduate outcomes and the varied
contexts in which the studies are set.

Strong evidence

 Technology-enhanced simulations in comparison with no intervention or when added to traditional

interventions were associated with better learning outcomes19.
 Simulation supports learners in the recognition and management of specific clinical conditions
compared with non-experiential forms of learning in randomised control trials (RCTs). For
example, in dyspnoea20, cardiac arrhythmias20 and pre- and post-operative care in the ICU21.
 Most RCTs (70%) showed simulation training significantly improved procedural skills
performance in comparison with standard or no training22.
 Examples of clinical skill, modality and respondent group are:
o Dental procedures with haptic virtual reality for dental students7
o Cardiopulmonary resuscitation skills with manikins for nursing students23
o Intravenous cannulation with task trainers for medical students20
 Simulation leads to improved examination skills:
o Interpreting cardiac sounds for medical students20
o Intimate examinations for medical students24

Moderate evidence

By far the most evidence sits at a quality assessment of moderate.

 Almost all simulation-based education leads to increased knowledge of clinical conditions 20,24,25
although one review identified a very small number of neutral or negative results23.
 Simulation can lead to increased efficiency (learning faster) when compared with other methods7
and are effective when used in conjunction with other methods.

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 Patient safety knowledge, attitudes and skills are improved or enhanced by a range of simulation
modalities when integrated in curricula for medicine, nursing, pharmacy and dentistry students26
and specifically in using protocols in clinical settings20.
 Simulated learning technologies can lead to increased confidence in interprofessional collaborative
practice and team training in medicine, nursing and pharmacy students21,25,27.
 Simulation leads to clinical skill acquisition and retention when ongoing practice is offered 10,23,28
and, to transfer to clinical settings20.
 Although not evidence of actual transfer, nursing students believe that the skills learned through
simulation are transferable to clinical settings in relation to the deteriorating patient 29.
 Simulated learning technologies are shown to be valuable for nursing students in orientation to
clinical settings30.
 Simulation provides the only opportunity for students to learn some skills/manage some
events/situations in relation to the deteriorating patient in a patient safe environment 29,30.
 Specific simulation modalities lead to defined outcomes:
o Confidence, knowledge and skills are shown to improve with simulated patient based
simulations for communication10, patient counselling24, error disclosure skills24,25,31,
professionalism20 and other clinical skills24.
o Simulated health professionals and simulated students support the development of a
diverse range of professional skills24.
o Virtual patients compared with no intervention, are consistently associated with
higher learning outcomes – knowledge, clinical reasoning7,32 and other clinical
skills7,33.
o For nursing students, although knowledge acquisition was unrelated to manikin
fidelity, clinical reasoning skills were better supported by high rather than medium fidelity
manikins34.
 Feedback plays a critical role in effective outcomes. Simulation alone is rarely sufficient. It must
be accompanied by strong educational design and feedback or debriefing is essential. The source,
amount, nature and timing of feedback influences satisfaction, immediate and longer term
outcomes. The use of video assisted debriefing is thought to be valuable10.
 Real patients are noticeably absent from the design of simulations10.
 Most papers do not reference learning theory in the design or assessment of student learning 35.
 Student satisfaction with simulated learning technologies is moderate to very high.

Enablers for successful outcomes

Educational design is paramount with key stages including preparation, briefing, simulation,
debriefing, feedback, reflection and evaluation1.
 Feedback is considered a feature of simulation-based education14,28.
 Theoretical underpinning is important in educational design:

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 o Deliberate practice is an approach to developing expert status in skills that is derived
from psychological studies of experts18. Deliberate practice is characterised by a
highly motivated individual (learner), the opportunity for repeated practice with
feedback, the opportunity to increase the level of challenge and a coach or mentor 28.
o Mastery learning28 can lead to successful outcomes in the development of
psychomotor skills and includes establishing clear learning objectives, explicit
expectations of performance and repetitive practice with feedback.
 Curriculum integration of simulation activities is essential 7,28,34,36,37. Simulation usually forms part
of a broader program or as an adjunct to other learning experiences. Integration and coordination
is more likely to lead to successful outcomes than isolated programs. Simulation activities
need to reflect the educational, clinical and professional contexts of the learners 14,28.
 Simulation fidelity and modality needs to be fit for purpose7,28,34,36. For example, VPs are not well
suited to supporting the development of empathic skills which are better suited to SPs. Medium
fidelity manikins are at least of equal benefit as high fidelity manikins in supporting the
development of clinical skills for managing deteriorating patients38.
 Undergraduate students usually value the experiential nature of simulation28,30.
 Successful outcomes depend on access to simulation programs, simulators and simulation
educators. Kneebone et al (2010) argue for distributed simulation enabling anytime anywhere 39
simulations with local educators (or at least co-educators). Flinders University operates a small van
to take simulators and faculty/technicians to sites where they are needed across the state. The
Queensland Skills Development Service operates a central sharing and maintenance service of
simulators to health services and higher education facilities40.
 Faculty who are informed about simulation education28 combined with a network of simulation
educators is needed to ensure successful outcomes. The national simulation educator programs -
AusSETT and NHET-Sim - were developed with three pillars of a theoretical community of
practice in mind41. That is, joint enterprise (members of the community have a common goal),
mutual engagement (many opportunities for participation) and a shared repertoire (common
language and resources)42. This approach has been successful and has led to the establishment of
local communities of practice. The overarching national perspective has enabled sharing of
resources and practices across the country with a positive impact on quality. Leveraging existing
networks is important to further advance healthcare simulation practice.

Barriers to successful outcomes

Unsurprisingly, the barriers directly contrast with the enablers. These include macro level barriers. Not
using simulation in undergraduate health professions education may result in greater costs in the longer
term22. Different funding streams for those responsible for undergraduate education and those who
provide health services may discourage education providers from investing in simulated learning
technologies. However, few papers considered the cost of simulation. Cook et al (2009)36 report
development cost of a virtual patient at US$10-50K, time for development (approximately 16 months),
and then there are maintenance costs. This is a substantial investment for the development of a single

17
virtual patient case. In contrast, Lapkin and Levett-Jones (2011) conducted a cost analysis of manikins
and found the same learning outcomes could be achieved for $AU1.21 for medium compared with
$AU6.28 for high fidelity38 per student. Kneebone et al (2010) provide evidence for learning outcomes
in low cost, mobile simulated learning environments compared with static, resource intensive
simulation centres39. That is, not all simulated learning technologies are expensive but they do need to
be carefully selected for their intended purpose. Some technologies need significant maintenance, some
have other recurring costs8 and some require highly specialised skills to operate8.

Barriers may exist at the level of the professional association where there may be a reluctance to
embrace simulation-based training methods, especially those that challenge traditional work integrated
learning through clinical placements.

At the faculty level, there are several barriers to effective outcomes and include a lack of training in
simulation methods9,28,34,37, of educational theories that inform simulation practice, such as instructional
design7,9 and even in fundamentals such as not making learning objectives explicit. There may be
insufficient time to develop simulation resources 9. Faculty may not have scope to integrate their
simulation program into broader curricula28. There may be logistical issues of timetabling into already
crowded curricula and in providing learners with opportunities for repeated practice and feedback 23,28.

Barriers also include access to appropriate simulators7,8,34. For example, a lack of clinical realism has
been reported with simulated patients8 who may have had limited or no training. Inadequacy34 of
simulation equipment (e.g. fidelity of simulator to replicate tissue swelling, stiffness)8 or not fit for
purpose (e.g. inappropriate communication skills with manikin and virtual patients) constrains effective
outcomes.

Review question 2
In which settings are simulated learning technologies most effective?
This question was largely answered in the section above. In summary, simulation design needs to
ensure that learning is contextualised. That is, by locating the clinical skills or knowledge in the wider
arc of care required for safe practice. That is, physical examination skills learned in simulation without
reference to communicating with patients may lead to unprofessional practice. Learning intravenous
cannulation without attention to proper hand washing and safe disposal of sharps may lead to poor
performance in clinical settings. Therefore, students need access to facilities in which they can place
their learning in context. The physical settings varied widely with simulation centres, skills labs and
training provider tutorial/class rooms. Like selecting simulators, environments also need to be fit for
purpose. Undergraduate health professional education often takes place on campuses that may not be
co-located with clinical and social care settings in which students undertake placements. In order for
students to have ready access to simulation facilities throughout their education, simulated learning
technologies need to be available where and when they are needed on campus. Additionally, unless the
scale of healthcare service simulation facilities is substantive, they may be unable to provide access for
large student cohorts.

18
High technology does not necessarily lead to better outcomes. Other “settings” for effective simulation
include those:
 Associated with transitions, usually into clinical settings20,30 and from medical student to junior
doctor.
 Coupled with appropriate pedagogy (e.g. acquisition and performance of the skill were improved
when manikin-based simulations were coupled with the principles of cognitive task analysis and
mental imagery)21.
 Learning technologies such as audio-visual capture are now relatively inexpensive and easily
integrated into non-specialised environments. There is moderate evidence for the value of video-
assisted debriefing.
 There is some limited evidence of using video technologies for remote simulation-based
instruction21. That is, high definition teleconferencing can support the learning of clinical skills
through simulation where faculty from a central location can brief, observe and debrief simulation
activities in a remote location.

Research papers
 We extracted 439 research papers that have relevance to the NSW context.
 Table 3 summarises the respondent groups with medical students the most commonly reported
group (n=218) followed by nursing (n=119), pharmacy (n=36), dentistry (n=15) and other
professions students with less than 5 papers. Combinations of students were identified in 15
papers, which usually but not always implied interprofessional education.
 With respect to simulation modality, manikins (n=92) and SPs (n=92) were most commonly
reported (Table 4). Seventy-two of the papers extracted reported the use of multiple modalities
in their studies. For example, both manikins and SPs.
 The majority of papers used a quantitative research design (n=277) followed by mixed
methods (n=66) and qualitative design (n=45) (Table 5).
 Based on the abstract, the study design was given a quality assessment as very weak, weak,
strong or very strong. More papers were assessed as weak (weak n=167 and very weak n=72)
than strong (strong n=167 and very strong n=30).
 Thirty-six studies were drawn from Australia.

RCTs are difficult to establish in educational interventions. Reasons include the underfunding of new
educational interventions, educational interventions not conceived as research and that educational
developers may not be working with researchers who have these skills. So although RCTs are used in
education, other approaches for assessing quality are more accessible and also valued. RCTs may not
give insight to why or how simulation is working (or not). Additionally, we do not know if negative
findings are occurring but are simply not published. Although the overall weak quality assessment of
these papers carries some weight, it does not minimise their value to simulation educators, clinicians
and policy makers.

19
Common themes and summary of selected papers
There are several commonly referenced studies that improve patient outcomes for healthcare
professionals following simulation43-46. Although there is limited evidence of patient outcomes as a
result of simulation-based programs in undergraduate education, this is likely to relate to the
relatively limited role that health professional students have in direct patient care. However, there are
some notable exceptions. Nestel and Campbell (In press) reported better performance in workplace
assessments of medical students who learned intravenous cannulation in a progressive stepwise
simulation model when compared with students who learned in a traditional way 47.

Watson et al (2012) report an important Australian study on the substitution in simulation of selected
clinical placements (15%) for physiotherapy students and found no difference in performance of
students between experimental and control groups48. In late 2014, the results will be released of a
national US study on the replacement of traditional clinical hours in nursing curricula with 10%, 25%
and 50% of simulation49. This is an important large-scale longitudinal study that is likely to have
implications for nursing education internationally. Ten schools of nursing have participated, with the
students randomly allocated to the different percentages of simulation and students evaluated after their
first year of clinical practice.

Gaps in the evidence

We note gaps in the evidence in the following areas for undergraduate health professions education:
 Comparisons of theory-based simulation designs.
 Feedback (and debriefing) models to establish timing, nature, source etc.
 Timing, frequency and repetitions of simulation in curricula (e.g. how much, how often etc.)
including the timing of interprofessional simulation education.
 The role of real time in simulations. That is, for which skills is it important that students practise
skills in the time frames in which they would be needed in real clinical settings?
 The role of student observers in simulations with respect to optimising learning.
 Retention of learning.
 Impact of simulation education for undergraduate students on patient outcomes.
 Impact of simulation on the emerging professional identities of students.
 Fit for purpose simulators relative to the targeted competencies including the necessity for the
development of new simulators to meet the needs of undergraduate students (e.g. physiotherapy,
dentistry etc).
 Simulation and the healthcare of Aboriginal and Torres Strait Islanders.
 Cost effectiveness of simulation compared with other educational methods.
 Distributed models of simulation to increase access for all health professional students.
 Process for development and impact of shared simulation resources (including governance
models).

20
Most of these topics are suited to multi-site studies and relevant across professions but require
infrastructure to support the planning of research, implementation, analysis and dissemination of
results.

In 2013, the Australian Society for Simulation in Healthcare held a research summit in which a national
research agenda was created. The research questions generated by the participants is in draft form and
the eleven themes listed in Box 4. Three of the authors of this Report (DN, MB, KK) participated in the
Summit. Each of the themes has several associated research questions and these are likely to inform
HETI strategic planning. The questions are currently being refined and will be made available on the
Simulation Australia website. The US based Society for Simulation in Healthcare has also just
completed a White Paper on healthcare simulation research. The White Paper will be published shortly
and is likely to be valuable in informing HETI of gaps in research and strategic direction.

The NSW context

We noted that some of the reviews involved NSW based academics. Of course the HWA SLE reports
also have NSW relevance. Although none of the 439 research papers were obviously based in NSW,
we wanted to consider examples of simulation education in undergraduate health professional
curricula.

In response to a call for illustrations of contemporary practice, there appear to be excellent initiatives
across NSW. Kelly (2014) has explored the impact of manikin-based simulations on the clinical
judgement of final year nurses and followed their transition to registered nurse practice 50. Marley and
Pedersen (2013) evaluated the contribution of SPs to the management of critically unwell patients by
final year medical students51 in direct response to participating in the NHET-Sim program. EdWise is
increasing access to simulation through web-based and mobile technologies from an established
Sydney group52, while U-ITCT (Undergraduate Interprofessional Teamwork and Communication
Training) is a large collaboration that seeks to offer interprofessional simulation education addressing
core graduate competencies of medical, nursing and allied health professional students53. The Hunter
New England Simulation Centre offers simulation training to over 4,000 students and clinicians
annually with a focus on interprofessional collaborative practice. These examples document practices
that reflect those reported in the reviews and wider literature. Maintaining such activities is important
in leveraging the momentum and enabling maturity of programs.

With respect to simulation educators, as of the end of May 2014, 1,232 NSW-based participants had
registered for the NHET-Sim Program and 645 have completed. This is a substantial investment in
individuals able to use simulation as an educational method. Additionally, there are 53 NHET-Sim
faculty from NSW who have made a significant contribution to professional development of simulation
educators within the state and nationally. Most of the faculty is directly involved in undergraduate
health professions education although they are mainly from medicine and nursing.

21
Strengths and limitations of the review
The strengths of this review are that it was tightly defined in order to answer specific questions.
Although the relatively recent 2005 time frame for inclusion may be considered a limitation, we
believed it to be a strength because it is more likely to reflect contemporary practices in health care
simulation and therefore to have greater relevance than earlier studies. The complementarity of the
project team’s experience meant we were receptive to different simulation modalities and their
applications in undergraduate health professions education.

The limitations of the review are that data was sourced from just four databases. However, these were
carefully selected to reflect a wide coverage of professional disciplines and to include Australasian
data. We also sought expert advice on essential reviews and papers of interest. We used abstracts to
make decisions about inclusion and may have overlooked important papers because of inadequate
abstracts. Some reviews were excluded when they focused more on qualified health professionals
rather than undergraduate students. Additionally, the scope of the review did not cover identifying the
most effective simulation methods associated with specific clinical skills. However, we are confident
the Report reflects contemporary simulation practices in health professions education. A final
limitation was the relatively short time in which the review was to be conducted and the large number
of reviews that met inclusion criteria.

22
Conclusions
We conclude the Report by referring to the graduate outcomes identified in the thematic analysis and for
which simulated learning technologies were found to be effective. The direction of evidence is clear that
simulated learning technologies generally leads to improved knowledge and skills under specific
conditions for several core graduate outcomes in undergraduate curricula. In particular, for application
of theoretical knowledge, clinical skills including communication with patients, patient assessment
skills, physical examination skills, procedural skills and clinical reasoning, patient safety, teamwork
and professionalism.

Under specific conditions, the value of simulated learning technologies is overwhelmingly positive.
There are ethical imperatives for the use of simulation in health professions education. The first
imperative is to minimise risks to patients by ensuring health professional students are prepared for
integrated work learning (clinical placements) and for transition to professional practice. The second
imperative is to students where strong evidence exists for the benefits of learning in simulation, they
should be afforded this opportunity.

Simulated learning technologies have relevance in all undergraduate health professions education.
Although high technology learning environments are not essential for effective simulation practice,
efforts must be made for learning of procedures and skills to be contextualised. That is, students have
the opportunity to integrate whole procedures and skills with the people and settings that resemble
those in which they will be expected to practice. Simulation facilities need to be accessible for students
across their undergraduate education and reflect the varied environments in which they will eventually
work. Learning technologies such as audio-visual capture are now relatively inexpensive and easily
integrated into non-specialised environments.

Simulation modalities have different degrees of relevance across health professions. Simulated patients
have value in all health professions. Task trainers are highly relevant in procedure-oriented health
professions. Manikins are essential for recognising and managing deteriorating patients and can be
enhanced by adding simulated patients to scenarios. Virtual patients assist the development of clinical
reasoning but can be unhelpful for empathic communication.

Further, not using simulation (or using it ineffectively) in undergraduate education may result in
greater costs in the longer term to the health and social care services.

Finally, there is emerging evidence that simulation can replace some clinical placement activities
without impacting graduate outcomes. That is, simulation is at least as effective as learning in clinical
placements. However, the amount of substitution is not yet determined.

23
Recommendations
Based on the evidence, the resources and expert opinion, recommendations for implementing effective
simulated learning technologies in undergraduate health professions education include:
1. Ensuring sound design of simulation-based education programs that are integrated with
broader curriculum activities.
a. Theoretical underpinning of simulation-based education programs.
b. Explicit learning objectives.
c. Feedback and debriefing processes to optimise student learning.
d. Provision of multiple opportunities to practise and rehearse using simulation.
e. Access to a wide range of simulators (including simulated patients, manikins,
task trainers etc.). For example, establish a simulated patient database, training
program and network (as part of a simulation educator network). Increase access
to a wide range of simulators through distributed models supported by
appropriate technology such as EdWISE. Commission the development of new
simulator task trainers appropriate to specific professions whose needs are
currently not met.
f. Access to scenarios including a database that include profession specific and
interprofessional resources that are graded by task difficulty and map to graduate
outcomes.
g. Access to simulated learning environments where undergraduate programs are
offered.
h. Assessment methods in simulation that reflects curriculum goals and real clinical
practice.
2. Using simulation to prepare students for clinical placements.
3. Using simulation to transition from student to professional.
4. Providing professional development opportunities for faculty involved in simulation
education.
5. Supporting professional networks for simulation educators to share experiences and
resources by establishing/maintaining state-wide/regional or local simulation educator
networks to facilitate exchange of experience, ideas and resources.
6. Implementing quality improvement processes.
a. Develop research skills of simulation educators or fund educational researchers
to work with simulation educators to conduct multi-site studies on healthcare
simulations.
b. Develop a state-based research strategy in healthcare simulation.

24
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27
Box 1: Search terms used in databases

nurs*OR midw* OR medicine OR surgery OR physiotherap* OR pharmacy OR paramedic* OR dentist* OR

dietet* OR aboriginal torres strait islander health* OR indigen*

AND simulat* OR standardized patient OR standardised patient OR manikin OR mannequin OR task trainer OR
part task trainer OR parttask trainer OR part-task trainer OR virtual ADJ3 (object* OR system* OR environ* OR
world OR program* OR patient) OR OSCE OR Objective Structured* OR role play OR role-play OR roleplay OR
hybrid simulation OR patient focused simulat*

AND clinical skill OR procedural skill OR clinical examination OR teamwork OR professionalism OR

communication OR consultation skill OR history-taking OR ethics OR clinical judgement OR decision-making
OR patient safety OR physical examination OR patient care

AND undergraduate OR student OR intern OR junior doctor OR pre-registration OR pre-licensure

AND curriculum OR graduate outcomes OR learning outcomes

28
Box 2: Search strategy for review

Initial search in
Ovid Medline (2638)
Cochrane (167)
Informit (923)
PsychInfo (717)
Remove duplicates
Total 3277

Abstracts
included
37 + 425
Expert identified
Expert identified papers
reviews 14
13

Reviews Papers
Included Included
50 439

37 reviews 439 papers

(Table 1) (Table 2)

29
Box 3: Reasons for excluding reviews and papers

Reviews
 Validation studies of simulators or assessment instruments
 Only focused on healthcare professionals
 Not a graduate outcome (e.g. laparoscopic skill proficiency)
 Not a simulation modality
Papers
 Validation studies of simulators or assessment instruments
 Pilot studies
 Not undergraduate/entry level except for intern/junior doctor/pre-registration medical
 Not a graduate outcome (e.g. laparoscopic skill proficiency)
 Descriptive and no data
 Study aim not articulated
 Letters
 No abstract or insufficient information
 Culturally disparate
 Book chapter

30
Box 4: Themes from the national research agenda from the 2013 Research
Summit of the Australian Society for Simulation in Healthcare

1. Using simulation to support learning in students and clinicians

2. Debriefing and simulation
3. Using simulation for performance assessment
4. Establishing standards for simulators and simulated environments
5. Modelling healthcare systems
6. Using simulation to address education and workforce issues
7. Considering simulation in the broader world
8. Theorising simulation
9. Conducting research on healthcare simulation
10. Considering funding, costs and efficiencies in education and research
11. Translating research outcomes to education and healthcare

31
Appendix I: List of simulators or simulation modalities and their
descriptions
Simulator Description

Animal or cadaveric simulators Real animal or human tissue used which may be used in another simulator to
increase realism (e.g. issue in a box trainer for learning minimally invasive
skills). Human cadavers for learning anatomy and clinical skills.

Computer b a s e d simulation Learner interaction is with a computer-based activity such as virtual patients,
(e.g. virtual patients, virtual second life and avatars.
worlds)

Task trainers Bench top models or devices that replicate only a part of the real thing,
or part of the body, to teach specific tasks or skills (e.g. male pelvis for
urinary catheterisation)

Simulated patients (SP) (or A well person trained to portray a patient in a simulation of a health care
standardised patient) scenario. The SP may offer feedback to the learners.

Hybrid simulations A combination of two or more simulation modalities such as a simulated

patient and task trainer.

Manikin (or human patient Full body patient manikins of various degrees of
simulator or high fidelity capability/sophistication with which the learner’s must interact. The
human patient simulators) models vary in level of technology and realism.

32
Objective Structured Clinical A series of scenarios or stations reflecting a range of skills-based clinical
Examinations (OSCEs) activities. OSCEs are used to teach and assess clinical skills and a dominant
form of skills assessment in undergraduate medical education.

Role-play Learners take on their own role or that of another (e.g. patient, relative,
health professionals) in a health care scenario.

Virtual reality Parts or all of the patient and environment are presented to the user via
2D or 3D visual and audio representations, with or without “touch”
(haptics) to create a more “immersive” experience.

33
Appendix II: Data display table of graduate outcomes for eleven eligible
health professions
Theme Profession Graduate outcome
Theoretical Medicine Demonstrate an understanding of established and evolving biological, clinical,
knowledge epidemiological, social, and behavioural sciences
(including Apply core medical and scientific knowledge to individual patients, populations
and health systems
biomedical science,
Describe the aetiology, pathology, clinical features, natural history and prognosis
therapeutics and of common and important presentations at all stages of life
other theories
underpinning
practice)
Dentistry Apply a thorough knowledge of the complex interactions between oral health,
nutrition, general health, drugs and systemic diseases that can have an impact on
oral health care and oral diseases
Understand and apply knowledge of the scientific basis of dentistry, including
the relevant biomedical and psychosocial sciences, the mechanisms of
knowledge acquisition, scientific method and evaluation of evidence
Apply knowledge and understanding of the basic biological, medical, technical
and clinical sciences in order to recognise the difference between normal and
pathological conditions relevant to clinical dental practice
Understand the causes and factors that lead to dental diseases or disorders
Recognise the clinical features of oral mucosal diseases and disorders
Examine the dentition for pathology and abnormalities including dental caries,
attrition, wear, abrasion and erosion, and other damage to dental hard tissues
Identify the location, extent, contributing factors and degree of activity of dental
caries, tooth wear and other structural or traumatic anomalies
Recognise the presence of systemic disease and know how the disease and its
treatment, including present medication, affect the delivery of dental care and
vice versa
Diagnose abnormalities in dental or periodontal anatomical form that
compromise periodontal health, function or aesthetics and identify conditions
which require management
Distinguish between periodontal health and periodontal disease and identify
conditions that require management
Diagnose, explain and manage the deterioration and breakdown of existing
restorations
Conduct, explain and discuss the planning of restorative, periodontic and
prosthetic dental treatment as part of comprehensive oral rehabilitation
Understand the common impairments of function as a consequence of tooth loss

Physiotherapy Demonstrate a working knowledge and understanding of theoretical concepts

and principles relevant to physiotherapy practice
Relevant knowledge of theoretical concepts and principles of biomedical and
behavioural sciences is applied to physiotherapy practice
Principles of the physiotherapy assessment process, its basis and use of relevant
outcome measures are applied to physiotherapy practice
Knowledge of common clinical presentations, interventions and management
approaches is applied to physiotherapy practice

Dietetics Applies current knowledge of the theory of human nutrition and dietetics and
related practice to a level which supports safe practice
Describes personal, social, cultural, psychological, environmental, economic and
political factors influencing food and food use, food habits, diet and lifestyle
Demonstrates knowledge of foods and food preparation methods used in the
practice community
Relates knowledge of food science to nutrition and dietetics
Describes and compares food service systems
Describes food systems, food use, and food and nutrition policy
Applies the basic principles of education theory as it applies to nutrition and
dietetic practice
Relates theories of organisation, management and marketing to nutrition and
dietetic practice
Describes and compares theories of health promotion, program planning, and
management and public health

34
 Applies the National Physical Activity Guidelines in practice
Applies principles of learning theory
Applies clinical reasoning theory

Paramedicine Understands the key concepts of the bodies of knowledge which are specifically
relevant to Paramedic practice:
• understands the structure, function and pathophysiology of the human
body, relevant to their practice, together with knowledge of health,
human growth and development, disease, disorder and dysfunction;
• understands the principles and applications of scientific enquiry,
including the evaluation of treatment efficacy and the research
process;
• understands the theoretical basis of and the variety of approaches to
assessment and intervention;
• knows human anatomy and physiology sufficient to understand the
nature and effects of injury or illness and to conduct assessment and
observation in order to establish patient management strategies;
• understands psychological and social factors that influence an
individual in health and illness;
• understands the clinical sciences underpinning paramedic practice,
including physiological, pharmacological, behavioural and functional
Describe major areas of applied psychology (eg, clinical, counselling,
organisational, forensic, health)

Psychology Display basic knowledge and understanding of the following core† topics:
 abnormal psychology
 biological bases of behaviour
 cognition, information processing and
 language
 individual differences in capacity and
 behaviour, testing and assessment,
 personality
 learning
 lifespan developmental psychology
 motivation and emotion
 perception
 social psychology
 history and philosophy of
 psychology
 intercultural diversity and
 indigenous psychology
Demonstrate knowledge of the theoretical and empirical bases underpinning the
construction, implementation, and interpretation of some of the most widely used
cognitive and personality assessments
Demonstrate knowledge of the theoretical and empirical bases underpinning
evidence-based approaches to psychological intervention
Delineate psychology as a scientific discipline and describe its major objectives
Explain the major themes (eg, interaction of genetics and environment) and
perspectives (eg, behavioural, evolutionary, sociocultural) of psychology
Explain psychological phenomena using the concepts, language, and major
theories of the discipline

Clinical skills Medicine Demonstrate by listening, sharing and responding, the ability to communicate
(including clearly, sensitively and effectively with patients, their family/carers, doctors and
communication, other health professionals
Communicate effectively in wider roles including health advocacy, teaching,
procedural physical
assessing and appraising
examination and Explain the main principles of ethical practice and apply these to learning
patient assessment) scenarios in clinical practice
Communicate effectively about ethical issues with patients, family and other
health care professionals
Perform a full and accurate physical examination, including a mental state
examination, or a problem-focused examination as indicated
Select and perform safely a range of common procedural skills
Recognise and assess deteriorating and critically unwell patients who require
immediate care
Perform common emergency and life support procedures, including caring for
the unconscious patient and performing CPR

Nursing Communicates skill mix requirements to meet care needs of individuals/groups

to management

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 Communicates effectively with individuals/groups to facilitate provision of care:
 Uses a range of effective communication techniques
 Uses language appropriate to the context
 Uses written and spoken communication skills appropriate to
the needs of individuals/groups
 Uses an interpreter where appropriate
 Provides adequate time for discussion
 Establishes, where possible, alternative communication methods
for individuals/groups who are unable to verbalise
 Uses open/closed questions appropriately
Demonstrates the necessary communication skills to manage avoidance,
confusion and confrontation
Demonstrates the necessary communication skills to enable negotiation
Ensures that written communication is comprehensive, logical, legible, clear and
concise, spelling is accurate and only acceptable abbreviations are used

Midwifery Communicates information to facilitate decision making by the woman

Communicates effectively with the woman, her family and friends
Demonstrates effective communication with midwives, health care providers and
other professionals

Dentistry Communicate effectively, interactively and reflectively with patients, their

families, relatives and carers in a manner that takes into account factors such as
their age, intellectual development, social and cultural background
Provide open, complete and timely communication throughout the period of care
Provide information in a manner that ensures patients and families can be fully
informed when consenting to any procedure and encourage them to make fully
informed decisions by discussing treatment options and expected outcomes
Communicate effectively with other health professionals involved in patients’
care and convey written and spoken information clearly
Communicate effectively and responsibly in all communication media
Recognise and communicate to patients the properties and risks and benefits of
dental materials and related tissue responses
Apply the scientific principles of sterilisation, disinfection and antisepsis, and
cross infection control
Work safely with ionising radiations with consideration for their effects on
biological tissues and understand and apply the regulations relating to their use,
including radiation protection and dose reduction
Apply the principles of pharmacology in using therapeutics relevant to clinical
dental practice
Perform an extraoral and intraoral examination appropriate to the patient,
including assessment of vital signs and the recording of those findings
Complete and record a comprehensive examination of oral hard and soft tissues
Formulate and record a comprehensive diagnosis, management and/or referral
plan which meets the needs of patients
Take radiographs of relevance to the diagnostic process and dental practice
Interpret radiographic and other diagnostic tests relevant to clinical practice
Manage oro-facial pain, including TMJ disorders, discomfort and psychological
distress
Manage periodontal disease
Manage caries and other hard tissue tooth loss
Manage pulp and peri-radicular disease and disorders
Restore teeth and the dentition to acceptable form, function and aesthetics
Manage patients with prosthodontic needs, including the provision of fixed,
patient-removable and implant prostheses
Treat and manage conditions requiring minor surgical procedures of the hard and
soft tissues, and apply and /or prescribe appropriate pharmaceutical agents to
support treatment
Manage common oral mucosal diseases and disorders
Manage minor developmental or acquired dentoalveolar, growth related and
functional abnormalities of the primary, mixed and permanent dentition
Produce diagnostic casts, mounted with inter-occlusal records

Physiotherapy Communicate effectively with the client

Rapport is established with the client
Verbal and non-verbal communication is adapted to the needs and profile of the
client

36
 Communication with the client is conducted in a manner and environment that
ensures confidentiality, privacy and sensitivity
The goals, nature, purpose and expected outcomes of the physiotherapy
intervention are discussed and agreed
Appropriate techniques are used to communicate effectively with the client about
health promotion issues relevant to area of physiotherapy practice
Where communication barriers exist, efforts are made to communicate in the
most effective way possible and assistance is sought as required from sources
including technology and other persons
Communication is adapted to accommodate client needs
Appropriate strategies are employed to address communication difficulties
Prepare and deliver presentations to groups
• Presentations are planned and prepared to match audience needs
• Information is conveyed in a format and style to match audience
needs
• A range of relevant delivery strategies are applied to presentations
A systematic format is applied to measuring and recording client data to ensure
the effectiveness of the intervention is evaluated

Aboriginal Health Collaborating and communicating with other health professionals

Occupational Develops, communicates and implements an effective, efficient plan for
Therapy occupational therapy intervention
Facilitates active participation of the client in service provision
Adopts a communication approach appropriate to the working environment
Documents and reports relevant aspects of service provision
Shares professional information responsibly
Performs a relevant, comprehensive assessment of occupational performance

Dietetics Demonstrates or employs effective communication and counselling strategies as

they apply to nutrition and dietetic practice
Uses appropriate verbal and non-verbal communication
Listens and provides feedback that encourages participation and engagement
Communicates in a way which respects customs of other cultures, using socially
and culturally appropriate strategies
Uses an interpreter appropriately to communicate nutrition and health
information
Presents an accurate, clear and logical message that is targeted to the audience
when speaking publicly
Develops and delivers education sessions for small groups
• Develops, implements and evaluates nutrition education plans for a
variety of target groups
• Provides appropriate rationale for educational approach based on
evidence
• Uses a variety of presentation techniques
• Displays innovation implementing nutrition education plans
• Displays group facilitation skills
Communicates food service and supply needs of individual clients to appropriate
persons
Formulates unambiguous instructions for other personnel involved in the
delivery of nutrition care
Communicates the nutrition care plan to other members of the healthcare team as
appropriate, including referring practitioners
Communicates outcomes of nutrition programs to relevant internal and external
stakeholders
Clearly articulates and justifies conclusions and recommendations for action
Provides accurate and clear information to food service personnel and other
health carers to allow implementation of plans
Communicates to effect practice change if required
Uses negotiation and conflict resolution skills to promote best practice
Translates technical nutrition information into practical advice on food and
eating
Uses food composition data, food regulations and codes of practice, nutrient
reference tools and food guides to identify food options, which meet nutrition
needs
Develops and uses specific tools to assist food choices and preparation
Collects health and medical, social, cultural, psychological, economic, personal
and environmental data

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Identifies and records health and medical, social, cultural, psychological,
physical activity, economic, personal and environmental data, which are
necessary to plan nutritional management
Uses a variety of sources to obtain health and medical, social, cultural,
psychological, economic, personal and environmental data, taking into account
ethical issues
Provides assessment of food intake data
Selects a suitable method and level of detail for assessing intake of foods and
nutrients identified by referral, the client, previous history or epidemiological
data
Is able to estimate nutrient intake for individuals using food composition tables
and/or databases and compare with Nutrient Reference Values (NRVs) or
estimated requirements
Is able to interpret nutrient intake for groups and populations using food
composition tables and/or databases and compare with Nutrient Reference
Values (NRVs) or estimated requirements
Uses food guidance systems to contribute to the assessment of the client’s dietary
intake
Provides assessment of nutritional status
Selects suitable methods for assessment of anthropometry and body composition
Is able to interpret anthropometric and body composition and nutritional
assessment data using appropriate reference ranges
Recognises clinical signs of malnutrition
Assesses and assigns priorities to all data
Undertakes screening and assessment to identify and prioritise those at
nutritional risk
Demonstrates awareness of the range of validated nutrition screening and
assessment tools available, including strengths and limitations
Identifies and uses appropriate validated tools in nutrition screening and
assessment
Includes appropriate follow-up timeline
Determines nutritional status using assessment data
Interprets available documentation to identify problems
Assesses anthropometric and other body composition data
Assesses clinical, biochemical and other biomedical parameters
Assesses dietary intake, food habits, mental health and well-being issues,
physical activity and lifestyle habits
Makes appropriate nutrition diagnoses
Develops dietary prescriptions and formulates meal plans and feeding regimens
consistent with nutrition goals
Implements nutrition care plan in collaboration with client or carer and other
members of health care team
Selects the most suitable strategy in terms of feasibility and client outcome
Implements nutrition plan and a system for monitoring and review with client
and other health care team members
Promotes physical activity guidelines in care plan with client and other health
care team members
Conducts a needs assessment
Plans nutrition programs with the population group
Develops program plans, that are relevant to the target group, which consider the
social determinants of health
Develops program plans that incorporate goals, objectives and strategies relevant
to identified determinants and needs assessment findings
Develops program plans that incorporate process, impact, outcome evaluation
Develops program plans that incorporate a communication strategy
Applies existing standards to evaluate available nutrients and nutritional
adequacy and recommends strategies to improve nutrition in general and in
therapeutic menus
Assesses the nutrition implications of food service systems on individuals and
groups
Develops plans to provide safe and nutritious foods in a food service institution
Prepares meal plans for individuals and groups, which meet nutritional, personal,
cultural, sociological, psychological, socioeconomic needs and specific health
needs, taking into account the ordering, preparation, service, availability and
distribution of food
Applies these meal plans for groups in an institutional, commercial or

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 community foodservice setting
Provides advice on appropriate ingredients and alternatives to achieve nutritional
goals for general, diverse or therapeutic diets
Formulates, modifies or standardises recipes for general, diverse or therapeutic
diets that are relevant to the production and distribution system within a food
service

Paramedicine Demonstrates effective and appropriate skills in communicating information,

advice, instruction and professional opinion to colleagues, service users, their
relatives and carers;
Communicates effectively in English;
Identifies that communication skills affect the assessment of patients and how
the means of communication should be modified to address and take account of
factors such as age, physical ability and learning ability;
Selects, moves between and uses appropriate forms of verbal and nonverbal
communication with patients and others;
Identifies the characteristics and consequences of non-verbal communication and
how this can be affected by culture, age, ethnicity, gender, religious beliefs and
socio-economic status;
Provides patients (or people acting on their behalf) with the information
necessary to enable them to make informed decisions;
Uses an appropriate interpreter to assist patients whose first language is not
English, wherever possible;
Recognises that relationships with patients should be based on mutual respect
and trust, and is able to maintain high standards of care even in situations of
personal incompatibility; and
Identifies anxiety and stress in patients, carers and others and recognises the
potential impact upon communication
Effectively communicates throughout the care of the patient:
• uses interpersonal skills to encourage the active participation of
patients;
• utilises appropriate communication skills to effectively manage
avoidance, confusion and confrontation
• utilises appropriate communication skills when dealing with the
patient’s relatives and carers
Knowledge, understanding and skills required for Practice
Conducts a thorough and detailed physical examination of the patient using
observations, measurement and other assessment skills to inform clinical
reasoning;
Conducts a detailed physical examination of the patient to inform clinical
reasoning
Demonstrates an understanding of the public health model for response to major
incidents;
Demonstrates a working knowledge of the application of emergency medicine in
a mass casualty/major incident event;
Maintains currency with organisational policy, directions, procedures and
guidelines relating to the ambulance major incidents

Psychology Communicate effectively in a variety of formats and in a variety of contexts

Suggested learning outcomes:
Write a standard research report using American Psychological Association
(APA) structure and formatting conventions
Write effectively in a variety of other formats (eg, essays, research proposals,
reports) and for a variety of purposes (eg, informing, arguing)
Demonstrate effective oral communication skills in various formats (eg, debate,
group discussion, presentation) and for various purposes
Describe the basic characteristics of the science of psychology
Describe, apply and evaluate the different research methods used by
psychologists
Demonstrate practical skills in laboratory-based and other psychological research
Describe and evaluate questionnaire and test construction, implementation and
interpretation
Describe the key principles for designing, implementing and evaluating
programs of behaviour change
Locate, evaluate and use information appropriately in the research process
Undertake statistical analysis appropriately
Use basic web-search, word-processing, database, email, spreadsheet, and data

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 analysis programs
Design and conduct basic studies to address psychological questions: frame
research questions; undertake literature searches; critically analyse theoretical
and empirical studies; formulate testable hypotheses; operationalise variables;
choose an appropriate methodology; make valid and reliable measurements;
analyse data and interpret results; and write research reports
Evaluate psychologists’ behaviour in psychological research and other
professional contexts in relation to the Australian Psychological Society Code of
Ethics and the complementary Ethical Guidelines, as well as the Australian
National Practice Standards for the Mental Health Workforce
Promote evidence-based approaches to understanding and changing human
behaviour

Patient history Medicine Elicit an accurate, organised and problem-focused medical history, including
taking and record family and social occupational and lifestyle features, from the patient, and other
keeping sources
Elicit patients’ questions and their views, concerns and preferences, promote
rapport, and ensure patients’ full understanding of their problem(s)
Involve patients in decision-making and planning their treatment, including
communicating risk and benefits of management options

Dentistry Identify patients’ expectations, desires and attitudes when planning and
delivering treatment
Obtain and record a complete history of the patient’s psychosocial, medical, oral
and dental status
Maintain an accurate, consistent and legible record of patient management
including referral, delegation or handover

Physiotherapy Relevant information and communication technology is used efficiently to

record, store, convey and retrieve client information
Client information and history are obtained
Presenting signs and symptoms are explored
Relevant measurable data are obtained and accessed where possible
Goals, values and expectations of the client are identified
All information is recorded to enable the development of a detailed management
plan based on accurate and current information

Paramedicine Identifies and assesses health and social care needs in the context of the
environment
Analyses the situation, gathers appropriate information and selects and uses
appropriate assessment techniques:
Undertakes and records a thorough assessment
Frames questions that indicate the use of a structured approach

Psychology Demonstrate basic interviewing skills

Demonstrate effective interpersonal communication skills including the abilities
to: listen accurately and actively; use psychological concepts and theories to
understand interactions with others; identify the impact or potential impact of
one’s behaviour on others; Provide constructive feedback to others; adopt
flexible techniques to communicate sensitively and effectively with diverse
ethnic and cultural partners, including in the context of team-work

Patient safety Nursing Provide information to patients, and family/carers where relevant, to enable them
to make a fully informed choice among various diagnostic, therapeutic and
management options
Prescribe medications safely, effectively and economically using objective
evidence Safely administer other therapeutic agents including fluid, electrolytes,
blood products and selected inhalational agents
Describe the principles of care for patients at the end of their lives, avoiding
unnecessary investigations or treatment, and ensuring physical comfort including
pain relief, psychosocial support and other components of palliative care
Place the needs and safety of patients at the centre of the care process
Demonstrate safety skills including infection control, graded assertiveness,
adverse event reporting and effective clinical handover
Describe a systems approach to improving the quality and safety of health care
Provide care to all patients according to “Good Medical Practice: A Code of
Conduct for Doctors in Australia” and “Good Medical Practice: A Guide for
Doctors” in New Zealand
Demonstrate professional values including commitment to high quality clinical

40
 standards, compassion, empathy and respect for all patients Demonstrate the
qualities of integrity, honesty, leadership and partnership to patients, the
profession and society
Demonstrate awareness of and explain the options available when personal
values or beliefs may influence patient care, including the obligation to refer to
another practitioner

Recognises and responds appropriately to unsafe or unprofessional practice:

• identifies interventions which prevent care being compromised and/or
law contravened
• identifies appropriate action to be taken in specified circumstances
• identifies and explains alternative strategies for intervention and their
likely outcomes
• identifies behaviour that is detrimental to achieving optimal care, and
• follows up incidents of unsafe practice to prevent recurrence
Questions and/or clarifies interventions that appear inappropriate with relevant
members of the health care team
Integrates nursing and health care knowledge, skills and attitudes to provide safe
and effective nursing care:
• maintains a current knowledge base
• considers ethical responsibilities in all aspects of practice
• ensures privacy and confidentiality when providing care, and
• questions and/or clarifies interventions which appear inappropriate
with relevant members of the health care team
Provides comprehensive, safe and effective evidence-based nursing care to
achieve identified individual/group health outcomes
Effectively manages the nursing care of individuals/groups:
• uses resources effectively and efficiently in providing care
• performs actions in a manner consistent with relevant nursing
principles
• performs procedures confidently and safely
• monitors responses of individuals/groups throughout each
intervention and adjusts care accordingly
Provides effective and timely direction and supervision to ensure that delegated
care is provided safely and accurately:
• supervises and evaluates nursing care provided by others
• uses a range of direct and indirect techniques such as instructing,
coaching, mentoring, and collaborating in the supervision and support
of others
• provides support with documentation to nurses being supervised or to
whom care has been delegated

Midwifery Accepts accountability and responsibility for own actions within midwifery
practice
• Recognises and acts within own knowledge base and scope of
practice
• Identifies unsafe practice and takes appropriate action
• Consults with, and refers to, another midwife or appropriate health
care provider when the needs of the woman and her baby fall outside
own scope of practice or competence
Promotes safe and effective midwifery care
• Applies knowledge, skills and attitudes to enable woman centred care
• Provides or supports midwifery continuity of care
• Manages the midwifery care of women and their babies
Assesses, plans, provides and evaluates safe and effective midwifery care
• Uses midwifery knowledge and skills to facilitate an optimal
experience for the woman
• Assesses the health and well being of the woman and her baby
• Plans, provides, and is responsible for, safe and effective midwifery
care
• Protects, promotes and supports breastfeeding
• Demonstrates the ability to initiate, supply and administer relevant
pharmacological substances in a safe and effective manner within
relevant state or territory legislation
• Evaluates the midwifery care provided to the woman and her baby
Ensures midwifery practice is culturally safe
Plans, implements and evaluates strategies for providing culturally safe practice
for women, their families and colleagues

Dentistry Provide patient-centred care, respect patients’ dignity and choices; acknowledge
that all interactions, including history taking, diagnosis, treatment planning and
treatment, must focus on the patient’s best interests
Manage and maintain a safe working environment; have an appreciation of the

41
 systems approach to quality health care and safety, and the need to adopt and
practise health care that maximises patient safety
Select treatment options based on the best available information and the least
invasive therapy necessary to achieve the appropriate and favourable outcome
for the patient
Appreciate the importance of identifying both the patient and the intended site
for a procedure before undertaking irreversible treatment
Propose, discuss and agree treatment options that are sensitive to each patient’s
individual needs, goals and values, compatible with contemporary methods of
treatment, and congruent with an appropriate oral health care philosophy
Prevent and manage where necessary medical and dental emergency situations
encountered in clinical dental practice, including oro-facial infections and trauma
to the teeth, mouth and jaws
Evaluate systematically all treatment outcomes, including information on a
patient’s and/or patient’s family/carer’s satisfaction/dissatisfaction with
treatment and providing and/or recommending additional action and planning for
the maintenance of oral health

Physiotherapy Form a preliminary hypothesis

• The information collected is analysed
• The factors influencing clinical presentation are identified
• Assessment needs, including priority and urgency, are identified
• Differential diagnoses are hypothesised
• Potential diagnoses are checked to ensure client needs are within the
practitioner’s scope of expertise
Design and conduct an assessment
• An appropriate assessment plan is formulated, including selecting
tests to measure impairment and activity limitation
• Potential problems and contraindications to assessment are identified
• The assessment process is modified in recognition of factors such as
the client’s age, occupation, pain, co-morbidities, cultural
background, ability to communicate, level of understanding, and the
assessment environment
• Appropriate assessment tools are used
• A systematic, safe, efficient and goal-oriented physical examination
appropriate to physiotherapy is conducted
• Examination findings are assessed against the preliminary hypothesis
• Further testing and examination is conducted or scheduled as required
Conduct assessment safely
• Risk identification, assessment and reporting procedures are applied
• Appropriate modifications are implemented to address risks for the
client or the physiotherapist undertaking the assessment
• Referrals are made to other service providers where clinical
presentation is not consistent with the diagnosis, the client is not
progressing as expected or is unexpectedly or significantly
deteriorating
Prioritise client needs
• The problems and priorities of the client are identified in
collaboration with the client
• Presenting symptoms and their interrelationships are identified
• Possible sources/mechanisms of presenting symptoms are considered
and compared with preliminary diagnosis
• Realistic, shared goals that address the client’s problems, needs,
expectations, potential for change and lifestyle modifications are
developed and prioritised in consultation with the client
• Options for physiotherapy intervention are identified and justified,
based on the needs identified and best practice evidence
• Indications, contraindications and risks associated with intervention
are identified and appropriate action is taken
• Interventions are selected with consideration to assessment findings
from other health service providers, pathology, cost, client profile,
needs and choices
• Intervention selected is up to date, reflects best evidence and follows
best practice
• The client is referred to other relevant colleagues when the issues or
problems identified are not appropriate for physiotherapy or require a
multidisciplinary approach
Prepare equipment and treatment area appropriate to the intervention
• Equipment is selected appropriate to the physiotherapy intervention
• Equipment is checked to ensure readiness for safe operation and use
• The treatment area, including equipment, is prepared for intervention
to maximise effectiveness, efficiency, safety and privacy for the client

42
 Implement intervention safely and effectively
• Interventions are conducted safely and effectively
• Risks to the client and the physiotherapist are identified and managed
• Appropriate precautions are applied
• Appropriate mechanical equipment is used to assist in client transfer
and handling
• Infection control procedures are implemented
• Intervention is implemented sensitively to minimise distress
• Intervention implemented is consistent with the agreed intervention
program
• Strategies are used to motivate the client to participate in the
intervention program
• Quality interventions are provided that best meet the needs of the
client, within the resource constraints of the organisation
• The client is monitored throughout the intervention and appropriate
modifications are made for the client’s comfort and according to the
client’s condition

Aboriginal Health Promoting culturally safe health care

Implementing safe and appropriate care according to care planning principles

Occupational Adopts a client centered approach to practise

Therapy Demonstrates client centeredness during intervention
Promotes client occupational performance and participation
Selects and implements intervention strategies and methods appropriate to the
client
Selects and implements intervention strategies and methods appropriate to the
working environment
Demonstrates an understanding of, and commitment to, principles and methods
of quality improvement

Dietetics Uses dietary methodology to collect retrospective, current and prospective food
and nutrient intakes for individuals which identify nutrient and food intake
patterns as required by the situation
Identifies appropriate dietary methodology to collect retrospective, current and
prospective food and nutrient intakes for groups and populations which identify
nutrient and food intake patterns as required by the situation
Uses client-centred counselling skills to facilitate nutrition and lifestyle change
and supports clients to self manage
Assists client to clarify issues, identify the barriers to resolution of the problem,
and identify appropriate goals and strategies
Negotiates client oriented goals and strategies
Demonstrates safe practice
• Exercises professional duty of care in accordance with the DAA Code
of Professional Conduct and the organisation’s guidelines or
protocols
• Refers clients/patients/issues to appropriate professional when beyond
own level or area of competence
• Develops and maintains a credible professional role by commitment
to excellence of practice

Paramedicine Operates within a framework of making informed, evidence based, reasonable

and professional judgments about their practice, with acting in the best interests
of their patients as their prime concern
Makes sensible, practical decisions about their practice, taking account of all
relevant information and the best interests of the people who use or are affected
by the service that is being provided
Acts in the best interests of patients and service users at all times;
Operates within the requirements of approved Paramedic Professional
Competency Standards and their employment conditions/relationship;
Demonstrates the need to respect, and so far as possible uphold, the rights,
dignity, values and autonomy of every patient/service user This includes their
role in the diagnostic and therapeutic process and in maintaining health and
wellbeing;
Assesses a situation, determines the nature and severity of the problem and calls
upon the required knowledge and experience to provide a response that is in the
best interest of the patient/s;
Exercises personal initiative in providing care that is in the best interest of the
patient/s

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 Effectively supervises tasks that they have asked other people to perform
Considers the health and social care needs of patients and carers in the
assessment process
Maintains the safety of both patients and those involved in their care;
Positions for safe and effective interventions;
Knows the indications and contra-indications of using specific paramedic
interventions including their modifications;
Responds to urgent and non-urgent requests for assistance in a low risk manner
in accordance with relevant road safety legislation, organisational directives,
policies and procedures;
Utilises appropriate transport platforms taking into account clinical need, time
criticality and environmental considerations;
Co-operates with and utilises the support of other emergency service and rescue
organisations to facilitate patient access / egress / extrication in the most
effective manner

Teamwork Medicine Understand and describe the roles and relationships between health agencies and
services, and explain the principles of efficient and equitable allocation of finite
resources, to meet individual, community and national health needs
Describe and respect the roles and expertise of other health care professionals,
and demonstrate ability to learn and work effectively as a member of an inter-
professional team or other professional group

Nursing Clarifies responsibility for aspects of care with other members of the health team
Consults relevant members of the health care team when required
Contributes to the professional development of others:
• demonstrates an increasing responsibility to share knowledge with
colleagues
• supports health care students to meet their learning objectives in
cooperation with other members of the health care team
• facilitates mutual sharing of knowledge and experience with
colleagues relating to individual/group/unit problems
• contributes to orientation and ongoing education programs
• acts as a role model to other members of the health care team
• participates where possible in preceptorship, coaching and mentoring
to assist and develop colleagues
• participates where appropriate in teaching others including students of
nursing and other health disciplines, and inexperienced nurses, and
• contributes to formal and informal professional development
Collaborative and therapeutic practice
Relates to establishing, sustaining and concluding professional relationships with
individuals/groups This also contains those competencies that relate to nurses
understanding their contribution to the interdisciplinary health care team
Establishes, maintains and appropriately concludes therapeutic relationships
Establishes therapeutic relationships that are goal directed and recognises
professional boundaries: demonstrates empathy, trust and respect for the dignity
and potential of the individual/group
Interacts with individuals/groups in a supportive manner
Effectively initiates, maintains and concludes interpersonal interactions
Collaborates with the interdisciplinary health care team to provide
comprehensive nursing care
Recognises that the membership and roles of health care teams and service
providers will vary depending on an individual’s/group’s needs and health care
setting:
• recognises the impact and role of population, primary health and
partnership health care models
• recognises when to negotiate with, or refer to, other health care or
service providers
• establishes positive and productive working relationships with
colleagues, and
• recognises and understands the separate and interdependent roles and
functions of health care team members
Demonstrates an understanding of how collaboration has an impact on the safe
and effective provision of comprehensive care
Establishes and maintains effective and collaborative working relationships with
other members of the health care team
Consults with relevant health care professionals and service providers to
facilitate continuity of care
Recognises the contribution of, and liaises with, relevant community and support
services

Midwifery Establishes, maintains and evaluates professional relationships with other health
care providers

44
 Collaborates with, and refers women to, appropriate community agencies and
support networks
Contributes to, and evaluates, the learning experiences and professional
development of others

Dentistry Contribute to teams of health care practitioners in delivering health care in a

cooperative, collaborative and integrative manner

Physiotherapy Effective working relationships with colleagues and team members are
established and maintained
Written and verbal communication with health professionals and other service
providers follows accepted protocols and procedures to ensure information is
conveyed clearly and accurately
Issues relevant to evidence-based practice are discussed with colleagues,
supervisors and other health professionals
Work effectively within a team
• Collaborative working arrangements with others are established and
practised to provide an effective team-based approach to service
delivery
• Input is provided to meetings and planning discussions
• A holistic approach to client care is promoted
• Support and respect for colleagues and other professionals is provided
• Advocacy is provided for the client, community and physiotherapy
profession
• The physiotherapy perspective is provided in inter-professional
teams, to the client’s benefit
• Risk reduction strategies are promoted to increase awareness amongst
health professionals, communities and clients

Aboriginal Health Sharing and creating knowledge

Collaborating and communicating with other health professionals
Occupational Engages in critical, collaborative professional reasoning processes to determine
Therapy priorities for intervention

Dietetics Interprets nutritional information and communicates it using socially and

culturally appropriate language
Participates in multi-disciplinary team activities (such as case conferencing) to
achieve nutrition goals
Identifies opportunities to collaborate with other professionals/organisations to
improve nutrition outcomes
Demonstrates willingness to share information and act as a resource person to,
and advocate for, colleagues, community and other agencies
Discusses and explores ideas with colleagues/others on an ongoing basis
Seeks external ideas
Develops cooperative relationships with stakeholders in the food system to
positively influence nutrition outcomes
Develops sustainable collaborative relationships and networks
• Contributes effectively to work undertaken as part of a multi-
disciplinary team
• Builds relationships with stakeholders
• Acknowledges the different ways that different people may contribute
to building or enhancing a team

Paramedicine Develops and maintains professional relationships

Works, where appropriate, in partnership with other professionals and support
staff
Builds and sustains collaborative professional relationships as a member of a
team;
Makes appropriate referrals to other health care professionals/service providers;
Demonstrates an understanding of the range and limitations of operational
relationships between Paramedics and other healthcare professionals;
Demonstrates an understanding of the principles and practices of other healthcare
professionals and healthcare systems and how they interact with the role of a
Paramedic;
Consults effectively with relevant health care professionals and service providers
to facilitate continuity of care
Contributes effectively to work undertaken as part of a multi-disciplinary team
Participates in guiding the learning of others;

45
 • shares knowledge with colleagues;
• supports health care students to meet their learning objectives;
• shares knowledge and experience with colleagues relating to
individual/group/unit problems;
• contributes to orientation and ongoing education programs;
• acts as a role model to other members of the health care team;
• participates where possible in coaching and mentoring to assist and
develop colleagues;
• participates where appropriate in teaching others including Paramedic
students and those of other health disciplines and developing less
experienced Paramedics

Psychology Collaborate effectively, demonstrating an ability to: work with groups to

complete projects within reasonable timeframes; manage conflicts appropriately
and ethically

Professionalism Medicine Demonstrate professional values including commitment to high quality clinical
(including law and standards, compassion, empathy and respect for all patients Demonstrate the
ethics) qualities of integrity, honesty, leadership and partnership to patients, the
profession and society
Describe the principles and practice of professionalism and leadership in health
care
Identify the boundaries that define professional and therapeutic relationships and
demonstrate respect for these in clinical practice
Describe and apply the fundamental legal responsibilities of health professionals
especially those relating to ability to complete relevant certificates and
documents, informed consent, duty of care to patients and colleagues, privacy,
confidentiality, mandatory reporting and notification Demonstrate awareness of
financial and other conflicts of interest
Explain the main principles of ethical practice and apply these to learning
scenarios in clinical practice

Nursing Integrates organisational policies and guidelines with professional standards:

• maintains current knowledge of and incorporates relevant
professional standards into practice
• maintains current knowledge of and incorporates organisational
policies and guidelines into practice
• reviews and provides feedback on the relevance of organisational
policies and professional standards procedures to practice
Demonstrates accountability and responsibility for own actions within nursing
practice
Demonstrates an understanding of standards and practices of professional
boundaries and therapeutic relationships
Identifies legislation governing nursing practice
Describes nursing practice within the requirements of common law
Describes and adheres to legal requirements for medications
Identifies legal implications of nursing interventions
Actions demonstrate awareness of legal implications of nursing practice
Identifies and explains effects of legislation on the care of individuals/groups
Identifies and explains effects of legislation in the area of health, and
Identifies unprofessional practice as it relates to confidentiality and privacy
legislation
Practises in accordance with the nursing profession’s codes of ethics and
conduct:
• accepts individuals/groups regardless of race, culture, religion, age,
gender, sexual preference, physical or mental state
• ensures that personal values and attitudes are not imposed on others
• conducts assessments that are sensitive to the needs of
individuals/groups
• recognises and accepts the rights of others
• maintains an effective process of care when confronted by differing
values, beliefs and biases
• seeks assistance to resolve situations involving moral conflict, and
• identifies and attempts to overcome factors which may constrain
ethical decisions, in consultation with the health care team
Maintains an effective process of care when confronted by differing values,
beliefs and biases
Maintains confidentiality in discussions about an individual/group’s needs and
progress

Midwifery Functions in accordance with legislation and common law affecting midwifery
practice
• Demonstrates and acts upon knowledge of legislation and common
law pertinent to midwifery practice

46
 • Complies with policies and guidelines that have legal and
professional implications for practice
• Formulates documentation according to legal and professional
guidelines
• Fulfils the duty of care in the course of midwifery practice
Bases midwifery practice on ethical decision making
• Practises in accordance with the endorsed Code of Ethics and relevant
state/ territories and commonwealth privacy obligations under law
Identifies personal beliefs and develops these in ways that enhance midwifery
practice
• Addresses the impact of personal beliefs and experiences on the
provision of midwifery care
• Appraises and addresses the impact of power relations on midwifery
practice

Dentistry Demonstrate appropriate caring behaviour towards patients and respect

professional boundaries in relationships between themselves and patients and
members of the community
Work productively in his or her role in the dental team and display appropriate
professional behaviour towards other team members
Recognise and respect patients’ rights, particularly with regard to confidentiality,
privacy, informed consent
Understand the ethical principles and legal responsibilities involved in the
provision of dental care to individual patients, to communities and populations,
practising with personal and professional integrity, honesty and trustworthiness
Understand and apply Commonwealth, State and Territory legislation relevant to
practise as a dentist
Ensure the personal health information of patients is shared only with relevant
health care providers and where permitted by law
Obtain and record informed consent for all forms of treatment

Physiotherapy Relationships with clients and colleagues are in accordance with accepted
standards of conduct for health professionals
Demonstrate practice that is ethical and in accordance with relevant legal and
regulatory requirements
• Compliance with relevant legislation, standards and codes of conduct
is demonstrated in all aspects of work
• Compliance with the medico-legal requirements relating to informed
consent and confidentiality of client information
• Compliance with privacy legislation
• Work practice and environment comply with occupational health and
safety standards and legislation
Prepare and provide documentation according to legal requirements and accepted
procedures and standards
• All documentation is legible, accurate and concise
• Documentation is provided that meets the needs of the recipient
• All records comply with legal accountability, confidentiality
requirements, accepted procedures and standards
• Documentation is produced that is comprehensive and provides
adequate evidence of assessment and intervention planning
Collect client information
• Informed consent is obtained as appropriate for assessment
Work complies with the relevant guidelines, legislation, healthcare initiatives
and the Australian healthcare system

Aboriginal Health Understanding and professionally managing relationships with family and
community
Practising ethically
Understanding and practising within confidentiality guidelines
Understanding and practising within legislative frameworks and policies

Occupational Promotes and facilitates occupation through the application of professional

Therapy knowledge, skills, attitudes and evidence appropriate to the practice context
Demonstrates professional knowledge, skills, and attitudes appropriate for the
working environment
Adopts an efficient, effective and systematic approach to daily workload
management
Works effectively within the structure of the workplace environment
Practises in a professional manner that meets ethical and legal responsibilities

47
 Dietetics Maintains clear and concise records, in accordance with the organisation’s policy
and legal requirements, of all facets of the nutrition care process
Uses appropriate behaviour change, health promotion, social marketing,
communication, community development and public health policy frameworks
in the planning of nutrition programs
Considers confidentiality of information and records
Applies food legislation and regulations to develop and evaluate food service
systems to maintain food safety
Develops recommendations for the review of systems or policies or procedures
Prepares and implements achievable quality activities, consistent with policy and
procedures
Complies with legislation and regulations which define ethical behaviour,
including maintaining confidentiality

Paramedicine Demonstrates accepted standards of personal conduct

Behaves with honesty, integrity and impartiality to ensure that their behaviour
does not damage the public’s confidence in themselves or their employer
Demonstrates the principles, application and need for quality control and quality
assurance in Paramedic practice;
Demonstrates an awareness of the role of audit and review in quality
management, including quality control, quality assurance and the use of
appropriate outcome measures;
Operates within the current legislation applicable to ambulance operations and
paramedic practice;
• practices in accordance with the applicable legislative requirements in
the country or state of employment governing the use of prescription-
only medicines by Paramedics;
• practices in a non-discriminatory manner, regardless of individuals or
groups race, culture, religion, age, gender, sexual preference, physical
or mental state;
• maintains the privacy and confidentiality of information;
• obtains informed consent wherever practicable
Recognises the need to handle these records and all other information in
accordance with applicable privacy legislation, policies, protocols and
guidelines;
• uses only accepted terminology in completing patient care records

Psychology Display high standards of personal and professional integrity in relationships

with others
Use information in an ethical manner (eg, acknowledge and respect the work and
intellectual property rights of others through appropriate citations in oral and
written communication)
Recognise how privilege, power, and oppression may affect prejudice,
discrimination, and inequity
Explain how prejudicial attitudes and discriminatory behaviours might exist in
oneself and in others
Apply knowledge of legislative frameworks (including privacy, human rights)

Self- Medicine Self-evaluate their own professional practice; demonstrate lifelong learning
reflection/Self- behaviours and fundamental skills in educating colleagues
awareness/self- Recognise the limits of their own expertise and involve other professionals as
needed to contribute to patient care
management
Demonstrate awareness of factors that affect doctors’ health and wellbeing,
including fatigue, stress management and infection control, to mitigate health
risks of professional practice
Recognise their own health needs, when to consult and follow advice of a health
professional and identify risks posed to patients by their own health

Nursing Demonstrates awareness and understanding of developments in nursing that have

an impact on the individual’s capacity to practise nursing, and
Considers individual health and wellbeing in relation to being fit for practice
Seeks clarification when questions, directions and decisions are unclear or not
understood
Seeks feedback from a wide range of sources to improve the quality of nursing
care
Participates in professional development to enhance nursing practice:
• reflects on own practice to identify Professional development needs
• seeks additional knowledge and/or information when presented with
unfamiliar situations

48
 • seeks support from colleagues in identifying learning needs
• participates actively in ongoing professional development, and
• maintains records of involvement in professional development which
includes both formal and informal activities
Uses reflective practice to identify personal needs and seek appropriate support

Midwifery Acts to enhance the professional development of self and others

Assesses and acts upon own professional development needs

Dentistry Recognise personal limitations and know when to refer or seek advice
appropriately
Employ a critically reflective approach to practice which involves learning from
experience and participating in and contributing to peer review
Demonstrate an ethos of lifelong professional growth and development, and
support continuing professional development for all members of the dental team
Maintain their own health and understand its importance in relation to
occupational hazards and its impact on the ability to practise as a dentist
Understand his or her limitations and know when and how to refer a patient for
an appropriate opinion and/or treatment, where the diagnosis and/or treatments
are beyond his or her skills or to confirm prescribed treatment

Physiotherapy Demonstrate strategies to maintain and extend professional competence

• Self reflection is used to maintain and extend professional
competence
• Feedback is sought from supervisors, peers and other health
professionals, and acted upon to improve own practice
• An understanding of the need for a commitment to continuous
professional development is demonstrated
Operate within individual and professional strengths and limitations
• A self assessment is made about the capacity to operate safely and
effectively, based on knowledge, impairments, activity limitations,
participation restrictions, skill level, the environment and the client
profile and needs
• Appropriate action is taken to manage own health factors that may
affect the capacity to operate safely and effectively
• Services to the client are in accordance with defined work roles and
the bounds of personal and professional competence and strengths
• Assistance is sought to complement own limitations so that services
to the client are not compromised either in safety or effectiveness
• The client is referred to relevant professionals, including other
physiotherapists, when limitations of skills or job role prevent the
client’s needs being adequately addressed
Knowledge and information needs are identified
Identify areas that are outside skills and expertise and refer client appropriately
• Conditions that are not amenable to physiotherapy intervention or are
beyond the management skills and knowledge of the practitioner are
identified
• Appropriate referrals are made to other practitioners, including
physiotherapists, based on knowledge of presenting condition and
management options and own skill levels
Strategies are implemented to minimise the risks of work related injury or harm
to self or others
Referrals are made to physiotherapists with specialised skills and to other service
providers as required

Aboriginal Health Reflecting on and developing own practice

Occupational Maintains and enhances competence through lifelong learning and continuing
Therapy professional development activities
Engages in lifelong learning processes and activities to maintain professional
competence

Dietetics Accepts responsibility for and manages, implements and evaluates personal
professional development
Demonstrates consistent, reflective practice in collaboration with peers and
mentors

Paramedicine Provides their employer with relevant information that may affect their ability to
practice
Limits their work or stops practicing if their performance or judgment is affected

49
 by their health or other personal factors
Operates within the limits of their practice, seeks advice or refers to another
professional;
Recognises that they are responsible for and must be able to justify their
decisions within the particular employers approved scope of practice;
Utilises a range of integrated skills and self-awareness to manage clinical
challenges effectively in unfamiliar circumstances or situations
Applies effective self-management of workload and resources and is able to
practice accordingly within the individual activity
Develops and maintains personal health and wellbeing strategies
• practices safe manual handling techniques within the scope of
paramedic duties
• maintains physical health, fitness and nutrition
• maintains psychological wellbeing:
• actively maintains a safe working environment for self and partner;
Considers feedback from colleagues about and critically reflects on their own
Paramedic practice;
Maintains an effective audit trail and work towards continual improvement;
• participates in quality assurance programmes, where appropriate or
required;
• reflects on practice and the application of such reflection to their
future practice;
• participates in case conferences and other methods of review
Contributes to formal and informal professional development;
• maintains records of their involvement in both formal and informal
professional development activities

Psychology Explain how prejudicial attitudes and discriminatory behaviours might exist in
oneself and in others
Recognise the limitations of one’s psychological knowledge and skills, and
value life-long learning
Reflect on one’s experiences and learn from them in order to identify and
articulate one’s personal, sociocultural, and professional values; demonstrate
insightful awareness of one’s feelings, motives, and attitudes based on
psychological principles
Apply psychological principles to promote personal development through self-
regulation in setting and achieving career and personal goals; self-assess
performance accurately; incorporate feedback for improved performance;
purposefully evaluate the quality of one’s thinking (metacognition)
Demonstrate a capacity for independent learning to sustain personal and
professional development in the changing world of the science and practice of
psychology

Cultural Medicine Understand and describe the factors that contribute to the health and wellbeing of
understanding Aboriginal and Torres Strait Islander peoples and/or Māori, including history,
spirituality and relationship to land, diversity of cultures and communities,
epidemiology, social and political determinants of health and health experiences
Demonstrate effective and culturally competent communication and care for
Aboriginal and Torres Strait Islander peoples and/or Māori

Nursing Practises in a way that acknowledges the dignity, culture, values, beliefs and
rights of individuals/groups:
• demonstrates respect for individual/group common and legal rights
in relation to health care
• identifies and adheres to strategies to promote and protect
individual/group rights
• considers individual/group preferences when providing care
• clarifies individual/group requests to change and/or refuse care with
relevant members of the health care team
• advocates for individuals/groups when rights are overlooked and/or
compromised
• accepts individuals/groups to whom care is provided regardless of
race, culture, religion, age, gender, sexual preference, physical or
mental state
• ensures that personal values and attitudes are not imposed on others
• undertakes assessments which are sensitive to the needs of
individuals/groups
Protects the rights of individuals and groups and facilitates informed decisions
Identifies and explains policies/practices which infringe on the rights of
individuals or groups
Clarifies policies, procedures and guidelines when rights of individuals or groups

50
 are compromised, and
Demonstrates sensitivity, awareness and respect for cultural identity as part of an
individual’s/ group’s perceptions of security
Demonstrates sensitivity, awareness and respect in
regard to an individual’s/group’s spiritual needs

Dentistry Understand systems of health care provision in a culturally diverse society

including their advantages and limitations, the principles of efficient and
equitable allocation and use of finite resources, and recognition of local and
national needs in health care and service delivery
Understand and apply the principles of culturally safe and sensitive practice and
provide care in an empathic way that is free of discrimination

Physiotherapy Adapt communication style recognising cultural safety, and cultural and
linguistic diversity
• Respect for cultural and linguistic diversity is demonstrated in all
communication with the client, colleagues and other service providers
so that effective relationships are developed and maintained
• When required, a third party is requested to be present for reasons
including cultural sensitivity and the provision of interpreter services
• Appropriate effort is applied to sensitively recognise, negotiate and
where possible resolve conflicts, taking into account cultural
considerations

Aboriginal Health Providing culturally safe health care

• Knowing and respecting our history, context, culture and customs
• Engaging and consulting respectfully with the community and its
elders
• Addressing local community health issues and needs
• Advocating for the rights and needs of the individual and the
community
• Promoting culturally safe health care
Understanding the social, spiritual and cultural conditions which impact on
emotional and physical wellbeing
Assessing, identifying and communicating health care needs considering
community values, beliefs and protocols

Occupational Practises in a culturally safe professional manner

Therapy
Dietetics Interprets nutritional information and communicates it using socially and
culturally appropriate language
Develops education material that is evidence-based, culturally sensitive, and
pitched at the appropriate literacy level, to meet the needs of the target group
Communicates with individuals, groups, organisations and communities from
various cultural socio-economic, organisational and professional backgrounds to
enable them to take actions to improve nutrition and health outcomes applying
the principles of learning theory
Communicates in a way which respects customs of other cultures, using socially
and culturally appropriate strategies
Uses an interpreter appropriately to communicate nutrition and health
information
Identifies individual, socio-economic, cultural and environmental determinants,
including equity and social justice issues
Demonstrates cultural competency
Understands what is meant by cultural awareness with respect to the Aboriginal
and Torres Strait Islander and Culturally and Linguistically Diverse (CALD)
communities and is aware of the skills required for communicating in a culturally
respectful way
Has a working knowledge of the nutrition issues and diet related diseases
impacting on the health of Aboriginal and Torres Strait Islanders and people
from CALD communities
Has an awareness of the current policy and implementation frameworks for
Aboriginal and Torres Strait Islander and CALD communities

Paramedicine Adapts practice to meet the needs of different groups distinguished by, for
example, physical, psychological, environmental, cultural or socioeconomic
factors within their authorised scope of practice;
Demonstrates sensitivity to the factors which shape lifestyle that may impact on
the individual’s health and affect the interaction between the patient and

51
 Paramedic

Psychology Recognise and respect social, cultural, linguistic, spiritual and gender diversity
Explain how the science and practice of psychology is influenced by social,
historical, professional, and cultural contexts
Identify and describe the sociocultural and international contexts that influence
individual differences in beliefs, values, and behaviour

Managing complex Nursing Responds effectively to unexpected or rapidly changing situations

clinical scenarios • responds effectively to emergencies
• maintains self-control in the clinical setting and under stress
conditions
• implements crisis interventions and emergency routines as necessary
• maintains current knowledge of emergency plans and procedures to
maximise effectiveness in crisis situations, and
• participates in emergency management practices and drills according
to agency policy

Midwifery Assesses, plans, provides and evaluates safe and effective midwifery care for the
woman and/or baby with complex needs
• Uses a range of midwifery knowledge and skills to provide midwifery
care for the woman and/or her baby with complex needs as part of a
collaborative team
• Recognises and responds effectively in emergencies or urgent
situations

Physiotherapy Manage adverse events

• Potential adverse events are identified, and relevant precautionary
measures are taken, including strategies to manage personal safety
• Adverse events are recognised, managed appropriately, reported and
clearly documented
• Emergency procedures for the workplace are identified and are able
to be carried out as required

Paramedicine Utilises a range of integrated skills and self-awareness to manage clinical

challenges effectively in unfamiliar circumstances or situations
Maintains self control in the clinical setting and under stressful conditions
Selects or modifies approaches to meet the needs of patients, their relatives and
carers, when presented in emergency and urgent situations;
Modifies and adapts their practice appropriate to the emergency environment

Organisational Dietetics Applies organisational skills in the practice of nutrition and dietetics
skills • Manages workload and resources to complete tasks within required
timeframes
• Applies the principles of personnel management, using principles of
human resource management and industrial relations
• Allocates resources (time, personnel, other) according to established
priorities
• Performs and manages administration tasks effectively (eg makes
appointments, responds to referrals, maintains records and statistics)
Applies management principles in the practice of nutrition and dietetics
• Applies the strategic or organisational planning process to the
nutrition and dietetics service
• Develops a case to justify program, service, product, or procedure
• Understands and performs simple budgeting and cost control
measures
Applies quality management principles to all aspects of professional practice

Paramedicine Records information systematically in an accessible and retrievable form;

Keeps accurate, comprehensive, logical, legible and concise records;

Dentistry Understand basic principles of practice administration, financial and personnel

management in a dental practice
Maintain an accurate, consistent and legible record of patient management
including referral, delegation or handover

Research skills Medicine Access, critically appraise, interpret and apply evidence from the medical and
(critical thinking, scientific literature
analysis, Apply knowledge of common scientific methods to formulate relevant research
questions and select applicable study designs
evaluation,
Integrate and interpret findings from the history and examination, to arrive at an
problem solving)

52
 initial assessment including a relevant differential diagnosis Discriminate
between possible differential diagnoses, justify the decisions taken and describe
the processes for evaluating these
Select and justify common investigations, with regard to the pathological basis of
disease, utility, safety and cost effectiveness, and interpret their results
Make clinical judgements and decisions based on the available evidence Identify
and justify relevant management options alone or in conjunction with colleagues,
according to level of training and experience
Retrieve, interpret and record information effectively in clinical data systems
(both paper and electronic)

Nursing Performs nursing interventions following comprehensive and accurate

assessments
Questions and/or clarifies orders and decisions that are unclear, not understood
or questionable, and
Assesses consequences of various outcomes of decision making
Demonstrates analytical skills in accessing and evaluating health information and
research evidence:
• demonstrates understanding of the registered nurse role in
contributing to nursing research
• undertakes critical analysis of research findings in considering their
application to practice
• maintains accurate documentation of information which could be
used in nursing research, and
• clarifies when resources are not understood or their application is
questionable
Evaluates progress towards expected individual/group health outcomes in
consultation with individuals/groups, significant others and interdisciplinary
health care team
Determines progress of individuals/groups toward planned outcomes:
• recognises when individual’s/group’s progress and expected progress
differ and modifies plans and actions accordingly
• discusses progress with the individual/group
• evaluates individual/group responses to interventions, and
• assesses the effectiveness of the plan of care in achieving planned
outcomes

Midwifery Uses research to inform midwifery practice

• Ensures research evidence is incorporated into practice
• Interprets evidence as a basis to inform practice and decision making

Dentistry Utilise critical thinking, problem-solving skills and emotional intelligence

Apply decision-making, clinical reasoning and judgment to develop a
differential, provisional or definitive diagnosis by interpreting and correlating
findings from the history, clinical and radiographic examination and other
diagnostic tests, taking into account the social and cultural background of the
patient and the longer term consequences on patients’ oral and general health
Evaluate and integrate emerging trends in health care as appropriate
Formulate treatment plans which integrate research outcomes with clinical
expertise and patient views
Locate and evaluate evidence in a critical and scientific manner to support
professional practice and use information technology appropriately as an
essential resource for modern dental practice
Evaluate the validity of claims related to the risks/benefits of products and
techniques
Perform an appropriate physical examination, interpret the findings and organise
further investigations when necessary in order to arrive at an appropriate
diagnosis
Select appropriate clinical, laboratory and other diagnostic procedures and tests,
understand their diagnostic reliability and validity, and interpret their results
Critically reflects and makes recommendations about the nutrition program
based on evaluation data

Physiotherapy A range of information relevant to physiotherapy practice is accessed

Apply an evidence-based approach to own practice
• A working knowledge of commonly used research methodologies is
demonstrated
• Information from a range of sources is critically evaluated for the
impact on own work
• Practices are critically evaluated in the light of available evidence to
determine efficiency

53
Occupational Demonstrates ability to understand and conduct multiple evaluation methods and
Therapy techniques

Dietetics Conducts or uses nutrition research methodology, research principles and

evidence-based practice including qualitative and quantitative research methods
Accurately interprets dietary, health, medical, anthropometric, and body
composition data against standards relevant to the nutritional issues
Makes judgements about potential impact of health and medical, social, cultural,
psychological, economic, personal and environmental factors on nutrition
Integrates assessment data in order to assign priorities for nutrition and resource
planning
Draws justifiable conclusions from all data
Defines nutrition problems/diagnoses as a prelude to planning management
Interprets available documentation to identify problems
Organises, interprets and prioritises data to undertake nutritional diagnoses
Refers to all available evidence to inform clinical judgement
Uses qualitative and/or quantitative methods to collect and analyse data to
identify and inform program development and nutrition issues
Uses qualitative and/or quantitative methods to collect and analyse data to
identify food service and/or nutrition issues
Evaluates and disseminates results of activities
Evaluates outcomes using standard benchmarks and procedures, where
appropriate
Critically reflects on evaluation data in the context of plans, goals and
implementation activities, where possible
Adopts a questioning and critical approach in all aspects of practice
• Formulates a clear understanding of the nature of a practice problem
• Applies an evidence-based approach to practice
• Identifies and selects appropriate research methods to investigate and
resolve practice problems
• Applies valid and relevant conclusions and recommendations to
practice
Evaluates practice on an ongoing basis
• Monitors and reviews the ongoing effectiveness of practice and
modifies it accordingly
Applies the research process using appropriate research methods, ethical
processes and procedures and statistical analysis
• Critically reviews the literature
• Utilises ethical procedures in the research process
• Identifies and selects appropriate research methods to investigate and
resolve practice problems
• Collects and interprets information, including qualitative and
quantitative data
• Documents outcomes of research using the research process
Applies evaluation findings into practice
• Applies evidence and judgement to food and nutrition issues
• Disseminates outcomes of research in professional and scientific fora
Creates solutions which match and solve problems
Demonstrates initiative by proactively developing solutions to problems

Paramedicine Makes sensible, practical decisions about their practice, taking account of all
relevant information and the best interests of the people who use or are affected
by the service that is being provided
Uses clinical reasoning and problem-solving skills to determine clinical
judgments and appropriate actions:
• demonstrates a logical and systematic approach to problem solving
and situation analysis;
• analyses and critically evaluates the information collected to make
clinical judgments;
• recognises that clinical judgments involve consideration of
conflicting information and evidence;
• formulates a diagnosis informed by the patient assessment and
analysis of context and situation;
• identifies the time criticality of treatment and transport
Monitors and evaluates the quality of practice and the value of contributing to
the generation of data for quality assurance and improvement programs;
• makes reasoned decisions to initiate, continue, modify or cease
treatment or the use of techniques or procedures and record the
decisions and reasoning appropriately

54
 Practices within an evidence based framework:
• recognises the value of research to the critical evaluation of practice;
• participates in and evaluates research outcomes and incorporates
these into evidence based practice where relevant;
• participates in review of policies, procedures and guidelines based on
relevant research
• demonstrates awareness of a range of research methodologies;
• identifies problems/ issues which may be investigated through
research

Psychology Apply knowledge of the scientific method in thinking about problems related to
behaviour and mental processes
Question claims that arise from myth, stereotype, pseudo-science or untested
assumptions
Demonstrate an attitude of critical thinking that includes persistence, open-
mindedness, and intellectual engagement
Demonstrate a capacity for higher-order analysis, including the capacity to
identify recurrent patterns in human behaviour
Evaluate the quality of information, including differentiating empirical evidence
from speculation
Identify and evaluate the source and context of behaviour
Recognise and defend against the major fallacies of human thinking
Evaluate issues and behaviour using different theoretical and methodological
approaches
Use reasoning and evidence to recognise, develop, defend, and criticise
arguments and persuasive appeals
Demonstrate creative and pragmatic problem solving
Exhibit a scientific attitude in critically thinking about, and learning about,
human behaviour, and in creative and pragmatic problem solving
Apply psychological concepts, theories, and research findings to solve problems
in everyday life and in society

55
Table 1: Summary of data extracted from eligible reviews
Citation of reviews included in the study Aim
Bokken L, Linssen T, Scherpbier A, van der Vleuten C, To provide a systematic
Rethans J-J. Feedback by simulated patients in overview of the ways in which
undergraduate medical education: a systematic review of SPs provide feedback to
the literature. Medical Education. 2009;43(3):202-10. undergraduate medical students,
the domains in which SPs
provide feedback and the ways
in which SPs are trained to
provide feedback.
Carey JA, Madill A, Manogue M. Communications skills To explore the scope and
in dental education: a systematic research review. Eur J quality of evidence relating to
Dent Educ. 2010;14(2):69-78. communication skills training
for dental students.
Cleland JA, Abe K, Rethans J-J. The use of simulated To provide a detailed overview
patients in medical education: AMEE Guide No 42. of how to recruit, train and use
Medical Teacher. 2009;31(6):477-86. SPs appropriately for both
teaching and assessment
purposes.
Cook DA, Erwin PJ, Triola MM. Computeried virtual To summarise the effect of
Population Simulation modalities - Years Study findings
OSCEs, task trainers, VR,
animal, cadaveric, virtual
patients, SPs, hybrid, role-
play, manikin, game,
OTHER (State)
Medical students SPs Review There appear to be no clear standards with
regard to effective feedback training for SPs.
Furthermore, the processes by which feedback is
provided by SPs and the selection of domain(s)
in which SPs give feedback often seem to lack a
solid scientific basis.
Dental students Role-play; SPs Up to 2007 The review found extensive use of didactic
learning and clinical role-play involving SPs.
Reported assessment methods focus mainly on
observer evaluation of student interactions at
consultation. The reviews report weak evidence
for the impact of communication skills training.
The studies focused on pre and post operative
communication rather than intra-operative
treatment. Patient involvement in training
appears to be minimal. This review recommends
that several areas of methodology be addressed
in future studies, the scope of research extended
to include intra-operative communication, and
that the role of real patients in the development
of communication skills be active rather than
passive.
Medical students SPs Review SPs can be used for teaching and assessment of
consultation and clinical/physical examination
skills, in simulated teaching environments or in
situ. All SPs play roles but SPs have also been
used successfully to give feedback and evaluate
student performance. Clearly, given this
potential level of involvement in medical
training, it is critical to recruit, train and use SPs
appropriately.
All health VPs Up to 2009 Virtual patients are associated with large positive
patients in health professions education: a systematic virtual patients compared with professionals and effects compared with no intervention. Effects in
review and meta-analysis. Academic Medicine. no intervention and alternate students comparison with non-computer instruction are
2010;85(10):1589-602. instructional methods, and on average small. Comparisons of VP designs
elucidate features of effective suggest that repetition until demonstration of
virtual patient design. mastery, advance organisers, enhanced feedback,
and explicitly contrasting cases can improve
learning outcomes.
Cook DA, Triola MM. Virtual patients: A critical literature To summarise research on VPs, All health VPs 1971 to Virtual patients should be designed and used to
review and proposed next steps. Medical Education. highlight the spectrum of professionals and 2008 promote clinical reasoning skills.
2009;43(4):303-11. potential variation and identify students
an agenda for future research
and critically consider the role
of VPs in the educational
armamentarium.
Cook, D. A., Hatala, R., Brydges, R., Zendejas, B., To summarise the outcomes of All health All technology based Up to 2011 In general, simulation training was associated
Szostek, J. H., Wang, A. T., . . . Hamstra, S. J. (2011). technology-enhanced professionals and simulators with moderate to large, statistically significant
Technology-enhanced simulation for health professions simulation training for health students positive results but with high inconsistency.
education: a systematic review and meta-analysis .JAMA, professions learners in
306(9), 978-988. comparison with no
intervention. Asked two
questions: 1) To what extent are
simulation technologies for
training healthcare
professionals associated with
improved outcomes in
comparison with no
intervention? 2) How do
outcomes vary for different
simulation instructional
designs? Focused on 5 features
(curricular integration,
distributed practice, feedback,
mastery learning, range of
difficulty)
Fisher, D. and King, L. (2013). An integrative literature To synthesise studies that Nursing students Not stated 2004-2012 Simulation exposes students to a broader range
review on preparing nursing students through simulation to explored simulation as of experiences whilst
recognie and respond to the deteriorating patient. Journal preparation of nursing students in a safe environment with transference of skills
of Advanced Nursing, 69(11), 2375-2388. for recognition and response to to clinical practice occurring.
the deteriorating patient. Confidence, clinical judgment, knowledge and
competence, all vital in the care of a
deteriorating patient, were enhanced. However,
evidence of simulation used specifically to
prepare nursing students to recognise and
respond to the deteriorating patient appeared

Flanagan, B., O. Clavisi, and D. Nestel, Efficacy and
effectiveness of simulation-based training for learning and
assessment in healthcare, 2007, Department of Human
Services (Victoria): Melbourne.
Jull, G., et al., Health Workforce Australia National
Simulated Learning Project - Report for Physiotherapy, in
Simulated Learning Environments Program2010, Health
Workforce Australia: Adelaide, SA, Australia.
To identify efficacy and
effectiveness of simulation-
based training for learning and
assessment in health care
To gather information from a
literature review, two electronic
surveys of accredited schools of
physiotherapy (including
schools in the accreditation
process) and discussions with
physiotherapy academics at
universities around Australia in
order to identify current and
potential use of simulation in
limited. This educational field appears rich for
interprofessional collaboration and further
research.
All health Most simulation modalities 1950-2007 The search strategy identified 3753 articles of
professional which 458 were selected for inclusion after
students and review of the abstract. • There is a positive
clinicians relationship between simulation-based activities
and learning outcomes.
• There is substantial evidence for simulation-
based activities at levels one and two of
Kirkpatrick’s framework. Some evidence exists
at level three, and there are a small number of
studies where there is clear evidence of direct
benefit to patients (modified Kirkpatrick level
five).
• Most studies report high levels of participant
satisfaction with simulation-based activities with
few studies reporting dissatisfaction.
• Simulation is usually used as part of broader
programs. Therefore, it is difficult to isolate
simulation from other educational methods. In
fact it would be unhelpful to separate simulation
in this way since it is likely to be the “whole”
program rather than an isolated element that is
important.
• For each question in this review, the authors
identified gaps by population group, simulation
modality and topic.
• Most studies relate to the medical profession.
• Gaba (2007) proposes a classification of
simulations across 11 dimensions. This may be
valuable as a basis of comparison in future
studies.
Physiotherapy Manikin, role-play, SP, task 1950 to The literature review revealed that the use of
students trainers 2010 simulated learning platforms in education of
future health practitioners has dramatically
increased in the last two decades. This has been
in response to the many potential benefits to be
gained by the student as well as to the increasing
difficulties in obtaining sufficient clinical
placement opportunities and ‘clinical material’
for educating future health professionals.
Preliminary research suggests that simulated

Kaakinen, J. and E. Arwood, Systematic review of nursing
simulation literature for use of learning theory.
International Journal of Nursing Education Scholarship,
2009. 6(1(16)): p. 1-20.
Kiersma, M., K. Plake, and P. Darbishare, Patient safety
instruction in US Health professions education. American
Journal of Pharmaceutical Education, 2011. 75(8): p. 162.
Lapkin, S., et al., The effectiveness of using human patient
simulation manikins in the teaching of clinical reasoning
skills to undergraduate nursing students: a systematic
review. The JBI Database of Systematic Reviews and
Implementation Reports, 2010. 8(16): p. 661-694.
Laschinger, S., et al., Effectiveness of simulation on health
profession students' knowledge, skills, confidence and
satisfaction. JBI Library of Systematic Reviews, 2008.
6(7): p. 265-309.
physiotherapy education.
To determine how learning
theory was used to design and
assess learning that occurs in
simulations.
To describe patient safety
instruction in health
professional curricula,
including medicine, nursing,
pharmacy, and dentistry.
To identify best available
evidence for the effectiveness
of human patient simulation
manikins in developing clinical
reasoning skills to
undergraduate nurses.
To identify the best available
evidence on the effectiveness of
using simulated learning
experiences in pre-licensure
health profession education.
learning can enhance students’ skills, confidence
and competence. Practice is in a safe
environment, with no risk to patients. Until
recently, high quality research into the impact of
simulated learning platforms on skill acquisition
and graduate outcomes has been limited.
Preliminary results from a recent Australian
randomised trial are providing evidence that
students can meet the Australian Standards for
Physiotherapy when simulated learning
platforms are incorporated as part of the
traditional clinical education program
Nursing students   2000-2007 Most nursing faculty approach simulation from a
teaching paradigm rather than a learning
paradigm. For simulation to foster student
learning there must be a fundamental shift in
paradigm and a foundational learning theory to
design and evaluate simulation.
Medical, nursing, OSCE, SPs, role-play 1966-2010 Safe, patient-centred care is directly influenced
pharmacy and by the quality of education that healthcare
dentistry students professions students receive. Almost half (43%)
the patient safety curricula included a simulation
component however they are almost all
discipline specific. Self-assessment was
commonly used as an educational method.
Several studies reported improvements in
knowledge, attitudes and skills of participants.
Undergraduate Manikin 1999-2010 Manikins improve knowledge acquisition and
nursing students critical thinking and enhances students'
satisfaction with learning. There is a lack of
unequivocal evidence of the effectiveness of
using high-fidelity manikins in the teaching
clinical reasoning skills to undergraduate nurses.
Nursing, medical Manikin, task trainer 1995-2006 There is high learner satisfaction with using
and rehabilitation simulators to learn clinical skills. The studies
students demonstrated that human patient simulators
which are used for teaching higher level skills,
such as airway management, and physiological
concepts are useful. While there are short-term
gains in knowledge and skill performance, it is
evident that performance of skills over time after
initial training decline. simulation can be used as
an adjunct for clinical practice, not a
replacement for everyday practice. Students

Leigh, G. T. (2008). High-fidelity patient simulation and
nursing students' self-efficacy: a review of the literature.
[Review]. International Journal of Nursing Education
Scholarship, 5, Article 37. doi:
http://dx.doi.org/10.2202/1548-923X.1613
Levett-Jones, T., Examining the impact of simulated
patients and information and communication technology
on nursing students’ clinical reasoning, 2011, Australian
Learning and Teaching Council Ltd.: Surry Hills, NSW,
Australia.
To examine the effects of high
fidelity human patient
simulation (manikins) on
student's self-efficacy and
confidence
To identify best available
evidence for manikin-based
simulations on nursing students
clinical reasoning.
enjoyed the sessions and using the models
purportedly makes learning easier. However, it
remains unclear whether the skills learned
through a simulation experience transfer into
real-world settings. More research is needed to
evaluate whether the skills acquired with this
teaching methodology transfer to the practice
setting such as the impact of simulation training
on team function.
Nursing students Manikin The past High fidelity manikins are effective when used
decade with sound educational practices. From
participants’ perspectives, high fidelity manikins
were valuable to apply knowledge to practice,
learn from their mistakes, learn from their peers
and to identify gaps in their knowledge. Faculty
believe the benefits manikins can prepare
students to perform in real clinical settings and
that the experiences in the simulation
environment can transfer to clinical practice.
Simulation is most beneficial when the
participant believes it to be legitimate, authentic
and realistic. Multiple studies reveal learners
and educators perceptions that simulation
improves clinical performance. Nursing students
believed manikins improved both critical
thinking skills and confidence. Students rate
debriefing and direct feedback as a major
advantage of high fidelity manikins. The review
did not find conclusive evidence for the impact
of high fidelity manikins on nurses' self-efficacy
when compared with other methods.
Nursing students Manikin 1999-2010 Overall the survey results demonstrate that
Australian schools of nursing are actively
involved in, and committed to, the development
of simulation, and to a lesser extent, ICT. The
adequacy of equipment and facilities is a major
barrier to adoption and staff training was the
major constraint on the implementation of
simulation and ICT. These findings are
consistent with the literature, which identifies
the need for significant financial and personal
investment and the need for teaching staff to
develop new skill sets for effective
implementation of simulation (O’Donnell and

Lonne, B., R. Daniels, and J. King, Visioning technology To detail the current uses of
based simulated learning environments in the social work SLEs in social work education,
curriculum, in Simulated Learning Environments Program report on a number of studies
2010, Health Workforce Australia: Adelaide, SA, that gathered the perspectives of
Australia. staff and students using SLEs,
and provide a summary of the
benefits and limitations of SLEs
from the literature.
Lynagh, M., et al. (2007). "A systematic review of medical To evaluate the effectiveness
skills laboratory training: where to from here?" Medical of medical skills laboratories or
Education 41(9): 879-887. simulators, if skills are
transferable to clinical
performance and maintained
over time.
May, W., et al. (2009). "A ten-year review of the literature To review the body of literature
on the use of standardized patients in teaching and on the educational application
learning: 1996-2005." Medical Teacher 31(6): 487-492. of SPs in teaching and learning
McCallum, J. (2007). The debate in favour of using To identify the advantages and
simulation education in pre-registration adult nursing. disadvantages of simulation
[Review]. Nurse Education Today, 27(8), 825-831. education as a teaching,
learning and assessment
methodology within pre-
registration nurse education.
McGaghie, W. C., Issenberg, S. B., Petrusa, E. R., and To review and critically
Scalese, R. J. (2010). A critical review of simulation-based evaluate historical and
medical education research: 2003-2009. Med Educ, 44(1), contemporary research on
50-63. simulation-based medical
education (SBME). It also
presents and discusses 12
features and best practices of
SBME that teachers should
know in order to use medical
simulation technology to
maximum educational benefit.
Murdoch, N., J. Bottorff, and D. McCullogh, Simulation To identify best practice
Goode, 2008). The survey results indicate that
the impetus to increase the use of simulation and
ICT into nursing programs must be matched
with an increase in equipment, infrastructure and
staff training.
Social work SPs, virtual worlds, role-play 2005-2010 The available sources reveal the use of SLEs in
students social work education to support students doing
their field education placements, for distance
education, to teach clinical skills, and to enhance
students’ understanding of potential client issues.
These uses take various forms, and the literature
tends to describe them rather than evaluate them.
Medical students Manikin, VR, task trainer 1998-2006 Medical skills laboratories lead to improvement
and postgraduate in procedural skills compared with standard or
medical trainees no training at all when assessed by simulator
performance and immediately post-training.
However, there is a lack of well designed trials
addressing the crucial issues of transferability to
clinical practice and retention of skills over time.
All healthcare SPs Review Most studies reported that the educational use of
professionals and SPs was valuable. More rigorous studies would
students support the evidence-based contribution of SPs
in teaching and learning.
Nursing students SPs, task trainers, manikins Not stated There is evidence that nursing students want
more simulation education as a way of learning
clinical skills, but additionally this can help them
learn from making mistakes and repeatedly
practice skills, which would not appropriate with
actual patients. Simulation also removes some of
the pressure on assessments in real clinical
settings.
All health Manikin 2003-2009 The historical and contemporary research
professional synthesis is reported to inform the medical
students and education community about 12 features and best
clinicians practices of SBME: (i) feedback; (ii) deliberate
practice; (iii) curriculum integration; (iv)
outcome measurement; (v) simulation fidelity;
(vi) skill acquisition and maintenance; (vii)
mastery learning; (viii) transfer to practice; (ix)
team training; (x) high-stakes testing; (xi)
instructor training, and (xii) educational and
professional context.
Health Manikin, role-play, SP 2005-2011 There is growing evidence to suggest that
education approaches to enhance collaborative healthcare: recommendations to enhance professional
A best practices review. International Journal of Nursing collaborative healthcare using students
Education Scholarship, 2013. 2013(10): p. 307-321. interprofessional simulation
education innovations for
learners in pre-licensure nursing
programs.
Okuda, Y., Bryson, E. O., DeMaria, S., Jr., Jacobson, L., To explore the utility of Medical students
Quinones, J., Shen, B.,Levine, A. I. (2009). The utility of simulation in medical
simulation in medical education: what is the evidence? education.
[Review]. Mount Sinai Journal of Medicine, 76(4), 330-
343. doi: http://dx.doi.org/10.1002/msj.20127
Pittman, O. A. (2012). The use of simulation with To review use of simulation in Nursing students
advanced practice nursing students. [Review]. Journal of the education of advanced
the American Academy of Nurse Practitioners, 24(9), 516- practice nurses and to describe
520. doi: http://dx.doi.org/10.1111/j.1745- an innovative simulation
7599.2012.00760.x program for family nurse
practitioner (NP) students.
Rothgeb, M. K. (2008). Creating a nursing simulation To explore the current state of Nursing students
laboratory: a literature review. [Review]. Journal of nursing simulation laboratories.
Nursing Education, 47(11), 489-494.
Stroud, L., Wong, B. M., Hollenberg, E., Levinson, W. To identify studies of error Junior doctors
(2013). Teaching medical error disclosure to physicians-in- disclosure involving junior
training: a scoping review. [Review]. Academic Medicine, doctors or medical students.
88(6), 884-892. doi:
http://dx.doi.org/10.1097/ACM.0b013e31828f898f
Wallman, A., Vaudan, C., Sporrong, S. K. (2013). To identify communication Pharmacy
Communications training in pharmacy education, 1995- training strategies in pharmacy students
2010. [Review]. American Journal of Pharmaceutical education.
Education, 77(2), 36. doi:
http://dx.doi.org/10.5688/ajpe77236
Walsh, L.J., et al., Use of Simulated Learning To explore the use of Dental students
Environments in Dentistry and Oral Health Curricula, in simulation in dental education. and trainees
Simulated Learning Environments Program2010, Health
Manikins, task trainers, SPs
SPs, task trainers, manikins,
hybrid
Role-play; SPs, manikins,
task trainer
Role-play; SPs
SPs, VPs
Task trainees, role-play, SPs,
VR, manikin, virtual world,
VP
interprofessional simulation is valued by learners
and a useful strategy for educators to implement
collaborative learning in health professions
programs. Most studies supported the argument
that IPE simulation experiences in later years of
the curricula have positive outcomes for
learners. There is limited use of theories to guide
and design of IPE simulation. Many tool used in
the assessment of outcomes may not provide
valid and reliable data.
Not stated Patients are more willing to have students
perform procedures if they have simulation
training. Simulation has benefits and limitations
although it is here to stay. Funding models need
to be developed to facilitate access to simulation
and address issues of faculty development.
Not stated The literature on the use of simulation in
primary care APN programs is scant, but
simulation seems to represent an active learning
strategy that would be of benefit to primary care
APN students in increasing knowledge and
confidence about the management of clinical
situations. Students can also work with faculty to
create simulation experiences based on the
knowledge of their own learning needs and
expertise in specialty areas of nursing.
Not stated Many students are familiar with the use if
simulation and other technologies in their non-
working lives. Students expect hands on learning
opportunities.
1960-2011 Studies of existing error disclosure curricula
demonstrate improvements in learners'
knowledge, skills and attitudes, at least in the
short-term.
1995-2010 SPs were the most common simulation modality
contributing to communication skills training of
pharmacy students. Most educational
interventions were assessed by subjective
measures. Many of these programs were not well
integrated into the broader curricula.
Up to 2010 Many benefits of each simulation modality type
identified for dental students, similar to those
reported across other professions. Simulation
Workforce Australia: Adelaide, SA, Australia. was found to enhance decision-making in a
diverse range of dental topics - oral medicine,
orthodontics, jaw joint dysfunction, orofacial
pain, endodontics, prosthodontics, removal
partial denture design, geriatric dentistry. Virtual
microscopy ha been a major area of development
in dental education to improve students'
knowledge of normal and pathological oral
tissues. Haptic devices were also valued by
dental students offering 3D VR graphics and
tactile sensation allowing the student to feel a
variety of dental instruments.
 Table 2: Summary of data extracted from eligible papers

Citation Aim Population Simulation Study design: Study findings - from Country Quality - very
modalities - mixed methods abstract strong or strong
OSCEs, task or quant or qual or weak or very
trainers, Virtual or descriptive or weak or not
reality (VR), review applicable
animal,
cadaveric,
Virtual patients
(VPs), Simulated
patients (SPs),
hybrid, role-play,
manikin, game,
Virtual world,
OTHER (State)
To investigate the feasibility,
Aamodt CB, Virtue DW, Dobbie AE.
acceptability, and cost- This program was rated
Trained standardized patients can train OTHER (physical
effectiveness of training highly by students, and is
their peers to provide well-rated, cost- examination
medical students using Medical students Quantitative cost-effective, and USA Very weak
effective physical exam skills training to teaching
teaching associates trained generalisable to other
first-year medical students. Family associates)
by a lay expert instead of a institutions.
Medicine. 2006;38(5):326-9.
clinician.
Student and faculty
perceptions about the
simultaneous use of faculty
Abdelkhalek, N. M., Hussein, A. M., To evaluate student and
as simulated patients and
Sulaiman, N., & Hamdy, H. (2009). faculty perceptions of using a
assessors were generally
Faculty as simulated patients (FSPs) in faculty member
Medical students OSCE Quantitative positive. The results of this USA Weak
assessing medical students' clinical simultaneously as both the
study encouraged the
reasoning skills. Education for Health, simulated patient and the
program to continue using
22(3), 323. assessor in OSCEs.
faculty SPs on formative and
summative OSCE
assessments.
Aboumatar, H. J., Thompson, D., Wu, To develop a patient safety Medical students Not stated Quantitative The patient safety USA Weak
A., Dawson, P., Colbert, J., Marsteller, curriculum and evaluate its intersession resulted in
J., . . . Pronovost, P. (2012). impact on medical students' increased knowledge,
Development and evaluation of a 3-day safety knowledge, self- system-based thinking, and
patient safety curriculum to advance efficacy and system thinking. self-efficacy scores among
knowledge, self-efficacy and system students. Similar
thinking among medical students. BMJ intersessions can be
Quality and Safety, 21(5),416-22. implemented at medical,
nursing, pharmacy and other
allied health schools
separately or jointly as part

Ackermann, A. D., Kenny, G., &
Walker, C. (2007). Simulator programs
for new nurses' orientation: a retention
strategy. [Evaluation Studies]. Journal
for Nurses in Staff Development -
JNSD, 23(3), 136-139.
Acton, R. D., Chipman, J. G., Gilkeson,
J., & Schmitz, C. C. (2010). Synthesis
versus imitation: evaluation of a
medical student simulation curriculum
via Objective Structured Assessment of
Technical Skill. Journal of Surgical
Education, 67(3), 173-178.
Adachi K, Yoshimura A, Aso R,
Miyashita T, Yoshida D, Teramoto A, et
al. Clinical clerkship course for medical
students on lumbar puncture using
simulators. J Nippon Med Sch.
2012;79(6):430-7.
Afonso, N., Amponsah, D., Yang, J.,
Mendez, J., Bridge, P., Hays, G., . . .
Dulchavsky, S. (2010). Adding new
tools to the black bag--introduction of
ultrasound into the physical diagnosis
course. Journal of General Internal
Medicine, 25(11), 1248-1252
This article describes the
process of developing a
simulation program to
support role transition for
new nurses.
To assess students' ability to
integrate tasks (e.g., gowning
and gloving, suturing) that
are typically taught in
isolation over a series of
linked sessions while
executing an unrehearsed
procedure before and after a
new simulation curriculum
was introduced.
To evaluate the effectiveness
of the lumbar puncture
clerkship course in the
medical education program.
To study the feasibility of
incorporating ultrasound into
physical diagnosis (PD)
courses and to determine
whether learners can
demonstrate image
recognition and acquisition
skills.
of required school curricula.
A simulator program was
developed in Vassar Brothers
Medical Centre to assist in
Nursing students Not stated Descriptive USA Very weak
the transition of new
graduate registered nurses to
acute care practice.
An Objective Structured
Assessment of Technical
Skill (OSATS) was
administered to two groups
of medical students after an
animal lab and a skills lab
curriculum. All students had
Animal; SP; Task scope for improvement but
Medical students Quantitative USA Weak
trainer the SP and task trainer
program was superior to the
animal lab. A program that
provides students with the
opportunity to integrate skills
proved more valuable than
when skills were taught in
isolation.
The lumbar puncture
simulators achieved excellent
overall impressions and
represent useful tools for
training in lumbar puncture
procedures. In addition to the
Medical students Task trainer Quantitative simulators, an appropriate Japan Weak
preparatory text and a short
lecture before training
seemed to increase the
educational effect of this
lumbar puncture clerkship
course for medical students.
Medical students SPs Mixed methods Pre-post test data revealed USA Very weak
significant improvements in
image recognition suggesting
that an introductory
ultrasound course is effective
in improving medical
students' acquisition and
recognition of basic
cardiovascular and
abdominal ultrasound
images. The program
demonstrates the feasibility
of incorporating portable
ultrasound as a learning tool

Al-Ali K, Marghalani H, Al-Yahya A,
Omar R. An assessment of endodontic
re-treatment decision-making in an
educational setting. Int Endod J.
2005;38(7):470-6.
Alexander, S. C., Keitz, S. A., Sloane,
R., & Tulsky, J. A. (2006). A
Controlled Trial of a Short Course to
Improve Residents' Communication
with Patients at the End of Life.
Academic Medicine, 81(11), 1008-1012
Alinier G, Hunt B, Gordon R, Harwood
C. Effectiveness of intermediate-fidelity
simulation training technology in
undergraduate nursing education. J Adv
Nurs. 2006;54(3):359-69.
Allen SS, Miller J, Ratner E, Santilli J.
The educational and financial impact of
using patient educators to teach
introductory physical exam skills.
Medical Teacher. 2011;33(11):911-8.
Amer RS, Denehy GE, Cobb DS,
Dawson DV, Cunningham-Ford MA,
Bergeron C. Development and
evaluation of an interactive dental video
game to teach dentin bonding. J Dent
Educ. 2011;75(6):823-31.
To test the applicability of
Praxis Concept (PC) theory
in endodontic re-treatment
decision-making amongst
dental students of similar
backgrounds, but from two
dental schools.
To evaluate the effect of a
short course to improve
residents' communication
skills delivering bad news
and eliciting patients'
preferences for end-of-life
care.
To determine the effect of
scenario-based simulation
training on nursing students'
clinical skills and
competence.
To determine whether Patient
Educators (PEs) in an
introductory clinical
medicine (ICM) course were:
(1) as effective as physician
faculty in teaching the
physical exam, (2) impacted
consistency of student
performance on a final
practical exam, and (3)
whether this model was cost
effective.
To compare the change in
clinical knowledge and
practical clinical skill of first-
year dental students who
watch a clinical video
recording of the three-step
etch-and-rinse resin bonding
system to those using an
interactive dental video game
teaching the same procedure.
during medical school.
The findings support the
explanatory potential of PC
theory in endodontic re-
OTHER treatment decision-making in
Dental students (simulated Quantitative the group investigated, and USA Weak
radiography) suggest that factors besides
disease status alone, such as
gender, may contribute to the
choices that clinicians make.
Residents attending the
course demonstrated
statistically significant
increases in their overall skill
ratings in the delivery of bad
Junior doctors SPs Quantitative USA Strong
news, with improvement in
the specific areas of
information giving and
responding to emotional
cues.
Intermediate-fidelity
simulation is a useful training
technique. It enables small
groups of students to practise
Nursing students Manikin; OSCEs Quantitative UK Strong
in a safe and controlled
environment how to react
adequately in a critical
patient care situation.
In terms of sustainability and
student performance, the use
OSCEs, of trained lay educators has
Medical students OTHER(Patient Quantitative equivalent outcomes and is USA Weak
Educators) less costly for physical exam
instruction in the pre-clinical
years.
Dental students Games Quantitative There was no statistically USA Strong
significant difference
between teaching methods in
regards to change in either
knowledge or clinical skills,
with one minor exception
relating to the wetness of
dentin following etching.
Students expressed their
preference for an interactive

Ander DS, Heilpern K, Goertz F, Click
L, Kahn S. Effectiveness of a
simulation-based medical student course
on managing life-threatening medical
conditions. Simul. 2009;4(4):207-11.
Andrade AD, Bagri A, Zaw K, Roos
BA, Ruiz JG. Avatar-mediated training
in the delivery of bad news in a virtual
world. J Palliat Med. 2010;13(12):1415-
9.
Anker AE, Feeley TH, Friedman E,
Kruegler J. Teaching organ and tissue
donation in medical and nursing
education: a needs assessment. Prog
Transplant. 2009;19(4):343-8.
Aper L, Reniers J, Koole S, Valcke M,
Derese A. Impact of three alternative
consultation training formats on self-
efficacy and consultation skills of
To assess the competency
and the comfort level of
medical students in
lifesaving skills after a
simulation-based training
session and then determine
skill retention after one year.
To study the feasibility of
creating SP avatars in a
virtual world for the task of
training medical trainees to
deliver bad news.
To describe medical and
nursing students' training in
organ donation by examining
curriculum content and
methods of instruction by
using a national sample of
medical schools and a
statewide sample (New
York) of nursing schools.
To investigate the impact of
three consultation training
formats on students' self-
efficacy beliefs and their
self-paced method of
teaching.
A short course in simulation-
based life-saving clinical
skills is an effective means to
teach the third year medical
students. A decline in
competency over time was
observed for recognition of
ventricular fibrillation,
Medical students Manikin Quantitative USA Weak
defibrillation, airway
management, and
management of a choking
child. Cardiopulmonary
resuscitation and automatic
external defibrillator
competency did not decrease
over time.
Participants viewed the
avatar-mediated training as
an excellent approach for
learning how to deliver bad
news but believed it could
not substitute for real patient
VR; OTHER(SP interactions. However,
Medical students Quantitative USA Weak
avatar) participant self-efficacy
improved, which suggests
that avatar-mediated training
in a virtual world is a viable
educational approach for
skill training in delivering
bad news.
Although many educational
programs include an organ
donation component, a
significant proportion of
schools failed to provide
instruction on donation
consent processes,
Nursing students SPs Quantitative USA Very weak
definitions of brain and
cardiac death, and the
discussion of organ donation
during a routine health care
visit. Most schools rely on
lectures as the sole method of
instruction.
Each consultation training
contributes to the learning
Medical students SPs Quantitative Belgium Strong
process in a different way.
Autonomous training had a

medical students. Medical Teacher.
2012;34(7):e500-7.
Arevalo CR, Bayne SC, Beeley JA,
Brayshaw CJ, Cox MJ, Donaldson NH,
et al. Framework for e-learning
assessment in dental education: a global
model for the future. J Dent Educ.
2013;77(5):564-75.
Ashcraft AS, Opton L, Bridges RA,
Caballero S, Veesart A, Weaver C.
Simulation evaluation using a modified
Lasater Clinical Judgment Rubric. Nurs
Educ Perspect. 2013;34(2):122-6.
Austin Z, Gregory P, Tabak D.
Simulated patients vs. standardized
patients in objective structured clinical
examinations. Am J Pharm Educ.
2006;70(5):119.
consultation skills
acquisition.
To demonstrate strategies for
a global approach to e-
curricula in dental education
by considering a collection of
outcome assessment tools.
By combining the outcomes
for overall assessment, a
global model for a pilot
project that applies e-
assessment tools to virtual
learning environments
(VLE), including haptics, is
presented.
To describe the process for
evaluating senior nursing
students in a simulation
laboratory using a modified
Lasater Clinical Judgment
Rubric (LCJR).
To describe the use of
patient-actors as educators in
a senior-level pharmacy
practice course, and to
contrast the value and
application of "standardised
patient" and "simulated
patient" educational
methodologies.
significant positive effect on
students' self-efficacy while
traditional training and the
online training did only
positively influence the
cognitive component of the
consultation competence.
Equivalence for student
performance for haptic
versus traditional preparation
Dental students VR: Manikin Mixed methods methods was established, UK Very weak
thus establishing the validity
of the haptic solution for
performing these exercises.
The modified LCJR rubric
measured student
performance more
holistically than a procedural
checklist and provided
objective criteria for
evaluation. These findings
suggest that a well-
Nursing students Manikin Quantitative USA Weak
constructed rubric provides a
mechanism to evaluate
student performance in
simulation by focusing on
clinical reasoning essential
for patient safety and
allowing numeric evaluation
of performance.
Pharmacy SPs; OSCEs Mixed methods Students responded Canada Weak
students positively to the shift from
"standardised" patients to
"simulated" patients,
recognising their value in
teaching clinical and
pharmaceutical care skills.
Concerns were expressed
regarding objectivity in
assessment and individual
grading. Long-term follow-
up suggests students valued
this approach to education
and that it provided them

Austin Z, Gregory PAM. Evaluating the
accuracy of pharmacy students' self-
assessment skills. Am J Pharm Educ.
2007;71(5):89.
Avisar L, Shiyovich A, Aharonson-
Daniel L, Nesher L. Cardiopulmonary
resuscitation skills retention and self-
confidence of preclinical medical
students. Isr Med Assoc J.
2013;15(10):622-7.
Baer AN, Freer JP, Milling DA, Potter
WR, Ruchlin H, Zinnerstrom KH.
Breaking bad news: use of cancer
survivors in role-playing exercises. J
Palliat Med. 2008;11(6):885-92.
Baerheim A, Alraek TJ. Utilizing
theatrical tools in consultation training.
A way to facilitate students' reflection
on action? Medical Teacher.
2005;27(7):652-4.
To evaluate the accuracy of
self-assessment skills of
senior-level bachelor of
science pharmacy students
using a method involving
comparisons of pharmacy
students' self-assessment
with weighted average
assessments of peers,
standardised patients, and
pharmacist-instructors.
To evaluate the retention of
CPR skills and confidence in
delivering CPR by
preclinical medical students.
To teach medical students
how to deliver a diagnosis of
cancer using role-play with a
cancer survivor volunteer.
To evaluate a program that
used a simulated patient
consultation to give
individual student a group-
based opportunity to reflect.
with a foundation for better
understanding of the
psychosocial needs of
patients. Simulated-patient
educators can play an
important role in the
pharmacy curriculum, and
can complement practitioner-
educators in providing
students with a real-world
context for understanding
complex patient care needs.
The quality and accuracy of
pharmacy students' self-
assessment skills were not as
strong as expected. Further
work is necessary to ensure
Pharmacy
SPs Quantitative this important practice Canada Weak
students
competency and life skill is
at the level expected for
professional practice and
continuous professional
development.
Confidence and CPR skills of
preclinical medical students
deteriorate significantly
within 1 year post-training,
Medical students OSCEs; manikin Quantitative reaching an unacceptable Israel Weak
level 2 years post-training.
Refresher training is
recommended at least every
year.
Role-playing with cancer
survivor volunteers can be an
effective method of teaching
medical students how to
communicate bad news.
Students demonstrated a high
Medical students Role-play Descriptive USA Very Weak
level of adherence to
preferred communication
techniques and gained
significant confidence with
the task of "breaking bad
news."
Medical students SPs Qualitative The way of creating fiction Norway Very Weak
and manipulating temporality
in the consultation training
described in this study was
paralleled by most students'
reports on substantial

Baez A. Development of an objective
structured clinical examination (OSCE)
for practicing substance abuse
intervention competencies: An
application in social work education.
Journal of Social Work Practice in the
Addictions. 2005;5(3):3-20.
Baid H. The objective structured
clinical examination within intensive
care nursing education. Nurs Crit Care.
2011;16(2):99-105.
Baillie L, Curzio J. Students' and
facilitators' perceptions of simulation in
practice learning. Nurse Educ Pract.
2009;9(5):297-306.
Barley GE, Fisher J, Dwinnell B, White
K. Teaching foundational physical
examination skills: study results
comparing lay teaching associates and
physician instructors. Academic
To report the evaluation of a
program that teach medical,
nursing, and social work
students screening and brief
intervention skills, provide a
practice opportunity and
feedback to students on their
ability to demonstrate
substance abuse skills, and to
expose students to
interdisciplinary
collaboration.
To reflect back on a recent
experience of introducing an
OSCE into a post-registered,
degree level intensive care
nursing program.
To present the results from
an evaluative study of
students' and facilitators'
perceptions of simulation and
its application to clinical
practice.
To determine the differences
in the physical exam skills of
first-year medical students
learning physical exam
exclusively from
learning feed-forward
abilities from reflection on
action.
While the OSCE proved to
be highly compatible with
the teaching and practicing of
substance abuse intervention
skills, it is a tool that also has
Medical students; relevance and applicability
Nursing students; for the practicing and
OSCEs Quantitative USA Weak
Social work assessing of many other
students social work skills, and can be
a powerful addition to the
ways in which the field
approaches the challenge of
assessing competence in
more direct ways.
Organising and
implementing an OSCE for
an intensive care nursing
program required a great deal
Nursing students OSCEs Descriptive of preparation and time of UK Very Weak
the teacher but also offered
various benefits and
advantages compared with
other forms of assessment.
Students perceived that
simulation increased their
ability and confidence in
their clinical placements and
they did not feel
disadvantaged by the reduced
clinical placement hours.
There was no significant
difference between the
Nursing students OSCEs Quantitative perceived confidence of UK Weak
simulation and comparison
group students at the end of
placement. Undertaking
simulated learning during a
clinical placement appears to
be at least as effective as
learning during practice
placement without
simulation.
SPETA-trained students
performed equivalently to
Medical students SPs Quantitative physician faculty trained USA Strong
students across all stations.
Students taught by SPETAs

Medicine. 2006;81(10 Suppl):S95-7.
Barry M, Noonan M, Bradshaw C,
Murphy-Tighe S. An exploration of
student midwives' experiences of the
Objective Structured Clinical
Examination assessment process. Nurse
Educ Today. 2012;32(6):690-4.
Barsuk JH, McGaghie WC, Cohen ER,
Balachandran JS, Wayne DB. Use of
simulation-based mastery learning to
improve the quality of central venous
catheter placement in a medical
intensive care unit. J Hosp Med.
2009;4(7):397-403.
Bateman J, Allen M, Samani D, Kidd J,
Davies D. Virtual patient design:
exploring what works and why. A
grounded theory study. Medical
Education. 2013;47(6):595-606.
standardised physical
examination teaching
associates (SPETAs) and
those learning from
physician faculty.
To report on a qualitative
descriptive study that
explored midwifery students’
experiences on the OSCE
process for obstetric
emergencies within a
university setting.
To evaluate the effect of
simulation-based mastery
learning on Central venous
catheter (CVC) insertion
skill.
To research the influence of
Virtual Patient (VP) design
on medical undergraduates.
performed significantly
better on the abdominal
OSCE. Findings from this
study suggest that SPETAs
can effectively teach
foundational physical
examination skills to medical
students at a similar and
sometimes better
performance level as
physician faculty.
Preparation for the OSCE
was considered central to the
process. Learning via OSCEs
was perceived to be more
effective in comparison to
other forms of assessment
and prepared students for
Midwifery clinical practice. Positive
OSCEs Qualitative Ireland Very weak
students aspects of the process and
areas for improvement were
identified. Using OSCEs
increased the depth of
learning for the students with
the steps taken in preparation
for the OSCEs proving to be
a valuable learning tool.
Simulation-based mastery
learning increased residents'
skills in simulated CVC
insertion, decreased the
Medical students Task trainer Quantitative USA Strong
number of needle passes
when performing actual
procedures, and increased
resident self-confidence.
A theoretical model
describing how students
learn from VPs was
produced. This is the first
grounded theory study to
explore VP design. This
original research has
Medical students VP Qualitative produced a theoretical model UK Weak
which enhances
understanding of how and
why the delivery and design
of VPs influence learning.
The model may be of
practical use to authors,
institutions and researchers.

Battaglia JN, Kieser MA, Bruskiewitz
RH, Pitterle ME, Thorpe JM. An online
virtual-patient program to teach
pharmacists and pharmacy students how
to provide diabetes-specific medication
therapy management. Am J Pharm
Educ. 2012;76(7):131.
Baxter P, Akhtar-Danesh N, Landeen J,
Norman G. Teaching critical
management skills to senior nursing
students: videotaped or interactive
hands-on instruction? Nurs Educ
Perspect. 2012;33(2):106-10.
Becker DE. The effect of patient
simulation on the critical thinking of
advanced practice nursing students.
Dissertation Abstracts International:
Section B: The Sciences and
Engineering. 2007;68(4-B):2221.
Beebe RI. Relationship between fidelity
and dose of human patient simulation,
critical thinking skills, and knowledge
in an associate degree nursing program.
Dissertation Abstracts International:
Section B: The Sciences and
Engineering. 2014;74(7-B(E)):No
Pagination Specified.
Beischel KP. Variables affecting
learning in a simulation experience: a
mixed methods study. West J Nurs Res.
2013;35(2):226-47.
To develop, implement, and
assess the effectiveness of an
online medication therapy
management (MTM)
program to train pharmacists
and pharmacy students in
providing MTM services for
patients with diabetes and to
increase their intent to
perform these services.
To examine and compare the
effectiveness of videotape
training versus hands-on
instruction in preparing
senior nursing students to
respond to emergency
clinical situations.
To examine the effect patient
simulation has on the critical
thinking of nurse practitioner
and nurse anesthesia
students.
To examine the relationship
between human patient
simulation (HPS), critical
thinking skills, and
knowledge acquisition after
HPS was integrated across
the curriculum of an
associate degree nursing
program and to determine if
differences existed in critical
thinking and knowledge of
students based on the fidelity
of HPS used and amount of
student exposure to HPS.
To test a hypothesised model
describing the direct effects
of learning variables on
anxiety and cognitive
learning outcomes in a high-
fidelity simulation (HFS)
experience.
This online program using a
virtual patient improved both
participants' belief that they
have control over performing
MTM, and their knowledge
Pharmacy
VP Quantitative of how to perform MTM for USA Very weak
students
diabetic patients, which may
increase the likelihood that
pharmacists and pharmacy
students will perform MTM
in the future.
Instruction on crisis
management with a high-
fidelity simulator, using
Nursing students OSCEs; Manikin Quantitative either video or hands-on Canada Strong
instruction, can result in a
significant improvement in
performance.
Data analysis revealed
patient simulation to increase
critical thinking during the
management planning and
evaluation stages. The
Nursing students Manikin Quantitative current study has provided USA Strong
additional empirical evidence
supporting the use of
simulation during problem-
based learning, case analysis
to enhance critical thinking.
Results supported the use of
HPS as an effective teaching
strategy in lieu of a small
percentage of traditional
clinical experiences. No
Nursing students Manikin Quantitative USA Weak
significant statistical
differences were identified in
knowledge and critical
thinking based on the fidelity
of HPS used.
Nursing students Manikin Mixed methods Anxiety did not USA Very weak
quantitatively mediate
cognitive learning outcomes
as theorised, although
students qualitatively
reported debilitating levels of
anxiety. This study advances

Bell K, Cole BA. Improving medical
students' success in promoting health
behavior change: a curriculum
evaluation. Journal of General Internal
Medicine. 2008;23(9):1503-6.
Benedict N, Schonder K, McGee J.
Promotion of self-directed learning
using virtual patient cases. Am J Pharm
Educ. 2013;77(7):151.
Benedict N, Schonder K. Patient
simulation software to augment an
advanced pharmaceutics course. Am J
Pharm Educ. 2011;75(2):21.
Benedict N. Virtual patients and
problem-based learning in advanced
therapeutics. Am J Pharm Educ.
2010;74(8):143.
Bennett AJ, Arnold LM, Welge JA. Use
of standardized patients during a
psychiatry clerkship. Acad Psychiatry.
2006;30(3):185-90.
To design and evaluate a
formal curriculum to teach
medical students the
principles of motivational
interviewing (MI) that will
improve knowledge, skills,
and confidence in the area of
counseling patients for health
behavior change.
To assess the effectiveness of
virtual patient cases to
promote self-directed
learning (SDL) in a required
advanced therapeutics
course.
To implement and assess the
effectiveness of adding a
pharmaceutical care
simulation program to an
advanced therapeutics
course.
To enhance student learning
of a complex therapeutic
concept through the
incorporation of 2 case-
based, active-learning
strategies with lecture in a
required advanced
therapeutics course.
To evaluate whether the
addition of a Psychiatry
Clinical SP Examination
(PCX) during the third-year
clerkship improved students'
performances on the
psychiatry component of the
Clinical Competency
Examination (CCX) that is
used to prepare fourth-year
nursing education science by
providing evidence
concerning variables
affecting learning outcomes
in HFS.
Participation in a focused
curriculum on the use of
motivational interviewing
techniques significantly
improved 3rd year medical
students' knowledge,
Nursing students Role-play Quantitative USA Weak
confidence, and skills in the
area of behavior change
counseling. These gains may
help students succeed in
promoting good health habits
in their future patients.
Completion of virtual patient
cases, designed to replace
lectures and promote SDL,
Pharmacy
VP Quantitative was overwhelmingly USA Strong
students
supported by students and
proved to be as effective as
traditional teaching methods.
Patient simulation software
that used a branched-
outcome decision model was
Pharmacy an effective supplement to
VP Quantitative USA Weak
students class lectures in an advanced
pharmaceutics course and
was well-received by
pharmacy students.
Using a multifaceted
teaching approach,
combining active- and
Pharmacy passive-learning strategies,
VPs Quantitative USA Weak
students the course was well received
by students and fostered an
effective learning
environment.
The implementation of the
PCX during the psychiatry
clerkship significantly
improved student
SPs; OTHER performance on several
Medical students Quantitative USA weak
(PCX;CCX) important components of the
CCX, which is used to
prepare students for the Step
2 CSA. This suggests that
learning with SPs during the

Berg K, Majdan JF, Berg D, Veloski J,
Hojat M. A comparison of medical
students' self-reported empathy with
simulated patients' assessments of the
students' empathy. Medical Teacher.
2011;33(5):388-91.
Berg K, Majdan JF, Berg D, Veloski J,
Hojat M. Medical students' self-reported
empathy and simulated patients'
assessments of student empathy: an
analysis by gender and ethnicity.
Academic Medicine. 2011;86(8):984-8.
Bickenbach J, Schalte G, Beckers S,
Fries M, Derwall M, Rossaint R. The
intuitive use of laryngeal airway tools
by first year medical students. BMC
emerg. 2009;9:18.
Biron VL, Harris M, Kurien G,
Campbell C, Lemelin P, Livy D, et al.
Teaching cricothyrotomy: a
multisensory surgical education
approach for final-year medical
students. J Surg Educ. 2013;70(2):248-
53.
Blackstock FC, Watson KM, Morris
NR, Jones A, Wright A, McMeeken JM,
et al. Simulation can contribute a part of
cardiorespiratory physiotherapy clinical
education: two randomized trials.
Simul. 2013;8(1):32-42.
students for the National
Board of Medical Examiners
Step 2 Clinical Skills Exam
(Step 2 CSA).
To examine associations
between SPs assessment of
medical students' empathy
and the students' self-
reported empathy.
To examine the contribution
of students' gender and
ethnicity to assessments by
SPs of medical students'
empathy, and to compare the
results with students' self-
assessments of their own
empathy.
To investigate the intuitive
use of airway devices by
first-year medical students as
well as the effect of a simple,
but well-directed training
program. Retention of skills
was re-evaluated six months
thereafter.
To evaluate the efficacy of a
multisensory teaching
approach in imparting the
necessary knowledge,
technical skills, and
confidence to perform a
cricothyrotomy to a cohort of
fourth-year medical students.
To evaluate, through
randomised controlled trials
(RCT), whether education in
simulated learning
environments (SLEs) can
partly replace time in the
clerkship may help students
improve their interviewing
and interpersonal skills.
While significant
associations exist between
students' self-reported scores
and SPs' evaluations of
Medical students SPs; OSCEs Quantitative students' empathy, the USA Weak
associations are not large
enough to conclude that the
two evaluations are
redundant.
Women scored higher than
men on all three measures of
empathy. There was no
significant difference on self-
Medical students SPs; OSCEs Quantitative reported empathy by white USA Weak
and Asian American
students. SPs' assessments
indicated less empathy for
Asian American students.
Untrained laypersons are
able to use different airway
devices in a manikin and
may therefore provide a
secured airway even without
having any detailed
background knowledge about
Medical students Manikin Quantitative Germany Weak
the tool. Minimal theoretical
instruction and practical skill
training can improve their
performance significantly.
However, refreshment of
knowledge seems justified
after six months.
This study provides further
evidence that a multisensory
teaching intervention
effectively improves the
Medical students Cadaveric Quantitative Canada Strong
knowledge, skill, and
confidence of fourth-year
medical students in
performing cricothyrotomy.
An SLE can replace clinical
time in cardiorespiratory
Physiotherapy physiotherapy practice. Part
SPs Quantitative Australia Strong
students education in the SLE
satisfied clinical competency
requirements, and all

Blanch DC, Hall JA, Roter DL, Frankel
RM. Is it good to express uncertainty to
a patient? Correlates and consequences
for medical students in a standardized
patient visit. Patient Educ Couns.
2009;76(3):300-6.
Blank WA, Blankenfeld H, Vogelmann
R, Linde K, Schneider A. Can near-peer
medical students effectively teach a new
curriculum in physical examination?
BMC Med Educ. 2013;13:165.
Blatt B, Plack M, Maring J, Mintz M,
Simmens SJ. Acting on reflection: the
effect of reflection on students' clinical
performance on a standardized patient
examination. Journal of General Internal
Medicine. 2007;22(1):49-54.
Blum CA, Borglund S, Parcells D.
High-fidelity nursing simulation: impact
on student self-confidence and clinical
competence. Int. 2010;7:Article 18.
clinical environment for
physiotherapy
cardiorespiratory practice.
To examine the
consequences of expressions
of uncertainty (EOUs) in
medical student interactions,
with a particular focus on the
gender of the expresser.
To investigate whether
adding a new near-peer
teaching course developed
with student input plus
patient examination under
supervision in small groups
improves basic clinical
examination skills in third
year medical students
compared to a traditional
clinical examination course
alone.
To determine whether
reflecting and revisiting the
"patient" during an SP
examination improves junior
medical students'
performance and to analyse
students' perceptions of its
value.
To study the relationship
between simulation and
student self-confidence and
clinical competence and to
report a novel approach to
measuring self-confidence
and competence of entry-
level nursing students
stakeholders were satisfied.
There was an overall
negative perception of
medical students who
Medical students SPs Qualitative expressed uncertainty; USA Very weak
however, the strength of the
associations varied due to
medical student gender.
Adding a near-peer teaching
course to the routine course
significantly improved the
clinical examination skills of
Medical students OSCEs Quantitative Germany Strong
medical students in an
efficient manner in the
context of a resource-
constrained setting.
Offering medical students the
option to reflect and revisit
an SP during a clinical skills
examination produced a
small but nontrivial increase
in clinical performance.
SPs; Students perceived the
Medical students Mixed methods USA Weak
OTHER(CPX) reflect-revisit experience as
enhancing patient-centred
practices (counselling,
education) as well as their
own medical decision-
making and clinical
confidence.
Nursing students Manikin Quantitative The results indicated an USA Very weak
overall improvement in self-
confidence and competence
across the semester,
however, simulation did not
significantly enhance these
caring attributes. The study
highlights the need for
further examination of
teaching strategies developed
to promote the transfer of
self-confidence and
competence from the
laboratory to the clinical

Bokken L, Rethans J-J, Jobsis Q,
Duvivier R, Scherpbier A, van der
Vleuten C. Instructiveness of real
patients and simulated patients in
undergraduate medical education: a
randomized experiment. Academic
Medicine. 2010;85(1):148-54.
Bokken L, Rethans J-J, van Heurn L,
Duvivier R, Scherpbier A, van der
Vleuten C. Students' views on the use of
real patients and simulated patients in
undergraduate medical education.
Academic Medicine. 2009;84(7):958-
63.
Bokken L, van Dalen J, Rethans J-J.
The case of "Miss Jacobs": adolescent
simulated patients and the quality of
their role playing, feedback, and
personal impact. Simul. 2010;5(6):315-
9.
Bokken L, Van Dalen J, Scherpbier A,
Van Der Vleuten C, Rethans J-J.
To evaluate which contact
(real patient or SP) is
perceived as most instructive
by students and which
variables contribute to this.
To determine students' views
about the strengths and
weaknesses of real patient
interactions as opposed to
simulated patient (SP)
interactions in the
undergraduate medical
curriculum in order to
evaluate how their strengths
can be optimally used and
weaknesses remedied.
To evaluate the effects of
performing a patient role on
adolescents trained SPs for
teaching purposes (in
contrast to SPs) and
evaluated the quality of
adolescent SPs' role-playing
and feedback.
To evaluate the views of
teachers, students and
setting.
The general instructiveness
of both real patient contacts
and SP contacts was marked
high. Several differences
between the evaluations of
real patient contacts and SP
contacts were found. For
example, students considered
real patient contacts less
helpful in practicing
Medical students SPs Mixed methods communication skills and Netherlands Strong
considered the real patients'
feedback less relevant.
Students consider
authenticity an important
advantage of real patients.
However, SPs were better
informed about the purpose
of the consultation and
provided the student with
more specific feedback.
Both real patient interactions
and SP interactions are
considered indispensable to
undergraduate medical
education. Each encounter
has unique strengths and
weaknesses from the
Medical students SPs Qualitative perspectives of students. On Netherlands Very weak
the basis of strengths and
weaknesses that were
identified, suggestions were
made for the use of real
patients and SPs in
undergraduate medical
education.
Generally, students and
teachers were satisfied with
the quality of the role-
playing and feedback
provided by the adolescent
Medical students SPs Quantitative SPs. The adolescent SPs Netherlands Weak
experienced no negative
effects related to their
performance, which confirms
earlier findings among
adolescent SPs.
Evaluations by teachers and
Medical students SPs Quantitative Netherlands Weak
adolescent SPs about the

Lessons learned from an adolescent
simulated patient educational program:
Five years of experience. Medical
Teacher. 2009;31(7):605-12.
Bonnetain E, Boucheix J-M, Hamet M,
Freysz M. Benefits of computer screen-
based simulation in learning cardiac
arrest procedures. Medical Education.
2010;44(7):716-22.
Bornais JA, Raiger JE, Krahn RE, El-
Masri MM. Evaluating undergraduate
nursing students' learning using
standardized patients. Journal of
Professional Nursing. 2012;28(5):291-6.
Bosse HM, Nickel M, Huwendiek S,
Junger J, Schultz JH, Nikendei C. Peer
role-play and standardised patients in
communication training: a comparative
study on the student perspective on
acceptability, realism, and perceived
effect. BMC Med Educ. 2010;10:27
Botezatu M, Hult H, Fors UG. Virtual
patient simulation: what do students
make of it? A focus group study. BMC
adolescent SPs with regard to
the adolescent SP program in
an undergraduate curriculum
and the changes that were
made to the program in the
past five years (from 2002-
2003 until 2006-2007).
To test the effectiveness of
transfer of learning from a
computer screen-based
simulator to more realistic
situations such as those
encountered with high-
fidelity patient simulators.
To examine the effectiveness
of using SPs in improving
health assessment skills
among first-year nursing
students.
To assess the student
perspective on acceptability,
realism, and perceived effect
of communication training
with peer role-play and SPs.
To explore the opinions of
medical students on the
educational use of a VPS, the
adolescent SP program were
very positive. The quality of
the feedback by adolescent
SPs has shown improvement
over the past five years,
although adolescents find it
quite difficult to give
feedback. Teachers, students
and adolescent SPs have
highly valued the adolescent
SP program over the past
five years. The program has
been changed on the basis of
the lessons learned and has
become mature.
Computer screen-based
simulation appears to be
OTHER effective in preparing
Medical students (computer screen Quantitative learners to use high-fidelity France Strong
based simulation) patient simulators, which
present simulations that are
closer to real-life situations.
The findings suggest that the
use of SPs is an effective
Nursing students SPs Quantitative educational technique in Canada Strong
undergraduate nursing
education.
Role-play and SPs represent
comparably valuable tools
for the training of specific
communication skills from
the student perspective. Both
provide highly realistic
training scenarios and
warrant inclusion in medical
curricula. Given the expense
of SPs, deciding which
Medical students Role-play; SPs Quantitative Germany Strong
method to employ should be
carefully weighed up. From
the perspective of the
students, SPs were seen as a
more useful and more
applicable tool than role-play
while role-play has the
potential to foster a greater
empathic appreciation of the
patient perspective.
Five main themes were found
Medical students VPs Qualitative to be associated with Columbia Weak
successful VPs use in

Med Educ. 2010;10:91.
Bottenberg MM, Bryant GA, Haack SL,
North AM. Assessing pharmacy
students' ability to accurately measure
blood pressure using a blood pressure
simulator arm. Am J Pharm Educ.
2013;77(5):98.
Bourquin C, Stiefel F, Berney A, Singy
P. Dunno if you've any plans for the
future: medical student indirect
questioning in simulated oncology
interviews. BMC Med Educ. 2012;12:8.
Bowling AM. The effect of simulation
on knowledge, self-confidence, and skill
performance. Dissertation Abstracts
International: Section B: The Sciences
and Engineering. 2012;73(6-B):3524.
Web-based SP application
(Web-SP).
To compare student accuracy
in measuring normal and
high blood pressures using a
simulator arm.
To investigate the motives of
medical students for using “I
don't know questions” (IDK-
Qs), such as "I don't know if
you have already heard about
chemotherapies", in SP
interviews during a
communication skills course.
To examine the effect of two
educational interventions -
medium-fidelity simulation
and low-fidelity simulation
(paper/pencil case study) - on
measures of knowledge, self-
confidence, and skill
performance in junior level
BSN nursing students.
medical curriculum:
Learning, Teaching,
Assessment, Authenticity
and Implementation. Medical
students perceive VPs as
important learning and
assessment tools, fostering
clinical reasoning, in
preparation for future clinical
practice as young doctors.
However, a number of issues
regarding VP design,
authenticity and
implementation need to be
fulfilled, in order to reach the
potential educational goals of
such applications.
Pharmacy students may need
additional instruction and
experience with taking high
Pharmacy
Task trainer Quantitative blood pressure measurements USA Strong
students
to ensure they are able to
accurately assess this
important vital sign.
IDK-Qs showed a question
design difference between
medical students and
oncologists in SP interviews.
Among other reasons for this
Medical students SPs Qualitative Switzerland Weak
difference, the possible
function of IDK-Qs as a
protective linguistic strategy
and marker for psychological
discomfort is discussed.
Nursing students OSCEs, Task Quantitative Medium-fidelity simulation USA Strong
trainer; OTHER did not result in a higher
(paper/pencil case level of knowledge or skill
study) performance than low-
fidelity simulation. Medium-
fidelity simulators have a
higher cost, both in dollars
and faculty time, than low-
fidelity simulation. Faculty
members and nursing
institutions need to identify
what the learning outcomes
of the educational experience
are and determine if a lower
technology, that is less
expensive and less labour

Branch C. Pharmacy students' learning
and satisfaction with high-fidelity
simulation to teach drug-induced
dyspepsia. Am J Pharm Educ.
2013;77(2):30.
Brim NM, Venkatan SK, Gordon JA,
Alexander EK. Long-term educational
impact of a simulator curriculum on
medical student education in an internal
medicine clerkship. Simul.
2010;5(2):75-81.
Brimble M. Skills assessment using
video analysis in a simulated
environment: an evaluation. Paediatr
Nurs. 2008;20(7):26-31.
Brindley PG, Simmonds MR, Needham
CJ, Simmonds KA. Teaching airway
management to novices: a simulator
manikin study comparing the 'sniffing
position' and 'win with the chin'
To assess second-year
pharmacy students'
acquisition of
pharmacotherapy knowledge
and clinical competence from
participation in a high-
fidelity simulation, and to
determine the impact on the
simulation experience of
implementing feedback from
previous students.
To report the experience of
using manikin simulation in
an internal medicine
clerkship.
To explore student
perceptions and support
needs before, during and
after video assessment in the
simulated environment.
To compare performance
following the ‘sniffing
position’ (widely promoted
for teaching airway
positioning before
intensive, will have the same
learning outcomes as the
higher technology
Participation in a high-
fidelity simulation allowed
pharmacy students to apply
knowledge and skills learned
in the classroom. Improved
Pharmacy student satisfaction with the
Manikin; OSCEs Quantitative UK Weak
students simulation suggests that
implementing feedback
obtained through student
course evaluations can be an
effective means of improving
the curriculum.
Manikin simulation is a
valuable and sustainable
addition to a third-year
internal medicine clerkship.
For some students,
simulation provides
otherwise unavailable
exposure to core content
material. For the majority of
Medical students Manikin Quantitative students, simulation also USA Strong
provides the only means of
exposure to multiple
presentations of a single
illness. Together, these data
strongly suggest that
simulation promotes both
experiential learning and
comparative analysis in a
clerkship setting.
This evaluation showed that
students regard the use of
video cameras in the clinical
skills laboratory as a useful
tool for assessing
Nursing students Not stated Quantitative competency. Fewer students UK Very weak
expressed concerns about
this approach after they had
experienced it and even those
who had concerns recognised
the benefits.
The 'win with the chin'
analogy resulted in adequate
Medical students Task trainer Quantitative airway positioning Canada Strong
significantly more often than
the 'sniffing position' or

analogies. Br J Anaesth.
2010;104(4):496-500.
Broder HL, Janal M. Promoting
interpersonal skills and cultural
sensitivity among dental students. J
Dent Educ. 2006;70(4):409-16.
Brown J. Transferring clinical
communication skills from the
classroom to the clinical environment:
perceptions of a group of medical
students in the United kingdom.
Academic Medicine. 2010;85(6):1052-
9.
Brown RS, Graham CL, Richeson N,
Wu J, McDermott S. Evaluation of
medical student performance on
objective structured clinical exams with
standardized patients with and without
disabilities. Academic Medicine.
2010;85(11):1766-71.
Brydges R, Carnahan H, Rose D,
Dubrowski A. Comparing self-guided
learning and educator-guided learning
formats for simulation-based clinical
training. J Adv Nurs. 2010;66(8):1832-
44.
intubation) instructions with
an alternate analogy, 'win
with the chin' and to compare
performance following
simple anatomic instructions
and no instructions.
To evaluate interpersonal
communication skills among
third- and fourth-year dental
students during two clinical
communications (CC)
training programs: CC1
addressed straightforward
patient care situations in
dentistry; CC2 added cultural
sensitivity issues to the
dental scenarios.
To better understand the
transfer of classroom-learned
clinical communication skills
(CCS) to the clinical
environment of the hospital
ward, where they are
practiced and refined by
students.
To investigate whether
medical students'
performance on a family
medicine clerkship OSCE
differed when the SP had a
disability versus when the SP
did not have a disability.
To test the over-arching
hypothesis that progressive
self-guided learning offers
equivalent learning benefit
vs. proficiency-based
training while limiting the
need to set proficiency
standards.
control. The 'win with the
chin' and anatomic
instructions were
significantly better than no
instructions. Overall, 'win
with the chin' was a superior
teaching analogy and could
replace the 'sniffing position'
analogy.
Interpersonal communication
skills improved during this
patient instructor program for
both CC1 and CC2
programs. Performance
OTHER (Patient scores at the start of CC2
Dental students Quantitative USA Very weak
Instructors) were statistically lower than
at the end of CC1, suggesting
that performance wanes
without practice. Student
evaluations of the program
were very positive.
Four main themes emerged,
including transfer
mechanisms, where
simulated practice with
actors and the clinical history
template were powerful
Medical students SPs Qualitative learning tools. These findings UK Very weak
indicate that more needs to
be done to support, develop,
and embed CCS into the
professional practice of
medical students in the
clinical workplace.
Students performed better
when the SP did not have a
disability. This suggests that
Medical students SPs, OSCEs Quantitative greater emphasis should be USA Weak
placed on teaching
appropriate care of patients
with a disability.
Nursing Students Task trainer; Quantitative Progressive training and Canada Strong
Manikin; SPs proficiency-based training
resulted in equivalent
transfer test performance,
suggesting that progressive
students effectively self-
guided when to transition
between simulators. Students'
preference for the

Brydges, R., et al., Coordinating
progressive levels of simulation fidelity
to maximize educational benefit. Acad
Med.2010. 85(5): p. 806-12.
Bunn W, Terpstra J. Cultivating
empathy for the mentally ill using
simulated auditory hallucinations. Acad
Psychiatry. 2009;33(6):457-60.
Burchard KW, Rowland PA, Berman
NB, Hanissian PD, Carney PA.
Clerkship enhancement of interpersonal
skills. Am J Surg. 2005;189(6):643-6.
To evaluate the effectiveness
of a novel, simulation-based
educational model rooted in
scaffolding theory that
capitalises on a systematic
progressive sequence of
simulators that increase in
realism and information
content.
To examine medical student
empathy pre- and post-
simulated auditory
hallucination experience.
To determine if students
improve interpersonal skills
as the third year progresses
despite the lack of any
specific curriculum or
teaching methods.
progressive practice schedule
indicates that educators
should consider this
sequence for simulation-
based training.
Allowing students to
progress in their practice on
simulators of increasing
fidelity led to superior
transfer of a broad range of
clinical skills. Further, this
progressive group was
resource-efficient, as
Task trainers, SPs,
Medical students Mixed methods participants concentrated on Canada Strong
hybrid simulation
lower resource-intensive
simulators. It is suggested
that clinical training curricula
incorporate exposure to
multiple simulators to
maximize educational benefit
and potentially save educator
time.
Results suggest that empathy
may increase when students
are given a brief glimpse into
the mind of a mentally ill
patient by listening to
simulated auditory
hallucinations. Specific
Role-play;
interventions to increase
Medical Students OTHER Quantitative USA Strong
empathy for the mentally ill
(Auditory)
can lead to a better
understanding of how
empathy can improve patient
care, enhance the doctor-
patient relationship, and
direct future educational
strategies.
Despite the lack of skill-
directed curriculum, most
medical students showed
improved interpersonal skill
performance after a 16-week
clerkship. (Each student
Medical students SPs Quantitative USA Weak
completed a clinical
performance examination
before and after clerkship
consisting of a videotaped SP
interview and physical
examination) Developing an

Burke J, Fayaz S, Graham K, Matthew
R, Field M. Peer-assisted learning in the
acquisition of clinical skills: A
supplementary approach to
musculoskeletal system training.
Medical Teacher. 2007;29(6):577-82.
Butter J, Grant TH, Egan M, Kaye M,
Wayne DB, Carrion-Carire V, et al.
Does ultrasound training boost Year 1
medical student competence and
confidence when learning abdominal
examination? Medical Education.
2007;41(9):843-8.
Butter J, McGaghie WC, Cohen ER,
Kaye ME, Wayne DB. Simulation-
based mastery learning improves
cardiac auscultation skills in medical
students. Journal of General Internal
Medicine. 2010;25(8):780-5.
Cahan MA, Larkin AC, Starr S,
Wellman S, Haley H-L, Sullivan K, et
al. A human factors curriculum for
surgical clerkship students. Arch Surg.
2010;145(12):1151-7.
Cardoza MP, Hood PA. Comparative
study of baccalaureate nursing student
self-efficacy before and after
simulation. Comput Inform Nurs.
2012;30(3):142-7.
To evaluate whether peer-
assisted learning (PAL) can
be used to improve students'
clinical examination skills.
To evaluate the added value
of ultrasound training when
Year 1 medical students learn
abdominal examination.
To describe a mastery model
of cardiac auscultation
education and evaluate its
effectiveness in improving
bedside cardiac auscultation
skills.
To study if early introduction
of a full-day human factors
training experience into the
surgical clerkship curriculum
will teach effective
communication skills and
strategies to gain
professional satisfaction from
a career in surgery.
To examine two separate
groups of senior
baccalaureate nursing
students' reported self-
efficacy for providing
family-centred care on the
interpersonal curriculum for
all third-year students may
not be necessary. Because
faculty are being asked to do
more with less, it is believed
that efforts focused on
individual students during
the third year will be more
productive.
This study shows that PAL is
a useful adjunct to MSS
training, and could be
Medical students OSCEs Quantitative UK Strong
incorporated into medical
curricula to enhance clinical
skills.
Ultrasound training as an
adjunct to traditional means
of teaching abdominal
examination improves
Medical students SPs Quantitative students' physical USA Strong
examination technique after
students have acquired skills
with basic examination
manoeuvres.
A cardiac auscultation
curriculum consisting of
deliberate practice with a
computer-based tutorial and
a cardiac patient simulator
Medical students Manikin Quantitative USA Strong
resulted in improved
assessment of simulated
heart sounds and more
accurate examination of
actual patients.
The significant increase in
student-patient
communication scores
suggests that a brief focused
presentation followed by
Medical students Not stated Quantitative USA Strong
simulation of difficult patient
encounters can be successful.
A video demonstration can
improve interdisciplinary
teamwork.
The concluding data
identified that senior
baccalaureate nursing
Nursing students Manikin Quantitative USA Weak
students have unrealistic self-
assessments of their clinical
knowledge and nursing

Carlson J, Abel M, Bridges D,
Tomkowiak J. The impact of a
diagnostic reminder system on student
clinical reasoning during simulated case
studies. Simul. 2011;6(1):11-7.
Carter MB, Wesley G, Larson GM.
Didactic lecture versus instructional
standardized patient interaction in the
surgical clerkship. Am J Surg.
2005;189(2):243-8.
first day of the paediatric
semester before and after
simulation and on the last
day of the paediatric
semester before and after
simulation. In addition, the
relationship between two
senior baccalaureate nursing
student groups' reported self-
efficacy at four data points
was examined.
To explore the influence of
Isabel PRO, a web-based
Diagnostic Reminder System
(DRS), on student diagnostic
reasoning during simulated
encounters.
To test the hypothesis that SP
interaction would increase
the self-confidence of
surgery students in their
history and physical
examination (H and P) skills
as compared with the classic
lecture format and that
students would perceive the
SPI as a valuable learning
tool.
performance capabilities
before simulation scenario
participation. The perceived
ability of undergraduate
students to self-identify their
previously acquired
knowledge and transferable
clinical reasoning to family-
centred situations is
inaccurate. Human
simulators are an effective
teaching and learning
modality in measuring
factors that affect student
outcomes.
Despite limited experience,
students were able to
effectively use a DRS to
improve their diagnostic
accuracy. Use of a DRS
within the context of a
patient case represents a
distinct clinical skill set
requiring appropriate
training. Providing learners
Medical students SPs; Manikin Quantitative with gold standard examples USA Weak
of how to best use a specific
informatics tool within
specific clinical situations is
an essential learning
component. Simulated case
scenarios offer an
appropriate platform for
introducing diagnostic
support tools to learners
within a clinical context.
The didactic lecture format
was not only enjoyed and
valued more than the SPI but
surgery students also
perceived it as superior to the
SP in building confidence in
history and physical
Medical students SPs Quantitative USA Strong
examination skills. These
findings suggest that surgical
educators should develop
ways to improve students'
perceptions and attitudes
surrounding the surgical SP
interaction.

Carter MB, Wesley G, Larson GM.
Lecture versus standardized patient
interaction in the surgical clerkship: a
randomized prospective cross-over
study. Am J Surg. 2006;191(2):262-7.
Cavaleiro AP, Guimaraes H, Calheiros
F. Training neonatal skills with
simulators? Acta Paediatr.
2009;98(4):636-9.
Cazzell M, Rodriguez A. Qualitative
analysis of student beliefs and attitudes
after an objective structured clinical
evaluation: implications for affective
domain learning in undergraduate
nursing education. J Nurs Educ.
2011;50(12):711-4.
Cederberg RA, Bentley DA, Halpin R,
Valenza JA. Use of virtual patients in
dental education: a survey of U.S. and
Canadian dental schools. J Dent Educ.
2012;76(10):1358-64.
To test the hypothesis that
students would enjoy and
value an instructional SP
interaction more than a
didactic lecture, and that this
perception would be
enhanced if the lecture
immediately preceded the
instructional SP interaction.
To compare two different
ways of learning (self-study
vs. simulation sessions) the
adequate steps to resuscitate
a neonate in the 5th year
undergraduate medical
curriculum.
To explore the feelings,
beliefs, and attitudes of
senior-level undergraduate
pediatric nursing students
upon completion of a
medication administration
Objective Structured Clinical
Evaluation (OSCE).
To determine the extent to
which virtual patients are
being utilised in dental
education by conducting a
survey that was sent to sixty-
seven dental schools in the
United States and Canada.
The classic lecture format is
enjoyed and valued as a
learning tool more by
surgical clerkship students
than the instructional SP
interaction, but having a
lecture just before an SP
interaction increased
perceived enjoyment and
Medical students SPs Quantitative USA Strong
value of the SP interaction
and enhanced performance
on the SP checklist. These
data suggest that educators
can improve student
perceptions and attitudes
surrounding the instructional
SP interaction by using
strategically timed lectures.
Simulation-based training of
medical students in
management of neonatal
resuscitation do not led to
Medical students Manikin Quantitative Portugal Strong
significant differences on
short-term knowledge
comparing with traditional
method (self-study).
Students integrated the
attitude of safety first into
future practice but felt that
anxiety, loss of control,
reaction under pressure, and
no feedback affected their
ability to connect the OSCE
performance with future
Nursing students Manikin Qualitative USA Very weak
clinical practice. The
findings affect future
affective domain
considerations in the
development, modification,
and assessment of OSCEs
across the undergraduate
nursing curriculum.
Survey results indicate the
use of virtual patients in
dental education for pre-
clinical or clinical exercises
Dental students VPs Quantitative USA; Canada Very weak
related to learning and
honing patient interviewing
skills, medical history taking,
recordkeeping, and patient

Cendan JC, Johnson TR. Enhancing
learning through optimal sequencing of
web-based and manikin simulators to
teach shock physiology in the medical
curriculum. Adv Physiol Educ.
2011;35(4):402-7
Chang A, Boscardin C, Chou CL,
Loeser H, Hauer KE. Predicting failing
performance on a standardized patient
clinical performance examination: the
importance of communication and
professionalism skills deficits.
Academic Medicine. 2009;84(10
Suppl):S101-4.
Chenot J-F, Simmenroth-Nayda A,
Koch A, Fischer T, Scherer M, Emmert
B, et al. Can student tutors act as
examiners in an objective structured
clinical examination? Medical
Education. 2007;41(11):1032-8.
Chou CL, Masters DE, Chang A,
Kruidering M, Hauer KE. Effects of
longitudinal small-group learning on
delivery and receipt of communication
skills feedback. Medical Education.
2013;47(11):1073-9.
Christner JG, Stansfield RB, Schiller
JH, Madenci A, Keefer PM, Pituch K.
To determine if student
knowledge and satisfaction
differ between participation
in web-based and manikin
simulations for learning
shock physiology and
treatment and to determine if
a specific training
sequencing had a differential
effect on learning.
To determine which
assessment measures identify
medical students at risk of
failing a clinical performance
examination (CPX).
To assess the reliability of
student tutors (STs) as OSCE
examiners and their
acceptance by their peers.
To study the effects of prior
shared learning experiences
among medical students in
the delivery and receipt of
feedback on clinical
(communication) skills.
To examine the effect of an
instructive session on
treatment planning. Virtual
patient interactive audio-
video elements, also increase
the realism of the simulation
encounter.
The two simulations may be
of similar efficacy for
educating students on the
Manikin; OTHER physiology of shock;
Medical students Quantitative USA Strong
(web-based) however, the data suggest
improved learning when
web-based simulation
precedes manikin use.
Two predictors of CPX
failure in patient-physician
interaction skills were
identified: low clerkship
Medical students OTHER(CPX) Quantitative ratings; and student progress USA Strong
review for communication or
professionalism concerns. No
assessments predicted CPX
failure in clinical skills.
STs can act as examiners in
summative OSCEs to assess
Medical students OSCEs Quantitative basic medical skills. Students Germany Weak
accepted assessment
performed by STs.
Year 3 medical student peers
can deliver specific feedback
on clinical skills; prior peer-
learning relationships in pre-
clerkship clinical skills
courses enrich the provision
of specific corrective
feedback about
SPs; communication skills.
Medical students Mixed methods USA Weak
OTHER(CPX) Feedback between peers with
pre-existing peer-learning
relationships represents an
additional and potentially
underutilised method of
helping students improve
clinical skills in sensitive
realms such as interpersonal
communication.
Communicating effectively
Medical students OTHER(e-mail) Quantitative USA Very Weak
with patients via e-mail is not

Use of simulated electronic mail (e-
mail) to assess medical student
knowledge, professionalism, and
communication skills. Academic
Medicine. 2010;85(10 Suppl):S1-4.
Chumley HS, Dobbie A, Pollock M,
Delzell JE, Jr. Teaching medical
students to prioritize preventive
services. Fam Med. 2006;38(10):696-9.
Clark GT, Suri A, Enciso R.
Autonomous virtual patients in
dentistry: system accuracy and expert
versus novice comparison. J Dent Educ.
2012;76(10):1365-70.
Cleland J, Mackenzie RK, Ross S,
Sinclair HK, Lee AJ. A remedial
intervention linked to a formative
assessment is effective in terms of
improving student performance in
subsequent degree examinations.
Medical Teacher. 2010;32(4):e185-90.
Clever SL, Dudas RA, Solomon BS,
Yeh HC, Levine D, Bertram A, et al.
Medical student and faculty perceptions
of volunteer outpatients versus
simulated patients in communication
skills training. Academic Medicine.
2011;86(11):1437-42.
Colbert-Getz JM, Fleishman C, Jung J,
Shilkofski N. How do gender and
anxiety affect students' self-assessment
and actual performance on a high-stakes
clinical skills examination? Academic
Medicine. 2013;88(1):44-8.
effective e-mail
communication.
To evaluate a workshop that
teach third-year medical
students to prioritise
preventive services during an
office visit.
To examine an autonomous
virtual patient (AVP) system
for identifying differences
between novices and experts
in dentistry.
To ask if remedial
intervention linked to a
formative assessment is
effective in terms of
improving student
performance in subsequent
degree examinations.
To determine whether
medical students and faculty
perceive differences in the
effectiveness of interactions
with real patients (volunteer
outpatients - VOs) with SPs
in communication skills
training.
To determine the effect of
gender and anxiety on
accuracy of students' self-
assessment versus actual
performance in the context of
a high-stakes assessment.
intuitive but can be taught. It
is feasible to introduce
responses to a simulated e-
mail case in a clinical
clerkship as an assessment
tool.
The brief intervention failed
to increase students' scores
Medical students SPs Quantitative on an SP case requiring USA Very Weak
preventive services
prioritisation.
These data demonstrated that
experts and novices asked
essentially the same
questions and spent similar
amounts of time with the
Dental students VPs Quantitative USA Weak
patients, yet the experts
consistently scored higher
and ordered fewer diagnostic
tests and medications than
the novices.
A remedial intervention
linked to poor assessment
Medical students OSCEs Quantitative performance predicted UK Weak
improved performance in
later examination.
Students rated their
experiences with VOs
significantly higher than
those with SPs on several
criteria. Faculty preceptors'
Medical students SPs Quantitative ratings did not differ USA Strong
significantly between VOs
and SPs. Use of VOs was
well received by students and
faculty for teaching
communication skills.
Medical students SPs; Quantitative Females with high anxiety USA Strong
OTHER(CPX) were more accurate in self-
assessment and achieved
higher actual scores
compared with males with
high anxiety. No differences
by gender emerged for
students with moderate or
low anxiety. These finding
suggest that both gender and
the role of emotion, in this

Collins LG, Schrimmer A, Diamond J,
Burke J. Evaluating verbal and non-
verbal communication skills, in an
ethnogeriatric OSCE. Patient Educ
Couns. 2011;83(2):158-62.
Consoli A, Fraser K, Ma I, Sobczak M,
Wright B, McLaughlin K. Diagnostic
performance 1 h after simulation
training predicts learning. Advances in
Health Sciences Education.
2013;18(5):893-900.
Cooper S, Bulle B, Biro MA, Jones J,
Miles M, Gilmour C, et al. Managing
women with acute physiological
deterioration: student midwives
performance in a simulated setting.
Women Birth. 2012;25(3):e27-36.
Cooper S, Kinsman L, Buykx P,
McConnell-Henry T, Endacott R,
Scholes J. Managing the deteriorating
patient in a simulated environment:
nursing students' knowledge, skill and
situation awareness. J Clin Nurs.
2010;19(15-16):2309-18.
Corbo M, Patel J, Tawab R, Davies J.
Evaluating clinical skills of
undergraduate pharmacy students using
objective structured clinical
examinations (OSCEs). Pharmacy
Education: An International Journal of
Pharmaceutical Education.
2006;6(1):53-8.
To assess the role of non-
verbal and verbal
communication skills on
evaluations by SPs during an
ethno-geriatric OSCE.
To assess if performance in a
one hour post-training has a
predictive value of
performance six weeks later.
To assess student midwives'
ability to assess, and manage
maternal deterioration using
measures of knowledge,
situation awareness and skill,
performance.
To examine, in a simulated
environment, the ability of
final-year nursing students to
assess, identify and respond
to patients either
deteriorating or at risk of
deterioration.
To evaluate the clinical
performance of 4th year
MPharm students, through
two academic years.
case anxiety, should be taken
into account when planning
interventions to help improve
accuracy of students' self-
assessment.
Non-verbal communication
skills played a role in
perception of overall
interview quality as well as
perception of culturally
competent communication.
Incorporating formative and
Medical students SPs; OSCEs Quantitative USA Weak
summative evaluation of
both verbal and non-verbal
communication skills may be
a critical component of
curricular innovations in
ethno-geriatrics, such as the
OSCE.
Students who successfully
diagnosed a cardiac murmur
one hour after simulation
training were very likely to
Medical students Not stated Quantitative recognize the same murmur Canada Weak
six weeks later, suggesting
that performance one hour
post-training can be used a
learning outcome.
Whilst knowledge levels
were generally good, skills
Midwifery
SPs Quantitative were generally poor and Australia Very weak
students
decreased as the women
deteriorated.
Knowledge scores suggest,
on average, a satisfactory
academic preparation, but
Nursing students Manikin Mixed methods this study identified Australia Weak
significant deficits in
students' ability to manage
patient deterioration.
This study demonstrates that
final year pharmacy
undergraduates perform
poorly in activities which
Pharmacy
OSCE Quantitative demand an element of UK Weak
students
clinical problem
identification and resolution
or when performing a clinical
calculation.

Crary WM. A study of the pre-licensure
nursing students' perception of the
simulation learning environment as
helpful in achieving clinical
competencies and their perception of the
impact of the level of fidelity.
Dissertation Abstracts International:
Section B: The Sciences and
Engineering. 2013;74(6-B(E)):No
Pagination Specified.
Creutzfeldt J, Hedman L, Fellander-Tsai
L. Effects of pre-training using serious
game technology on CPR performance--
an exploratory quasi-experimental
transfer study. Scand J Trauma Resusc
Emerg Med. 2012;20:79.
Creutzfeldt J, Hedman L, Medin C,
Heinrichs WL, Fellander-Tsai L.
Exploring virtual worlds for scenario-
based repeated team training of
cardiopulmonary resuscitation in
medical students. J Med Internet Res.
2010;12(3):e38.
Cunningham NJ, Weiland TJ, van Dijk
J, Paddle P, Shilkofski N, Cunningham
NY. Telephone referrals by junior
doctors: a randomised controlled trial
assessing the impact of SBAR in a
simulated setting. Postgrad Med J.
2012;88(1045):619-26.
Curran V, Heath O, Adey T, Callahan
T, Craig D, Hearn T, et al. An approach
To explore and describe the
phenomena of student
perceptions of learning in the
simulation environment and
the role of the level of
reality.
To explore medical students'
retention of knowledge and
skills as well as their
proficiency gain after pre-
training using a multiplayer
virtual world (MV) with
avatars for cardio-pulmonary
resuscitation (CPR) team
training.
To find a feasible way to
implement CPR training and
to investigate how a serious
game setting in a virtual
world using avatars would
influence medical students'
subjective experiences as
well as their retention of
knowledge.
To determine whether
exposing junior doctors to
Situation, Background,
Assessment,
Recommendation (SBAR)
improves their telephone
referrals.
To describe an evaluation of
a curriculum approach to
The more real the student
perceives the simulation
learning environment to be,
the more helpful they will
find the environment in
Nursing students Manikin Mixed methods achieving clinical USA Weak
competencies. Students also
reported more strongly that
the level of reality had an
impact on their ability to
learn.
This study supports the
beneficial effects of MVW-
VR; OTHER CPR team training with
Medical students (Avatar); Quantitative avatars as a method for pre- Sweden Strong
Manikin training, or repetitive
training, on CPR-skills
among medical students.
Using scenario-based virtual
world team training with
avatars to train medical
students in multi-person CPR
was feasible and showed
promising results. Although
no evidence of stimulated
VR; OTHER
Medical students Quantitative recall of CPR procedures in Sweden Weak
(Avatars)
the test-retest study was
found, the subjects were
enthusiastic and reported
increased concentration
during the training. Subjects'
self-efficacy had increased
after the training.
In this simulated setting
exposure to SBAR did not
improve telephone referral
performance by increasing
the amount of critical
OTHER(Simulate information presented,
Medical students d clinical Mixed methods despite the fact that it is a Australia Strong
scenarios) minimum data element tool.
SBAR did improve the 'call
impact' of the telephone
referral as measured by
qualitative global rating
scores.
IPE in collaborative mental
Medical students SPs Mixed methods Canada Strong
health practice was well

to integrating interprofessional
education in collaborative mental health
care. Acad Psychiatry. 2012;36(2):91-5.
Curran VR, Mugford J, Law RM,
MacDonald S. Influence of an
Interprofessional HIV/AIDS Education
Program on Role Perception, Attitudes
and Teamwork Skills of Undergraduate
Health Sciences Students. Education for
Health: Change in Learning & Practice.
2005;18(1):32-44.
Curtin LB, Finn LA, Czosnowski QA,
Whitman CB, Cawley MJ. Computer-
based simulation training to improve
learning outcomes in mannequin-based
simulation exercises. Am J Pharm Educ.
2011;75(6):113.
Curtis J. Working together: a joint
initiative between academics and
clinicians to prepare undergraduate
nursing students to work in mental
health settings. Int J Ment Health Nurs.
2007;16(4):285-93.
integrating interprofessional
education (IPE) in
collaborative mental health
practice across the pre- to
post-licensure continuum of
medical education.
To assess changes in role
perception, attitudes towards
collaboration, self-reported
teamwork skills and
satisfaction with a shared
learning experience in an
undergraduate HIV/AIDS
interprofessional education
program for medical, nursing
and pharmacy students.
To assess the impact of
computer-based simulation
on the achievement of
student learning outcomes
during mannequin-based
simulation.
To describe the response to
preclinical undergraduate
workshops that were
developed to address
problems related to the
recruitment of newly
graduated nurses to mental
health settings in the
Illawarra region of New
South Wales, Australia.
received at both the pre- and
post-licensure levels.
Satisfaction scores were very
high, and all welcomed the
opportunity to learn about
collaboration in the context
of mental health. Medical
student satisfaction increased
significantly with the
introduction of SPs as an
interprofessional learning
method. Medical students
and faculty reported that
experiential learning in
practice-based settings is a
key component of effective
approaches to IPE
implementation.
A problem-based learning
approach combined with SPs
was effective in enhancing
HIV/AIDS interprofessional
role perception, enhancing
Medical students;
attitudes towards
Nursing students;
SPs Quantitative collaboration and Canada Weak
Pharmacy
interprofessional approaches
students
to HIV/AIDS care and
fostering confidence in
teamwork skills among pre-
licensure health sciences
students.
The use of computer-based
Manikin; OTHER simulation prior to
Pharmacy
(Computer-based Quantitative mannequin-based simulation USA Strong
students
simulation) improved the achievement of
learning goals and outcomes.
Nursing students Role-play Mixed methods Both students' and clinicians' Australia Weak
attitudes to the workshops
were consistently positive
and indicated that the
workshops were beneficial in
preparing students for their
clinical placement.
Importantly, since the
implementation of the
workshops and other
collaborative initiatives, an
increasing number of newly
graduated nurses from the

Dadgar S-R, Saleh A, Bahador H,
Baradaran HR. OSCE as a tool for
evaluation of practical semiology in
comparison to MCQ & oral
examination. JPMA J Pak Med Assoc.
2008;58(9):506-7.
Daeppen J-B, Fortini C, Bertholet N,
Bonvin R, Berney A, Michaud P-A, et
al. Training medical students to conduct
motivational interviewing: a
randomized controlled trial. Patient
Educ Couns. 2012;87(3):313-8.
Davies BR, Leung AN, Dunne SM.
Perceptions of a simulated general
dental practice facility - reported
experiences from past students at the
Maurice Wohl General Dental Practice
Centre 2001-2008. Br Dent J.
2009;207(8):371-6.
Davies J, Nathan M, Clarke D. An
evaluation of a complex simulated
scenario with final year undergraduate
children's nursing students. Collegian.
2012;19(3):131-8.
To compare medical
students' perceptions
regarding Objectively
Structured Clinical
Examination (OSCE) with
Multiple Choice Questions
(MCQ) and Oral exam in
their semiology course.
To examine the effectiveness
of motivational interviewing
(MI) training among medical
students.
To assess the perceived value
of a simulated general dental
practice centre as reported by
past undergraduates over five
years.
To evaluate a complex
simulated scenario with final
year undergraduate children's
nursing students
region are choosing to work
in mental health.
The findings of this study
support OSCE as an
Medical students OSCE Quantitative acceptable method to assess Iran Very weak
essentials of practical clinical
skills of medical students.
An 8-hours training
workshop was associated
Medical students SPs Mixed methods Switzerland Strong
with improved MI
performance.
A simulated general dental
practice centre was highly
rated by past dental students
in terms of the overall
learning experience received
and its relevance to later
vocational training. By far
the most consistently
reported attribute was the
opportunity to practise close
support four handed dentistry
with a nurse. Training in
Dental students Not stated Mixed methods UK Very weak
practice management and
organisational skills were
viewed as important with
effective teamwork and a
friendly environment seen as
conducive to building up
knowledge and confidence.
The role of experienced
current primary care
practitioners as teachers was
seen to be very effective in
this setting.
Overwhelmingly, the results
showed that this was a
positive experience for the
students, demonstrating a
number of perceived
Nursing students Role-play Mixed methods Australia Very weak
improvements in the
application of their clinical
skills. These included:
development of specific
management skills; enhanced

Dayal AK, Fisher N, Magrane D,
Goffman D, Bernstein PS, Katz NT.
Simulation training improves medical
students' learning experiences when
performing real vaginal deliveries.
Simul. 2009;4(3):155-9.
de Giovanni D, Roberts T, Norman G.
Relative effectiveness of high- versus
low-fidelity simulation in learning heart
sounds. Medical Education.
2009;43(7):661-8.
de la Croix A, Skelton J. The reality of
role-play: interruptions and amount of
talk in simulated consultations. Medical
Education. 2009;43(7):695-703.
de la Croix A, Skelton J. The simulation
game: an analysis of interactions
between students and simulated
patients. Medical Education.
2013;47(1):49-58.
To (1) determine the
relationship between
simulation training for
vaginal delivery manoeuvres
and subsequent participation
in live deliveries during the
clinical rotation and (2)
assess medical students'
performance and confidence
in vaginal delivery
manoeuvres with and without
simulation training.
To compare the effects of
training using a high-fidelity
heart sound simulator
(Harvey) and a low-fidelity
simulator (a CD) on
recognition of both simulated
heart sounds and those in
actual patients.
To resolve the following
questions: How are
interruptions and numbers of
words distributed in
simulated consultations? Do
they correlate with set
variables (e.g. gender,
scenario) or outcome
variables (e.g. grade)?
To find linguistic patterns in
predefined parts of the
conversations (questions,
topic initiations, openings,
closings) that might suggest
confidence; development of
self-awareness; and the
transferability of skills to
practice. Students also
demonstrated strong
agreement in terms of the
realism of the experience.
Students who receive
simulation training
participate more actively in
the clinical environment
during the course of the
clerkship. Student simulation
training is beneficial to learn
Medical students Manikin Quantitative USA Strong
obstetric skills in a minimal
risk environment,
demonstrate competency
with manoeuvres, and
translate this competence
into increased clinical
participation and confidence.
The study found little
evidence that students trained
with a high-fidelity simulator
were more able to transfer
skills to real patients than a
control group. Although
Manikin; OTHER
Medical students Quantitative there was some suggestion UK Strong
(CD)
that the Harvey-trained group
was better at recognising
heart sounds, there was no
difference between groups in
diagnostic accuracy or
clinical skills.
SPs talked and interrupted
significantly more than
medical students. Female SPs
are associated with more
words. The number of words
Medical students SPs Quantitative is significantly and positively UK Weak
associated with examination
grade. The number of student
interruptions is significantly
and positively associated
with grade.
Medical students SPs Qualitative The SP is conversationally UK Very weak
more dominant, despite
performing the role of the
patient, in that he or she asks
more direct questions, is

de Leng BA, Dolmans DHJM,
Muijtjens AMM, van der Vleuten CPM.
Student perceptions of a virtual learning
environment for a problem-based
learning undergraduate medical
curriculum. Medical Education.
2006;40(6):568-75.
de Sousa Eskenazi E, de Arruda Martins
M, Ferreira M, Jr. Oral health
promotion through an online training
program for medical students. J Dent
Educ. 2011;75(5):672-8.
Decara JM, Kirkpatrick JN, Spencer
KT, Ward RP, Kasza K, Furlong K, et
al. Use of hand-carried ultrasound
devices to augment the accuracy of
conversational dominance
related to conversations
between SPs and Year 3
students
To investigate the effects of a
virtual learning environment
(VLE) on group interaction
and consultation of
information resources during
the preliminary phase, self-
study phase and reporting
phase of the problem-based
learning process in an
undergraduate medical
curriculum.
To compare the impact on
knowledge and counselling
skills of face-to-face and
Internet-based oral health
training programs on medical
students.
To test the feasibility of
teaching medical students to
use hand-carried ultrasound
(HCU) devices to make
more likely to initiate topics,
is more likely not to follow
topic changes by students,
and closes the consultation.
The student is likely to
follow topics initiated by the
SP and to seek permission to
pre-close the consultation.
Students indicated that the
use of a VLE in the tutorial
room and the inclusion of
multimedia in case
presentations supported
processes of active learning
in the tutorial groups.
However, if we want to
exploit the full potential of
asynchronous computer-
Medical students VR Quantitative Netherlands Very weak
mediated communication to
initiate in-depth discussion
during the self-study phase,
its application will have to be
selective and deliberate.
Students indicated that the
links in the VLE to selected
information in library
repositories supported their
learning.
The Cybertutor + the Contact
Group (basic intervention
plus access to an Internet-
based training program about
oral health themes plus brief
proactive contact with a
tutor) performed significantly
better than the Control Group
(basic intervention) on both
Medical students OSCEs Quantitative Brazil Strong
the final assessment and the
OSCE and outperformed all
the other groups. The
Cybertutor + the Contact
Group also showed the most
significant increase in
knowledge and the best skills
in asking and counselling
about oral health.
Instruction of fourth-year
medical students on the use
Medical students SPs Quantitative USA Weak
of HCU device is feasible
and results in significantly
 bedside cardiac diagnoses
medical student bedside cardiac
and to compare the accuracy
diagnoses. J Am Soc Echocardiogr.
of their HCU and physical
2005;18(3):257-63.
examinations.
To use design based research
Deckers C. Designing high fidelity
to explore how to structure
simulation to maximize student
high fidelity simulation
registered nursing decision-making
(HFS) training to facilitate
ability. Dissertation Abstracts
the development of decision-
International: Section B: The Sciences
making in second semester
and Engineering. 2011;72(6-B):3345.
Registered Nursing learners.
To assess the benefit of
online teaching on students'
Degnan BA, Murray LJ, Dunling CP,
ability to administer drugs in
Whittlestone KD, Standley TDA, Gupta
a simulated critical incident
AK, et al. The effect of additional
scenario, during which they
teaching on medical students' drug
were scored on their ability
administration skills in a simulated
to administer drugs in
emergency scenario. Anaesthesia.
solution presented as a ratio
2006;61(12):1155-60.
(adrenaline) or percentage
(lidocaine).
To determine whether more
Deladisma AM, Cohen M, Stevens A,
complex communication
Wagner P, Lok B, Bernard T, et al. Do
skills, such as nonverbal
medical students respond empathetically
behaviours and empathy,
to a virtual patient? Am J Surg.
were similar when students
2007;193(6):756-60.
interacted with a VP or SP.
more accurate bedside
diagnoses.
Findings of this study
demonstrated that design
based research is a powerful
tool to create a rich
understanding of the high
fidelity simulation learning
experience. The results also
supported the work of
Jeffries (2005) reiterating
that HFS simulation design
must be created using strong
pedagogical principles that
support specific learning
outcomes. Particular
Nursing students Manikin Qualitative attention should be focused USA Very Weak
on maintenance of fidelity,
understanding complexity
and scaffolding learning
opportunities through a
multi-phased approach that
minimally includes
debriefing. The briefing stage
of HFS learning should be
further explored for its
influence on learning in HFS.
The influence of the
facilitator/faculty on the HFS
was emphasised in this
research.
The online teaching module
significantly improved the
students' ability to calculate
Nursing students Not stated Quantitative the correct volume of UK Strong
lidocaine and adrenaline, and
benefited each student's
overall performance.
Medical students
demonstrate nonverbal
communication behaviours
Medical students SPs; VPS Quantitative and respond empathetically USA Weak
to a VP, although the
quantity and quality of these
behaviours were less than

Denadai R, Toledo AP, Oshiiwa M,
Saad-Hossne R. Acquisition of suture
skills during medical graduation by
instructor-directed training: a
randomized controlled study comparing
senior medical students and faculty
surgeons. Updates Surg.
2013;65(2):131-40.
Deuster L, Christopher S, Donovan J,
Farrell M. A method to quantify
residents' jargon use during counseling
of standardized patients about cancer
screening. Journal of General Internal
Medicine. 2008;23(12):1947-52.
Diez N, Rodriguez-Diez M-C, Nagore
D, Fernandez S, Ferrer M, Beunza J-J.
A randomized trial of cardiopulmonary
resuscitation training for medical
students: voice advisory mannequin
compared to guidance provided by an
instructor. Simul. 2013;8(4):234-41.
DiFederico-Amicone Yates A. The
lived experience of associate degree
nursing students following a pediatric
simulation experience: A
phenomenological inquiry. Dissertation
Abstracts International: Section B: The
Sciences and Engineering. 2014;74(9-
B(E)):No Pagination Specified.
To compare the simulated
teaching of suture skills to
novice medical students by
senior medical students and
by experienced faculty
surgeons.
To assess the amount of
jargon used and explained
during discussions about
prostate or breast cancer
screening.
To assess the quality of CPR
training among second-year
medical students with a voice
advisory mannequin (VAM)
compared to guidance
provided by an instructor.
To explore the lived
experience of the associate
degree nursing student who
has completed a paediatric
clinical simulation; to gain an
understanding of the
meaning of this engaged
learning experience so
learning approaches can be
employed to attain positive
those exhibited in a similar
SP scenario. Student
empathy in response to the
VP was less genuine and not
as sincere as compared to the
SP scenario.
The acquisition of suture
skills after student-directed
training was similar to the
training supervised by
faculty surgeon, and the
Medical students Task trainer Quantitative increase in suture Brazil Strong
performances of trainees that
received instructor
administered training was
superior to self-directed
learning.
The large number of jargon
words and low number of
explanations suggest that
Medical students SPs Quantitative USA Weak
many patients may not
understand counselling about
cancer screening tests.
In comparison to the
traditional training method
involving an instructor,
training medical students in
CPR with VAM improves
the quality of chest
compressions in hand
position and in compression
Medical students Manikin Quantitative rate applied to mannequins. Spain Strong
Only among women was
VAM shown to be superior
in compression depth
training. This technology
reduces costs in 14% in the
setup and might potentially
release instructors' time for
other activities.
This research study primarily
revealed the desire and
strength of paediatric
simulation for these associate
degree nursing students. The
Nursing students Not stated Qualitative USA Very weak
concept of self-efficacy
within simulation influences
students' knowledge by
increasing their experience
and positively affecting their

Dillon PM, Noble KA, Kaplan L.
Simulation as a means to foster
collaborative interdisciplinary
education. Nurs Educ Perspect.
2009;30(2):87-90.
Dobson R, Taylor J, Cassidy J, Walker
D, Proctor P, Perepelkin J.
Interprofessional and intraprofessional
teams in a standardized patient
assessment lab. Pharmacy Education:
An International Journal of
Pharmaceutical Education.
2007;7(2):159-66.
Dubrowski A, MacRae H. Randomised,
controlled study investigating the
optimal instructor: student ratios for
teaching suturing skills. Medical
Education. 2006;40(1):59-63.
Duggan A, Bradshaw YS, Altman W.
How do I ask about your disability? An
examination of interpersonal
communication processes between
medical students and patients with
disabilities. J Health Commun.
2010;15(3):334-50.
outcomes that will lead to
competent paediatric nursing
care.
To initiate an
interdisciplinary
collaborative relationship
between nursing and medical
students; to determine the
usefulness of an
interdisciplinary approach
using simulations as an
educational strategy; and to
analyse students' perceptions
of collaboration.
To report on the relative
quality of patient care plans
produced by students
working in interprofessional
or intraprofessional teams, as
well as student expectations
and experiences working
with the different
collaborative models.
To assess the optimal ratio of
teachers to learners during
the teaching of a simulated
wound closure.
To examine interpersonal
communication processes
between medical students
and patients with disabilities.
performance.
Statistically significant
differences were seen in
medical students' post-test
scores for two factors,
collaboration and nursing
autonomy. The narrative
responses revealed that
Medical students;
Manikin Mixed methods nursing students' perceptions USA Very weak
Nursing students
of the nurse-physician
relationship became more
collaborative after the
simulation experience. Both
medical and nursing students
described the experience as
one that should be continued.
Pharmacy students working
in teams with other health
disciplines produce more
complete patient care plans
Pharmacy than pharmacy-only teams.
students; Nutrition Assessment lab activities
SPs Qualitative Canada Very weak
students; Physical also appear to increase
therapy students student support for
interprofessional teams and
appreciation for contributions
made by other health care
professions.
The optimal instructor-
student ratio was 1 instructor
for 4 students. Higher ratios
of instructors to students
resulted in no improvements
Medical students Task trainer Quantitative in learning, and lower ratios Canada Strong
of instructors to students
resulted in significantly less
learning. These findings are
in keeping with current
motor learning theories.
Medical students SPs Qualitative Results suggest that some USA Very weak
ways of asking about
disability may inhibit patient
disclosure and restrict
relationship building.
Students who ignored
disability altogether often
also recognised they missed
disability cues, thus

Duggan A, Bradshaw YS, Carroll SE,
Rattigan SH, Altman W. What can I
learn from this interaction? A
qualitative analysis of medical student
self-reflection and learning in a
standardized patient exercise about
disability. J Health Commun.
2009;14(8):797-811.
Dunnington, R. M. (2013). The nature
and determinants of presence among
nursing students participating in high
fidelity human patient simulation.
[Dissertation]. Dissertation Abstracts
International Section A: Humanities and
Social Sciences, 74(1-A(E)), No
Pagination Specified.
Duprey, M. D. (2011). Simulation
strategies in nursing education: An
experiential approach toward student
achievement. [Dissertation].
To examine medical students'
learning about disability in a
project using individuals
with disabilities as medical
educators.
To examine the nature of
presence in baccalaureate
nursing students participating
in high fidelity human patient
simulation (HF-HPS) and to
develop a conceptual model
that could explain the
dimensions and determinants
of presence as they may
impact learning outcomes.
To test the hypothesis that
the incorporation of
simulated learning activities
into traditional nursing
providing a learning
experience of considerable
value.
The current investigation
provided evidence of the
ways examining disability
Medical students SPs Qualitative can serve as a cornerstone for USA Very weak
building relationship-centred
patient care and encouraging
reflective practice overall.
The nature of presence was
found to be a dynamic state
of being with a centricity
between the simulation and
the natural environment
where students perceived the
stimuli from one
environment as salient over
the other. The results
revealed that presence was
experienced in the domains
of exocentricity,
endocentricity, or bicentricity
relative to the perceived
salience of the simulation
environment. Further, the
presence of students in
Nursing students Manikin Qualitative scenario based HF-HPS was USA Weak
impacted by pedagogical
factors, individual student
factors, and group factors.
Pedagogical factors found in
this study included
simulation design, stream of
stimuli, and instructional
process. Individual factors
included personality
characteristics, referential
experiences, preconceptions,
emotional responses, and
entry competencies. Group
dynamics and group structure
were also found to be
determinative of the nature of
presence in HF-HPS.
Statistically significant
differences between the
Nursing students Not stated Quantitative USA Strong
groups in achievement for
both the cardiovascular and

Dissertation Abstracts International
Section A: Humanities and Social
Sciences, 71(9-A), 3154.
Durham, J. A., Brettell, S., Summerside,
C., & McHanwell, S. (2009). Evaluation
of a virtual anatomy course for clinical
undergraduates. [Evaluation Studies
Research Support, Non-U.S. Gov't].
European Journal of Dental Education,
13(2), 100-109. doi:
http://dx.doi.org/10.1111/j.1600-
0579.2008.00549.x
Duvivier, R. J., van Geel, K., van Dalen,
J., Scherpbier, A. J. J. A., & van der
Vleuten, C. P. M. (2012). Learning
physical examination skills outside
timetabled training sessions: what
happens and why? Advances in Health
Sciences Education, 17(3), 339-355.
doi: http://dx.doi.org/10.1007/s10459-
011-9312-5
pedagogy would have a
positive effect on academic
achievement and students’
perceptions upon
transitioning to clinical
settings for students enrolled
in a nursing associate-degree
program.
To implement and evaluate a
series of interactive clinically
applied anatomy tutorials for
final year dental
undergraduate students.
To investigate what activities
medical students undertake
to improve their skills and
factors influencing students’
practice behaviour of
physical examination skills
outside timetabled training
sessions.
the high-risk obstetric
modules were observed.
Descriptive statistics showed
that 93% of participants
perceived simulation to be
useful in preparing for actual
clinical experiences.
Findings suggest that the
incorporation of simulated
learning may provide a
student-centred approach
toward enhancing student
achievement and confidence
among nursing students.
Overall perceptions of the
course were favourable
although a number of
modifications were
suggested. These included a
more concise presentation of
the mainstream tutorial text
with hyperlinks to more
detailed content. Students
also indicated a desire for
Dental students VR Mixed methods more line diagrams. These UK Weak
changes, it was suggested,
would help with the on-line
readability of the tutorials.
The primary focus for the
students’ learning appeared
to be provided by the pre-
and post-tutorial tests even
though explicit learning
outcomes were provided for
each tutorial.
Medical students OSCE, SPs Qualitative Practice patterns shift from Netherlands Weak
just-in-time learning to a
longitudinal self-directed
approach. Factors
influencing this change are
assessment methods and
simulated/real patients.
Simulated/real patients
stimulated students to
practise of physical
examination skills, initially
causing confusion and
anxiety about skill
performance but leading to
increased feelings of

Dyrbye, L. N., Starr, S. R., Thompson,
G. B., & Lindor, K. D. (2011). A model
for integration of formal knowledge and
clinical experience: the advanced
doctoring course at Mayo Medical
School. Academic Medicine, 86(9),
1130-1136. doi:
http://dx.doi.org/10.1097/ACM.0b013e
31822519d4
Edelbring, S., Brostrom, O.,
Henriksson, P., Vassiliou, D., Spaak, J.,
Dahlgren, L. O., . . . Zary, N. (2012).
Integrating virtual patients into courses:
follow-up seminars and perceived
benefit. [Research Support, Non-U.S.
Gov't]. Medical Education, 46(4), 417-
425. doi:
http://dx.doi.org/10.1111/j.1365-
2923.2012.04219.x
competence. Difficult or
enjoyable skills stimulate
students to practise. The
strategies students adopt to
master physical examination
skills outside timetabled
training sessions are self-
directed. OSCE assessment
does have influence, but
learning takes place also
when there is no upcoming
assessment. Simulated and
real patients provide strong
incentives to work on skills.
Early patient contacts make
students feel more prepared
for clinical practice.
Student feedback on course
evaluation forms is highly
positive. Further, on the 2009
To describe a year long Association of American
Advanced Doctoring course, Medical Colleges Graduation
a multidisciplinary clinical Questionnaire, graduating
skills course for second-year Mayo medical students were
Medical students Task trainers Quantitative USA Weak
students that was twice as likely as U.S.
implemented at Mayo medical students nationally
Medical School in 2006– to strongly agree that the
2007. basic science content was
sufficiently integrated and
had sufficient illustrations of
clinical relevance.
The perceived benefit of VPs
and their usage were higher
in the two intense-use
settings compared with the
moderate- and low-intensity
settings. The wish for more
guidance was high in the
low- and one of the high-
intensity settings. Students in
To investigate how best to
Medical students VPs Quantitative all settings displayed little Sweden Weak
use VPs in practice.
interest in more assessment
and feedback regarding VPs.
High case processing
intensity was related to
positive perceptions of the
benefit of VPs. However, the
low interest in more
assessment and feedback on
the use of VPs indicates the

Edelbring, S., Dastmalchi, M., Hult, H.,
Lundberg, I. E., & Dahlgren, L. O.
(2011). Experiencing virtual patients in
clinical learning: a phenomenological
study. Advances in Health Sciences
Education, 16(3), 331-345. doi:
http://dx.doi.org/10.1007/s10459-010-
9265-0
Ekmekci, O., Plack, M., Pintz, C.,
Bocchino, J., LeLacheur, S., &
Halvaksz, J. (2013). Integrating
executive coaching and simulation to
promote interprofessional education of
health care students. Journal of Allied
Health, 42(1), 17-24.
need to clearly communicate
the added value of the
follow-up seminar. The
findings suggest that a more
intense follow-up pays off in
terms of the benefit
perceived by students. This
study illustrates the need to
consider VPs from the
perspective of a holistic
course design and not as
isolated add-ons.
The VPs represented typical
clinical cases which
encouraged clinical
reasoning and allowed for
decision making. The
students reported that the
activities integrated
biomedical knowledge and
clinical experience,
providing structure that
prepared for the unstructured
clinical environment and
To elicit the nature of virtual
patient encounters under
patients in a clinical setting,
Medical students VPs Qualitative unstressful conditions. Sweden Weak
from the perspective of
However, the VPs were
students’ experience.
reported as lacking the
emotional interactivity and
complexity of actual patients.
VP activities during clinical
rotations provide students
with the experiences of
clinical reality and allow
them to solve problems
actively. These features are
dependent on VP technology
but are also contingent on the
surrounding environment.
A statistically significant
increase was noted pre- and
To evaluate a program that
post-program on the Team
uses executive coaching and
Assessment Inventory.
simulation to enhance
Health Qualitative analysis of
interprofessional teamwork
professional Not stated Mixed methods reflective essays and focus USA Weak
by promoting collaboration
students group interviews revealed
and leadership capacity in
that students participated as a
health professional
career-building opportunity
undergraduate students.
and because they wanted to
gain a better appreciation for

Ellison, S., Sullivan, C., Quaintance, J.,
Arnold, L., & Godfrey, P. (2008).
Critical care recognition, management
and communication skills during an
emergency medicine clerkship.
[Evaluation Studies]. Medical Teacher,
30(9-10), e228-238. doi:
http://dx.doi.org/10.1080/01421590802
334259
Ellman, M. S., Schulman-Green, D.,
Blatt, L., Asher, S., Viveiros, D., Clark,
J., & Bia, M. (2012). Using online
learning and interactive simulation to
teach spiritual and cultural aspects of
palliative care to interprofessional
students. [Research Support, Non-U.S.
Gov't]. Journal of Palliative Medicine,
15(11), 1240-1247. doi:
http://dx.doi.org/10.1089/jpm.2012.003
8
Endacott, R., Scholes, J., Buykx, P.,
Cooper, S., Kinsman, L., & McConnell-
Henry, T. (2010). Final-year nursing
students' ability to assess, detect and act
on clinical cues of deterioration in a
To evaluate a curriculum that
enable students to recognise,
manage, and simultaneously
communicate with critically
ill patients.
To evaluate an educational
program was that created
with five learning objectives
emphasised spiritual,
cultural, and
interprofessional aspects of
palliative care.
To investigate the processes
used by final-year nursing
students to recognise and act
on clinical cues of
deterioration in a simulated
the roles and contributions of
other health care providers.
The themes that emerged
related to aspects of the
process students found
helpful, lessons learned about
professional roles, and the
meaning of leadership in the
context of interprofessional
teams. Findings suggest that
integrating executive
coaching and simulation in
interprofessional education
may have the potential to
create meaningful
experiences for health
professional students.
According to faculty
assessment, students as a
group performed 79.6% (SD
0.15) of the critical care and
70.9% (SD 11.5%) of the
communication skills.
Medical students SPs Mixed methods USA Strong
Students most often
demonstrated basic
interpersonal skills and least
often demonstrated empathy
skills. Students rated the
curriculum positively.
Students of all professions
recognised important issues
beyond their own discipline,
the roles of other
professionals, and the value
of team collaboration.
Quantitative analysis
Health
indicated that students of all
professional Not stated Mixed methods USA Strong
professions perceived that
students
the program met its five
learning objectives, and
highly rated the program and
its two components for both
educational quality and
usefulness for future
professional work.
Thematic analysis of video
data and reflective interviews
Nursing students Manikin Qualitative identified considerable Australia Weak
differences in processes used
by students to identify cues.

simulated environment. [Research
Support, Non-U.S. Gov't]. Journal of
Advanced Nursing, 66(12), 2722-2731.
doi: http://dx.doi.org/10.1111/j.1365-
2648.2010.05417.x
Falcone, J. L., & Watson, G. A. (2011).
Differential diagnosis in a 3-station
acute abdominal pain objective
structured clinical examination (OSCE):
a needs assessment in third-year
medical student performance and
summative evaluation in the surgical
clerkship. [Comparative Study]. Journal
of Surgical Education, 68(4), 266-269.
doi:
http://dx.doi.org/10.1016/j.jsurg.2011.0
2.012
Farra, S., Miller, E., Timm, N., &
Schafer, J. (2013). Improved training
for disasters using 3-D virtual reality
simulation. [Randomized Controlled
Trial
Research Support, Non-U.S. Gov't].
Western Journal of Nursing Research,
35(5), 655-671. doi:
http://dx.doi.org/10.1177/01939459124
71735
Feddock, C. A., Hoellein, A. R.,
Griffith, C. H., Wilson, J. F., Lineberry,
M. J., & Haist, S. A. (2009). Enhancing
knowledge and clinical skills through an
adolescent medicine workshop.
[Randomized Controlled Trial
Research Support, U.S. Gov't, P.H.S.].
Archives of Pediatrics & Adolescent
Medicine, 163(3), 256-260. doi:
http://dx.doi.org/10.1001/archpediatrics.
2008.559
environment.
To test the following
hypotheses: (1) third-year
medical students in the
surgical clerkship will be
able to accurately diagnose
adult patients with acute
abdominal pain after
performing a focused history
and physical examination in
a 3-station OSCE, (2) service
assessments of a student's
ability to analyse data will
not correspond with OSCE
performance.
To examine the effects of
virtual reality simulation
(VRS) on learning outcomes
and retention of disaster
training.
To determine the effect of a
medical school adolescent
medicine workshop on
knowledge and clinical skills
using SPs.
Four aspects of cue
recognition were evident:
initial response, differential
recognition of cues,
accumulation of signs and
diversionary activity.
For 2 stations, more than half
of the medical students had
the correct diagnosis on the
differential diagnosis list. For
1 station, less than half of the
medical students had the
Medical students OSCE Quantitative correct diagnosis on the USA Strong
differential diagnosis list.
There were no differences in
the service evaluation scores
and the number of correct
differential diagnosis lists for
the students.
The main effect of the virtual
simulation was strongly
statistically significant. The
VRS effect demonstrated
stability over time. In this
Nursing students VR Quantitative USA Strong
preliminary examination,
VRS is an instructional
method that reinforces
learning and improves
learning retention.
Medical students SPs Mixed methods Medical students in the USA Very strong
intervention group scored
significantly higher on both
measures of clinical skills,
the SP stations during the
end-of-clerkship examination
and the Clinical Performance
Examination. Intervention
medical students also scored
significantly higher on both
measures of knowledge, the
open-ended post-encounter
written exercise and the
written examination. A brief
adolescent medicine
workshop using SPs
improved medical students'
knowledge and skills at the
end of a 4-week clerkship,
and the improvement in

Feeley, T. H., Anker, A. E., Soriano, R.,
& Friedman, E. (2010). Using
standardized patients to educate medical
students about organ donation.
Communication Education, 59(3), 249-
262. doi:
http://dx.doi.org/10.1080/03634521003
628289
Feeley, T. H., Tamburlin, J., & Vincent,
D. E. (2008). An educational
intervention on organ and tissue
donation for first-year medical students.
[Research Support, U.S. Gov't, P.H.S.].
Progress in Transplantation, 18(2), 103-
108.
Fenik, Y., Celebi, N., Wagner, R.,
Nikendei, C., Lund, F., Zipfel, S., . . .
Weyrich, P. (2013). Prepackaged central
line kits reduce procedural mistakes
during central line insertion: a
randomized controlled prospective trial.
[Randomized Controlled Trial]. BMC
Medical Education, 13, 60. doi:
http://dx.doi.org/10.1186/1472-6920-
13-60
Fernandez, R., Parker, D., Kalus, J. S.,
Miller, D., & Compton, S. (2007).
Using a human patient simulation
mannequin to teach interdisciplinary
team skills to pharmacy students.
To investigate students’
accuracy and missed
opportunities for educating
patients on cadaveric organ
donation. The focus of the
intervention is to promote
knowledge and improved
communication skills related
to cadaveric organ donation.
To implement and evaluate a
medical education
intervention on organ and
tissue donation designed for
first-year medical students.
To assess whether the use of
prepackaged all-inclusive
central line insertion kits
reduces procedural mistakes
during central line catheter
insertion by novices.
To determine the
effectiveness and student
acceptance of using a human
patient simulation (HPS)
training module focused on
clinical skills persisted at the
end of the third year of
medical school.
The results indicate several
areas of students’ missed
opportunities for patient
education including: (1)
logistics of the state health
care proxy, (2) timing of
Medical students SPs Quantitative funeral arrangements, and (3) USA Strong
ability to choose organs for
transplantation. The value of
using SP for communication
training and health
education/promotion is
discussed.
Significant increases from
pretest to posttest in medical
students' knowledge, self-
efficacy, and family
notification of donation
Medical students SPs Quantitative intentions were found. The USA Strong
intervention was successful
in increasing students'
knowledge and awareness
about organ and tissue
donation.
The prepackaged kit group
outperformed the standard kit
group in four of the five
quality indicators: procedure
duration; major technical
mistakes; minor technical
mistakes; and correct steps.
These differences were
Task trainers; statistically significant. The
Medical students Quantitative Germany Strong
Manikin difference for breaches of
aseptic technique was not
statistically significant.
Prepackaged all-inclusive
kits for novices improved the
procedure quality and saved
staff time resources in a
controlled simulation
environment.
Over 98% of students agreed
or strongly agreed that they
Pharmacy
Manikin Quantitative learned material relevant to USA Weak
students
their current studies. When
compared to student lectures,

American Journal of Pharmaceutical
Education, 71(3), 51.
Fernandez, R., Pearce, M., Grand, J. A.,
Rench, T. A., Jones, K. A., Chao, G. T.,
& Kozlowski, S. W. J. (2013).
Evaluation of a computer-based
educational intervention to improve
medical teamwork and performance
during simulated patient resuscitations.
[Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.].
Critical Care Medicine, 41(11), 2551-
2562. doi:
http://dx.doi.org/10.1097/CCM.0b013e3
1829828f7
Fisher, M. J., Taylor, E. A., & High, P.
L. (2012). Parent-nursing student
communication practice: role-play and
learning outcomes. [Research Support,
Non-U.S. Gov't]. Journal of Nursing
Education, 51(2), 115-119. doi:
http://dx.doi.org/10.3928/01484834-
20111216-04
interdisciplinary teamwork
skills.
To determine the impact of a
low-resource-demand, easily
disseminated computer-based
teamwork process training
intervention on teamwork
behaviors and patient care
performance in code teams.
To investigate students'
opinions before and after an
intervention where an
innovative method of
teaching nursing students
about communicating with
parents of sick children.
90% of students felt that they
learned clinical patient care
better when using a HPS
mannequin in simulated
patient scenarios. HPS-based
learning offers a realistic
training experience through
which clinical knowledge
and interpersonal teamwork
skills can be taught. Students
enjoy the experience and find
it relevant to their future
practice. Simulation-based
training may teach certain
topics better than traditional
lecture formats and as such
could help to fill gaps in the
current pharmacy
curriculum.
When controlling for team
members’ medically relevant
experience, teams in the
training condition
demonstrated better
Computer teamwork and patient care
Medical students Quantitative USA Strong
simulation than did teams in the placebo
condition. Computer-based
team training positively
impacts teamwork and
patient care during simulated
patient resuscitations.
Feedback provided by
students before and after the
parent session included
requests for additional
parents’ experiences,
appreciation and exceeded
expectations of hands-on
experience, recognised value
of information provided, and
Nursing students Role-play Not stated USA Weak
the recommendation that all
students attend. It is
demonstrate that empathy is
a teachable skill, nursing
students are apprehensive
about communicating with
parents, and nursing students
do not understand how much
families rely on nurses.

Foley, K. L., George, G., Crandall, S. J.,
Walker, K. H., Marion, G. S., &
Spangler, J. G. (2006). Training and
evaluating tobacco-specific
standardized patient instructors.
[Comparative Study
Research Support, N.I.H., Extramural].
Family Medicine, 38(1), 28-37.
Franc-Law, J. M., Ingrassia, P. L.,
Ragazzoni, L., & Della Corte, F. (2010).
The effectiveness of training with an
emergency department simulator on
medical student performance in a
simulated disaster. [Comparative Study
Randomized Controlled Trial]. CJEM
Canadian Journal of Emergency
Medical Care, 12(1), 27-32.
Fraser, K., Ma, I., Teteris, E., Baxter,
H., Wright, B., & McLaughlin, K.
(2012). Emotion, cognitive load and
learning outcomes during simulation
training. Medical Education, 46(11),
To assess the experience of
simulated patient instructors
(SPI) with a tabacco-specific
SPI training program. The
perceptions of medical
students on the interaction
with the SPI are also
evaluated.
To determine whether
exposure to an electronic
simulation tool would
improve the ability of
medical students to manage a
simulated disaster.
To assess emotion during
simulation training and to
explore the relationships
between emotion and
cognitive load, and
SPIs highly rated the content,
organisation, and presenters
of the training program.
Medical students positively
evaluated their experience
with the SPIs. The Tobacco
Intervention Risk Factor
Interview Scale (TIRFIS)
and Tobacco Beliefs
Management Scale-Tobacco
Cultural Concerns Scale
(TBMS-TCCS) subscales
demonstrated good internal
Medical students SPs Quantitative USA Strong
reliability, and
inconsistencies in ratings by
different SPIs were minimal.
In addition, a range of scores
on both measures attest to the
sensitivity of the instruments
to assess variations in student
performance. Significant
start-up costs are associated
with developing this training
program, although costs
decline when SPIs are
retained long term.
Participants in the
intervention group triaged
their patients more quickly
than participants in the
control group. The score of
performance indicators on a
standardised scale was also
significantly higher in the
intervention group when
Medical students Manikin Quantitative compared with the control Canada Very strong
group. All students indicated
that they preferred the
simulation-based curriculum
to a lecture-based
curriculum. When asked to
rate the exercise overall, both
groups gave a median score
of 8 on a 10-point modified
Likert scale.
Two principal components of
emotion which represented
Medical students Task trainer Quantitative invigoration and tranquility Canada Strong
were identified. Both of these
were associated with

1055-1062. doi:
http://dx.doi.org/10.1111/j.1365-
2923.2012.04355.x
Fraser, K., Wright, B., Girard, L.,
Tworek, J., Paget, M., Welikovich, L.,
& McLaughlin, K. (2011). Simulation
training improves diagnostic
performance on a real patient with
similar clinical findings. [Randomized
Controlled Trial
Research Support, Non-U.S. Gov't].
Chest, 139(2), 376-381. doi:
http://dx.doi.org/10.1378/chest.10-1107
Galal, S., Carr-Lopez, S., Seal, C. R.,
Scott, A. N., & Lopez, C. (2012).
Development and assessment of social
and emotional competence through
simulated patient consultations.
American Journal of Pharmaceutical
Education, 76(7), 132. doi:
http://dx.doi.org/10.5688/ajpe767132
diagnostic performance.
To determine whether
training on a
cardiorespiratory simulator
improves diagnostic
performance on a real
patient.
To determine whether a
quantitative tool could be
used to measure social
emotional competence and
whether the development of
social emotional competence
through a pharmacy
practicum course is possible.
cognitive load. A significant
negative association between
cognitive load and the odds
of subsequently identifying
the trained murmur was
found. Increased invigoration
and reduced tranquility
during simulation training
were associated with
increased cognitive load, and
that the likelihood of
correctly identifying a
trained murmur declined
with increasing cognitive
load.
Students trained on mitral
regurgitation were more
likely to identify and
diagnose these findings on a
real patient with mitral
regurgitation than those who
had trained on aortic stenosis
or a scenario with no cardiac
murmur. The differences in
Medical students Task trainer Quantitative result of performance of the Canada Very strong
three groups in accuracy
(SD) of identifying clinical
features of and diagnosing
mitral regurgitation were
statistically significant.
Simulator training on mitral
regurgitation increases the
likelihood of diagnosing this
abnormality on a real patient
Pharmacy Role-play Not stated Evaluation of students’ USA Weak
students performance in the clinical
cases using a patient
counselling assessment form
showed that students’ social
emotional competencies
significantly improved.
Observer ratings for
“influence” and “connection”
on the assessment form
predicted student
performance in the clinical
cases. Role-play exercises in
which students engage in
patient consultations can be
used to develop social

Gallimore, C., George, A. K., & Brown,
M. C. (2008). Pharmacy students'
preferences for various types of
simulated patients. American Journal of
Pharmaceutical Education, 72(1), 04.
Gantt, L. T., & Webb-Corbett, R.
(2010). Using simulation to teach
patient safety behaviors in
undergraduate nursing education.
[Evaluation Studies]. Journal of Nursing
Education, 49(1), 48-51. doi:
http://dx.doi.org/10.3928/01484834-
20090918-10
Garbee, D. D., Paige, J., Barrier, K.,
Kozmenko, V., Kozmenko, L.,
Zamjahn, J., . . . Cefalu, J. (2013).
Interprofessional teamwork among
students in simulated codes: a quasi-
experimental study. [Research Support,
Non-U.S. Gov't]. Nursing Education
Perspectives, 34(5), 339-344.
Garrett, B., MacPhee, M., & Jackson, C.
(2010). High-fidelity patient simulation:
considerations for effective learning.
Nursing Education Perspectives, 31(5),
309-313.
To evaluate pharmacy
students' preferences for
various types of simulated
patients.
To describe how a college of
nursing began to integrate
patient safety instruction into
simulation experiences for
undergraduate nursing
students.
To evaluate the efficacy of
using crisis resource
management (CRM)
principles and high-fidelity
human patient simulation
(HFHPS) for
interprofessional (IP) team
training of students from
undergraduate nursing, nurse
anaesthesia, medical, and
respiratory therapy.
To explore a case of the
implementation of high-
fidelity simulation (HFS) in
an undergraduate
preregistration nursing
program in a Canadian
school of nursing.
emotional competence in
pharmacy students, and the
Social Emotional
Development Inventory
(SED-I) and a patient
counselling assessment form
can be used to assess
learning and improvement in
this area.
Students preferred
community volunteers as
simulated patients, followed
by peers, instructors, and
staff members. Greater than
Pharmacy
SPs Quantitative 89% agreed or strongly USA Weak
students
agreed that their work with
simulated patients prepared
them for actual patients, with
community volunteers
receiving the highest ratings.
In the first semester in which
data were collected, students
did not demonstrate
satisfactory performance of
either hand hygiene or
Nursing students Not stated Quantitative USA Very weak
patient identification 61% of
the time. After instruction,
students still did not perform
these procedures consistently
38% of the time.
Mean scores increased after
training, and skills were
retained fairly well. Any loss
was regained with repeat
training in the spring. The
Nursing students;
Manikin Quantitative results suggest that using USA Strong
Medical students
CRM and HFHPS is an
effective pedagogy for
teaching communication and
teamwork skills to IP student
teams.
Nursing students Manikin Not stated Students identified positive Canada Very weak
learning experiences and
indicated that real-time
patient status changes proved
valuable to them. Also, using
these techniques offered a
safe environment for
improving competence. The
use of reflective debriefing

Gesundheit, N., Brutlag, P.,
Youngblood, P., Gunning, W. T., Zary,
N., & Fors, U. (2009). The use of
virtual patients to assess the clinical
skills and reasoning of medical students:
initial insights on student acceptance.
Medical Teacher, 31(8), 739-742.
Gilligan, C., Outram, S., Rasiah, R., &
Cooper, J. (2011). Exploring the
attitudes of pharmacy students to
clinical communications training. Focus
on Health Professional Education: A
Multi-disciplinary Journal, 13(2), 25-36.
To examine student
acceptance of a web-based
VP system, Web-SP,
developed for teaching and
assessment purposes.
To: (1) explore the students'
attitudes towards
communication skills
sessions and their confidence
in participating in role-play
scenarios with simulated
patients; (2) assess the extent
to which students perceive
that the skills practised
during these sessions are
implemented during
placement; (3) assess
whether an association exists
between attitude, confidence
and outcomes in terms of
appeared to be a focal area
for learning that requires
emphasis in the planning of
HFS experiences. This
template, team-focused
learning approach also
appeared to offer a cost-
efficient strategy for HFS.
Student acceptance of this
web-based method was high,
with greater acceptance in
pre-clinical (second-year)
compared with clinical
(fourth-year) medical
students. Students rated VPs
as realistic and appropriately
challenging; they particularly
liked the ability of VPs to
show physical abnormalities
(such as abnormal heart and
lung sounds, skin lesions,
Medical students VPs Not stated and neurological findings), a USA Very weak
feature that is absent in SPs.
These results document high
acceptance of web-based
instruction and assessment
by medical students. VPs of
the complexity used in this
study appear to be
particularly well suited for
learning and assessment
purposes in early medical
students who have not yet
had significant clinical
contact.
Most students reported that
they valued and benefited
from the communications
skills sessions in terms of
confidence and an awareness
of communication skills.
Recognition of the
Pharmacy
Role-play, SPs Mixed methods importance of learning Australia/NSW Strong
students
communication skills
increased after tutorials, and
students indicated that the
tutorials had helped in
equipping them with skills
which they used in clinical
placement situations. No

Gilliland, I., Frei, B. L., McNeill, J., &
Stovall, J. (2012). Use of high-fidelity
simulation to teach end-of-life care to
pharmacy students in an
interdisciplinary course. American
Journal of Pharmaceutical Education,
76(4), 66. doi:
http://dx.doi.org/10.5688/ajpe76466
Glass, C. C., Acton, R. D., Blair, P. G.,
Campbell, A. R., Deutsch, E. S., Jones,
D. B., . . . Yang, S. C. (2014). American
College of Surgeons/Association for
Surgical Education medical student
simulation-based surgical skills
curriculum needs assessment. [Research
Support, U.S. Gov't, Non-P.H.S.].
American Journal of Surgery, 207(2),
165-169. doi:
http://dx.doi.org/10.1016/j.amjsurg.201
3.07.032
assessment marks relating to
communication skills; and
(4) identify students' needs in
relation to communication
skills training.
To assess the effect of high-
fidelity simulation on
pharmacy students’ attitudes
and perceived competencies
in providing end-of-life care
in an interdisciplinary
palliative care course.
To survey surgical clerkship
directors nationally and
medical students at 5 medical
schools to rank and stratify
simulation-based educational
topics.
association could be
demonstrated between
students' attitudes or
confidence and their results
in oral exams. Large tutorial
groups were reported as a
key limitation to the
effectiveness, and students'
enjoyment of,
communications skills
sessions.
Students’ post-simulation
attitudes toward death
significantly improved
compared to pre-simulation
attitudes and they felt
significantly more competent
to take care of dying patients.
Pharmacy
Manikin Mixed methods Students were satisfied with Not stated Strong
students
this teaching method.
High-fidelity simulation is an
innovative way to challenge
pharmacy students’ attitudes
and help them with
knowledge acquisition about
end-of-life care.
Surgical clerkship Not stated Quantitative Clerkship directors and USA Weak
directors; Medical students generally agreed on
students the importance and timing of
specific educational topics.
Clerkship directors tended to
rank basic skills, such as
examination skills, higher
than medical students.
Students ranked procedural
skills, such as lumbar
puncture, more highly than
clerkship directors. Surgery
clerkship directors and 4th-
year medical students agree
substantially about the
content of a simulation-based
curriculum, although 4th-
year medical students
recommended that some
topics be taught earlier than
the clerkship directors
recommended. Students
planning to apply to surgical
residencies did not differ

Goodstone, L., Goodstone, M. S., Cino,
K., Glaser, C. A., Kupferman, K., &
Dember-Neal, T. (2013). Effect of
simulation on the development of
critical thinking in associate degree
nursing students. Nursing Education
Perspectives, 34(3), 159-162.
Goolsby, C., & Deering, S. (2013).
Hybrid simulation during military
medical student field training-A novel
curriculum. Military Medicine, 178(7),
742-745. doi:
http://dx.doi.org/10.7205/MILMED-D-
12-00541
Gordon, C. J., & Buckley, T. (2009).
The effect of high-fidelity simulation
training on medical-surgical graduate
nurses' perceived ability to respond to
patient clinical emergencies.
[Evaluation Studies]. Journal of
Continuing Education in Nursing,
40(11), 491-498; quiz 499-500. doi:
http://dx.doi.org/10.3928/00220124-
20091023-06
Gormley, G. J., McGlade, K., Thomson,
C., McGill, M., & Sun, J. (2011). A
virtual surgery in general practice:
evaluation of a novel undergraduate
virtual patient learning package.
[Evaluation Studies]. Medical Teacher,
33(10), e522-527. doi:
http://dx.doi.org/10.3109/0142159X.20
11.599889
To explore the development
of critical thinking for
students who received
instruction using high-
fidelity patient simulation
(HFPS) versus low-fidelity
simulation (instructor-written
case studies).
To determine if high-fidelity
hybrid simulation could be
successfully implemented in
a field environment. The
secondary goals were to
enhance the medical realism
of training, allow students to
practice crucial combat
emergency medical skills and
management in stressful field
conditions, and develop
medical team leadership.
To examine the effect of
simulation on medical-
surgical graduate nurses’
perceived ability and
confidence in responding to
patient clinical emergencies.
To evaluate the usefulness
and usability of a set of
online virtual patients in an
undergraduate general
practice clerkship.
significantly in their scoring
from students pursuing
nonsurgical specialties.
Both groups showed an
increase in critical thinking
skills; however, there was no
statistically significant
difference between the HFPS
Nursing students Manikin Quantitative and case study groups. USA Very strong
Results suggest that high-
and low-fidelity simulations
are both associated with
increases in critical thinking
scores.
High-fidelity simulation can
be successfully implemented
in combat-simulated field
Medical students Manikin hybrid Not stated USA Very weak
conditions, and feedback
indicated very positive
perceptions from students.
After simulation, participants
reported increased
confidence in their ability to
perform both technical and
nontechnical aspects of
Nursing students Manikin Quantitative responding to patient clinical Australia/NSW Strong
emergencies. Ninety-four
percent of participants
identified formal debriefing
as the most useful aspect of
the simulation experience.
Medical students VPs Quantitative Ninety-five per cent of UK Weak
students agreed that the
online package was a useful
learning tool and ranked
virtual patients third out of
six learning modalities.
Questions and answers and
the use of images and videos
were all rated highly by
students as useful learning
methods. The package was
perceived to have a high

Gottlieb, R., Lanning, S. K., Gunsolley,
J. C., & Buchanan, J. A. (2011). Faculty
impressions of dental students'
performance with and without virtual
reality simulation. [Comparative Study].
Journal of Dental Education, 75(11),
1443-1451.
Gough, J. K., Frydenberg, A. R.,
Donath, S. K., & Marks, M. M. (2009).
Simulated parents: Developing
paediatric trainees' skills in giving bad
news. Journal of Paediatrics and Child
Health, 45(3), 133-138. doi:
http://dx.doi.org/10.1111/j.1440-
1754.2009.01440.x
Green, A. R., Miller, E., Krupat, E.,
White, A., Taylor, W. C., Hirsh, D. A., .
. . Betancourt, J. R. (2007). Designing
and implementing a cultural
competence OSCE: lessons learned
from interviews with medical students.
[Research Support, Non-U.S. Gov't].
Ethnicity & Disease, 17(2), 344-350.
To compare faculty
perceptions and expectations
of dental students’ abilities
using VR simulation to those
who did not use VR in an
operative dentistry pre-
clinical course.
To obtain a better
understanding of the trainees'
experiences of a program that
involves simulated parents
supporting junior medical
staff to refine their skills in
communication, particularly
in giving parents bad news.
To evaluate an OSCE-based
curriculum that emphasises
cross-cultural
communication skills
(ccOSCE).
level of usability among
respondents.
Faculty perceptions of VR
simulation students’ abilities
were higher than for non-VR
simulation students for most
abilities examined. However,
the faculty members’
expectations of VR
simulations training were
higher than their perceptions
Dental students VR Mixed methods of the students’ abilities after USA Strong
VR simulation training for
most abilities examined.
Since ergonomic
development and technical
performance were positively
impacted by VR simulation
training, these results support
the use of VR simulation in a
preclinical dental curriculum.
Five themes emerged from
the qualitative data:
timeliness, emotional safety,
the complexity of
communication, practical
usefulness and the challenge
of effecting change. In
addition, the ratings of the
Junior doctors SPs Qualitative Australia/VIC Strong
videos helped to clarify those
‘parent-centred’
communication skills that
trainees may neglect in
difficult conversations: ‘ask
about support’, ‘encourage
the parent to ask questions’
and ‘repeat key messages’.
Themes that emerged
pertinent to design and
implementation of the station
were grouped into four
categories: learning goals,
logistical issues, faculty
Medical students OSCE Qualitative feedback, and SPs. Students USA Strong
were positive about the
overall experience. They
appreciated the practical
focus on non-adherence.
Some found the learning
goals complex, and others

Grice, G. R., Wenger, P., Brooks, N., &
Berry, T. M. (2013). Comparison of
patient simulation methods used in a
physical assessment course.
[Comparative Study
Research Support, Non-U.S. Gov't].
American Journal of Pharmaceutical
Education, 77(4), 77. doi:
http://dx.doi.org/10.5688/ajpe77477
Griswold-Theodorson, S., Hannan, H.,
Handly, N., Pugh, B., Fojtik, J., Saks,
M., . . . Wagner, D. (2009). Improving
patient safety with ultrasonography
guidance during internal jugular central
venous catheter placement by novice
practitioners. [Randomized Controlled
Trial]. Simulation in Healthcare: The
Journal of The Society for Medical
Simulation, 4(4), 212-216. doi:
http://dx.doi.org/10.1097/SIH.0b013e31
81b1b837
To determine whether there
is a difference in student
pharmacists’ learning or
satisfaction when SPs or
manikins are used to teach
physical assessment.
To compare ultrasonography-
guided (USG) placement
with anatomic placement
during internal jugular (IJ)
central venous catheter
(CVC) insertion by novice
practitioners using a
simulation model.
felt the format promoted
stereotypes. Logistical issues
included concerns about
marginalizing cross-cultural
care by creating a separate
station. Faculty feedback was
helpful when specific about
sociocultural issues students
did or did not explore well.
Students found SPs realistic
but inconsistent in how easily
they revealed information.
Learning goals should be
clear, concise, and
effectively communicated to
faculty and SPs so their
feedback can be standardized
and specific.
There was no difference in
performance scores between
student pharmacists who
were trained using manikins
vs SPs. Student pharmacists
who were trained using
manikins indicated that they
would have probably learned
to perform cardiac and
Pharmacy
SPs; Manikin Quantitative pulmonary examinations USA Strong
students
better had they been taught
using SPs and that they were
less satisfied with their
method of learning. Training
using SPs and manikins are
equally effective methods of
learning physical assessment,
but student pharmacists
preferred using SPs.
Medical students Task trainer Quantitative Fifty-four percent of USA Very strong
participants had at least one
arterial stick without USG
compared with 0% when
using USG. Significant
differences were shown in
the USG versus no-USG
groups in number of needle
advances until successful
cannulation of the vein; time
to successful cannulation;
and success rates. The
number needed to treat to

Haak, R., Rosenbohm, J., Koerfer, A.,
Obliers, R., & Wicht, M. J. (2008). The
effect of undergraduate education in
communication skills: a randomised
controlled clinical trial. [Comparative
Study
Randomized Controlled Trial].
European Journal of Dental Education,
12(4), 213-218. doi:
http://dx.doi.org/10.1111/j.1600-
0579.2008.00521.x
Haeseler, F., Fortin, A. H., Pfeiffer, C.,
Walters, C., & Martino, S. (2011).
Assessment of a motivational
interviewing curriculum for year 3
medical students using a standardized
patient case. Patient Education and
Counseling, 84(1), 27-30. doi:
http://dx.doi.org/10.1016/j.pec.2010.10.
029
Haist, S. A., Lineberry, M. J., Griffith,
C. H., Hoellein, A. R., Talente, G. M.,
& Wilson, J. F. (2008). Sexual history
inquiry and HIV counseling: improving
clinical skills and medical knowledge
through an interactive workshop
utilizing standardized patients.
[Research Support, U.S. Gov't, P.H.S.].
Advances in Health Sciences Education,
13(4), 427-434.
To determine whether
students improve their
communication skills as a
result of supervised patient
care and whether a newly
implemented communication
course could further improve
these skills.
To evaluate a year 3
motivational interviewing
(MI) curriculum using a SP
case.
To evaluate a SP educational
intervention teaching third-
year medical students
SHHIVC (Sexual history and
HIV counselling).
avoid an arterial stick by
using USG during IJ
insertion by novice
practitioners is ∼2. The USG
during IJ CVC placement by
novice practitioners is
essential to improve patient
safety.
A statistically significant
difference of the sum scores
of the ratings between test
and control group were
observed. The participants
Dental students Role-play Quantitative educated in communication Germany Very strong
skills improved significantly,
whereas in the control group
no accretion of practical
communication competence
was observed.
The SP reliably rated the
students on their
performance of 8 items.
Students who had
participated in the MI
curriculum were significantly
more proficient than
nonparticipating students in
Medical students SPs Quantitative the performance of 2 USA Very weak
strategic MI skills,
importance and confidence
rulers. The groups did not
differ in their use of patient-
centered counseling skills or
collaborative change
planning commonly used in
MI.
Medical students SPs Quantitative Workshop participants USA Very weak
scored higher than non-
participants on SHHIVC
items on the SP station,
written exam, and open-
ended written exercise after
the SP encounter. The
differences were statistically
significant. The curriculum
was associated with students
demonstrating better clinical
skills on a SP examination
station and more SHHIVC
knowledge on two measures

Halaas, G. W., Zink, T., Brooks, K. D.,
& Miller, J. (2007). Clinical skills day:
preparing third year medical students
for their rural rotation. Rural & Remote
Health, 7(4), 788.
Halbach, J. L., & Sullivan, L. L. (2005).
Teaching medical students about
medical errors and patient safety:
evaluation of a required curriculum.
[Evaluation Studies]. Academic
Medicine, 80(6), 600-606.
Hamilton, N. A., Kieninger, A. N.,
Woodhouse, J., Freeman, B. D.,
Murray, D., & Klingensmith, M. E.
(2012). Video review using a reliable
evaluation metric improves team
function in high-fidelity simulated
trauma resuscitation. [Comparative
To evaluate a clinical skills
day that featured human
patient simulators and SPs.
To assess the effectiveness of
a brief curriculum about
patient safety and medical
errors with third-year
medical students.
To demonstrate that
instruction of proper team
function can occur using
high-fidelity simulated
trauma resuscitation with
video-assisted debriefing and
that this process can be
of medical knowledge than
students not participating in
the educational intervention.
Evaluations were
overwhelmingly positive
with means well above four
on a five-point Likert scale.
Feedback from both
immediate and delayed
evaluations were and
continue to be used to
improve the session for the
Medical students SPs; Manikin Mixed methods following year. Both students Not stated Weak
and faculty were enthusiastic
about this 'hands on' team
learning format, which
provided students with
opportunities to begin to
understand the complex
skills that they will need
before they learn them step-
by-step.
Five hundred eleven (89%)
students reported that the
opportunity to present an
error to a patient increased
their confidence about
discussing this issue with
patients, and 537 (94%)
students reported that they
strongly agreed or agreed
that the SP and feedback
Medical students SPs Quantitative exercise was a useful USA Strong
learning experience. A
comparison of before and
after questionnaire data
revealed statistically
significant increases in the
self-reported awareness of
students' strengths and
weaknesses in
communicating medical
errors to patients.
Ninety percent of residents
found the video debriefing
very to extremely helpful in
Junior doctors Manikin Quantitative improving team function and USA Very weak
clinical competency. All
participants felt more
competent as both team

Study]. Journal of Surgical Education,
69(3), 428-431. doi:
http://dx.doi.org/10.1016/j.jsurg.2011.0
9.009
Hanna, M. N., Donnelly, M. B.,
Montgomery, C. L., & Sloan, P. A.
(2005). Perioperative pain management
education: a short structured regional
anesthesia course compared with
traditional teaching among medical
students. [Randomized Controlled
Trial]. Regional Anesthesia & Pain
Medicine, 30(6), 523-528.
Hansel, M., Winkelmann, A. M., Hardt,
F., Gijselaers, W., Hacker, W., Stiehl,
M., . . . Muller, M. P. (2012). Impact of
simulator training and crew resource
management training on final-year
medical students' performance in sepsis
resuscitation: a randomized trial.
[Randomized Controlled Trial
Research Support, Non-U.S. Gov't].
Minerva Anestesiologica, 78(8), 901-
909.
Haq, I., Fuller, J., & Dacre, J. (2006).
The use of patient partners with back
pain to teach undergraduate medical
students. [Research Support, Non-U.S.
Gov't]. Rheumatology, 45(4), 430-434.
Harder, B. N. (2013). Nursing students'
learning in high fidelity simulation: An
ethnographic study. [Dissertation].
Dissertation Abstracts International:
integrated rapidly into a
standard general surgery
curriculum.
To compare a structured
clinical instruction course on
regional anaesthesia
techniques for perioperative
pain management with
traditional teaching given to
senior medical students.
To evaluate the influence of
the CRM course on
situational awareness and
medical performance in crisis
scenarios and to compare the
results with the effects of a
purely clinical simulator
training.
To assess the impact of
teaching about back pain to
medical students using
trained patient partners (PP).
To look at the culture of
learning in HFS in
undergraduate nursing
education.
leaders and team members
because of the video
debriefing. The mean team
function score improved
significantly after video
debriefing pre-video vs. post-
video review.
The study group performed
better on each of the 11 items
Structured of the OSCE and on the total
Clinical performance scores of the
Medical students Instruction Quantitative study and control groups. USA Very strong
Module (SCIM) - The differences were
Similar to OSCE statistically significant. All
students rated the clinical
course highly valuable.
The SAGAT score rose in
the SIM group, whereas no
significant changes could be
shown in the CRM group and
the control group,
Medical students Manikin Quantitative Germany Very strong
respectively. The clinical
performance scores in the
post-intervention test did not
differ from those in the pre-
intervention test.
Students receiving the PP
teaching performed
significantly better in a
summative OSCE, but no
difference was seen in
analysis of a single station
assessing history-taking
skills in a patient with back
pain. Students felt that the PP
Medical students SPs Mixed methods teaching improved their UK Strong
ability to elicit information
from a patient during the
consultation. PPs enjoyed the
experience of teaching and
felt empowered to self-
manage their medical
conditions, and were better
able to seek medical advice
when needed.
Students believed that the
Nursing students; level of instructor
Manikin Qualitative Canada Strong
Instructors involvement at critical points
during HFS was important

Section B: The Sciences and
Engineering, 74(4-B(E)), No Pagination
Specified.
Harris, D. M., Ryan, K., & Rabuck, C.
(2012). Using a high-fidelity patient
simulator with first-year medical
students to facilitate learning of
cardiovascular function curves.
Advances in Physiology Education,
36(3), 213-219. doi:
http://dx.doi.org/10.1152/advan.00058.2
012
Harris, M. A. (2011). Simulation-
enhanced pediatric clinical orientation.
[Controlled Clinical Trial
Research Support, Non-U.S. Gov't].
Journal of Nursing Education, 50(8),
461-465. doi:
http://dx.doi.org/10.3928/01484834-
20110429-05
Hastings, J. K., et al. (2010). "An
Objective Standardized Clinical
To implement a HFPS
activity into a problem-based
curriculum to enhance the
learning of basic sciences.
To determine the effect of
simulation-enhanced
orientation on paediatric
acute care examination
scores and paediatric clinical
course grades among junior-
level baccalaureate nursing
students.
To add an objective
standardized clinical
and instructors believed that
their comfort level in
teaching with HFS had an
important influence on
teaching and subsequently
learning in HFS. Other
factors that enhanced or
impaired the simulated
clinical experience included
realism, the ability to make
mistakes in HFS and the
specific roles assigned to
students during HFS. An
important limitation of the
study was the possible bias
that might have resulted from
the researcher’s extensive
experience with HFS. A
major implication for
practice pertains to the
preparation of faculty and
students for HFS.
There was an increase in the
percentage of students
achieving correct answers on
a posttest compared with
their pretest score. Student
survey data showed
agreement that the activity
aided in learning. This study
suggests that a HFPS activity
Medical students Manikin Quantitative USA Strong
can be implemented during
the preclinical years of
medical education to address
basic science concepts.
Additionally, it suggests that
student learning of
cardiovascular function
curves and heart failure
strategies are facilitated.
No significant difference
between groups was detected
for the students’ examination
scores. Clinical grades of the
Nursing students Not stated Quantitative USA Very strong
intervention group were
statistically significantly
higher than those of the
control group.
Health The addition of the OSCE to
SPs Qualitative USA Very weak
professional the elective course provided
 examination (OSCE) to a
Examination (OSCE) in an advanced non-prescription medication
nonprescription medicines course." elective and assess the
American Journal of Pharmaceutical impact on students'
Education 74(6): 98. knowledge, skills, and
satisfaction.
To compare the impact of
Hauer, K. E., et al. (2009). "Impact of two formats of a formative
an in-person versus web-based practice SP examination (Web-based
standardized patient examination on vs. in-person) on scores on a
student performance on a subsequent subsequent high-stakes SP
high-stakes standardized patient examination and to compare
examination." Teaching and Learning in students' satisfaction with
Medicine 21(4): 284-290. each formative examination
format.
To characterize medical
Hauer, K. E., et al. (2011). "Assessment students' shared decision-
of medical students' shared decision- making with SPs and
making in standardized patient determine if students' use of
encounters." Journal of General Internal shared decision-making
Medicine 26(4): 367-372. correlates with SP ratings of
their communication.
To compared the impact of
Hayden, E. M., et al. (2012). "Web-
simulation sessions
conferenced simulation sessions: a
facilitated by in-person (IP)
satisfaction survey of clinical simulation
faculty versus those
encounters via remote supervision."
supervised remotely using
Telemedicine Journal & E-Health 18(7):
Web-conferencing software
525-529.
(WebEx(), Cisco
To investigate the perceived
Hearn, J. A. (2009). "Human Patient relationship between using
Simulators: Evaluation with beginning Human Patient Simulators
undergraduate nursing students." learning basic nursing skills
Dissertation Abstracts International and to examine the
Section A: Humanities and Social influences of faculty and
Sciences 69(12-A): 4695. environment on the nursing
curriculum.
Hedrick, T. L. and J. S. Young (2008). To see if repeated
"The use of "war games" to enhance simulations in the "war
high-risk clinical decision-making in games" format would
students with an enhanced
mechanism for evaluation of
students
their self-care education and
skill development
Two formats of a formative
SP examination led to
equivalent improvement in
scores on a subsequent high-
SPs, Web-based
Medical students Mixed methods stakes examination. Students USA Strong
vs. in-person
preferred an in-person
formative examination to
online but were satisfied with
both
No correlation between
shared decision-making and
overall communication
competence rated by the SPs.
Medical students SP's Quantitative These findings suggest that USA Strong
SP ratings of students'
communication skill cannot
be used to infer students' use
of shared decision-making.
Telecommunication can
successfully enhance access
OTHER (sim
to simulation-based
scenario -
Medical students Quantitative instruction. In this study, a USA Weak
participants vs
Web interface downgraded
faculty)
the quality of student-faculty
communication.
The respondents reported
having a high degree of
satisfaction with the use of
human patient simulation
and, had a better than
average level of trust in using
the simulator for
incorporation of knowledge,
Nursing students Manikin (HPS) Qualitative USA Very weak
cognitive and psychomotor
skills. The results supported
the use of simulator
technology in undergraduate
nursing education,
demonstrated the
effectiveness of the use of
simulation.
Subjects with the least
Junior doctors Manikin (HPS) Quantitative amount of clinical experience USA Strong
demonstrated the most
students and residents." American improvement from this
improve performance.
Journal of Surgery 195(6): 843-849. educational system
A short intervention based on
a training program using a
video and practice in part
task trainers. In an
To develop a training assessment using high-
Hein, C., et al. (2010). "A training program that provides fidelity simulation, we
program for novice paramedics provides student paramedics with demonstrated significant
initial laryngeal mask airway insertion initial knowledge and improvements in
Paramedic Task trainer /
skill and improves skill retention at 6 experience in laryngeal mask Quantitative maintenance of LMA Australia Strong
students (manikin)
months." Simulation in Healthcare: The airway (LMA) insertion insertion skills in student
Journal of The Society for Medical skills but equally important paramedics at 6 months. The
Simulation 5(1): 33-39. to provide ongoing skill model of just-in-time
retention. assessment and
reinforcement of training
prevents skill decay and has
implications for healthcare
skills training in general.
Simulation is an effective
teaching method for
preclinical basic science
Heitz, C., et al. (2009). "Large group This project studies whether
education. Students
high-fidelity simulation enhances large group simulation leads
Medical students Not stated Quantitative demonstrated significant USA Weak
medical student learning." Medical to enhanced basic science
improvements after
Teacher 31(5): e206-210. learning.
participating in a live
interactive simulation
scenario
Hendrickx, K., et al. (2009). "Learning Learning intimate
This study assessed the effect
intimate examinations with simulated SPs, OSCE, examinations with simulated
of learning intimate
patients: the evaluation of medical Medical students global rating Quantitative patients has a positive effect Belgium Strong
examinations with the use of
students' performance." Medical scales on the performance of
simulated patients.
Teacher 31(4): e139-147. medical students.
Herge, E., et al. (2013). "The The authors believe the SP
To describe the process for
standardized patient encounter: A experience is a viable
integrating SP encounters in
dynamic educational approach to Occupational teaching method in preparing
a professional healthcare SPs Descriptive USA Very weak
enhance students' clinical healthcare therapy students competent, reflective
curriculum for occupational
skills." Journal of Allied Health 42(4): practitioners for tomorrow's
therapy graduate students
229-235. healthcare environment.
Hernandez, C., et al. (2013). "Assessing To examined the proficiency Medical students SPs Quantitative The low detection rate and USA Weak
students' ability to detect melanomas of fourth-year University of failure of students who
using standardized patients and Illinois at Chicago medical noticed the moulage to
moulage." Journal of the American students at detecting identify the lesion as atypical
Academy of Dermatology 68(3): e83- melanomas. represents a lost opportunity
88. to provide a patient
intervention. Use of SP
examinations may help
physicians in training build
confidence and competence
in cutaneous malignancy

Hobgood, C. D., et al. (2009).
"Griev_Ing: death notification skills and
applications for fourth-year medical
students." Teaching & Learning in
Medicine 21(3): 207-219.
Hobgood, C., et al. (2010). "Teamwork
training with nursing and medical
students: does the method matter?
Results of an interinstitutional,
interdisciplinary collaboration." Quality
& Safety in Health Care 19(6): e25.
Hoellein, A. R., et al. (2009). "A
complementary and alternative
medicine workshop using standardized
patients improves knowledge and
clinical skills of medical students."
Alternative Therapies in Health &
Medicine 15(6): 30-34.
Hoffmann, R. L., et al. (2007). "The
effects of human patient simulators on
basic knowledge in critical care nursing
with undergraduate senior baccalaureate
nursing students." Simulation in
Healthcare: The Journal of The Society
for Medical Simulation 2(2): 110-114.
Horan, K. M. (2009). "Using the human
patient simulator to foster critical
thinking in critical situations." Nursing
Education Perspectives 30(1): 28-30.
To examine whether
GRIEV_ING improved death
notification skills of medical
students, whether pretesting
with simulated survivors
primed learners and
improved results of the
intervention, and whether
feedback on the simulated
encounter improved student
performance.
To evaluate four pedagogical
methods commonly used to
deliver teamwork training
and measured the effects of
each method on the
acquisition of student
teamwork knowledge, skills,
and attitudes.
To determine the impact of a
complementary and
alternative medicine (CAM)
workshop using SPs on
knowledge and clinical skills
of third-year medical
students.
To report on a study that
investigates whether
participation in instruction
involving human patient
simulators, in conjunction
with a traditional clinical
experience, improves
professional competence in
senior-level undergraduate
nursing students related to
basic knowledge of critical
care nursing
To give an example of mini-
scenario, using an oncology
patient with hypercalcaemia
and ventricular tachycardia
screening.
GRIEV_ING provides an
effective model medical
educators can use to train
medical students to provide
Medical students SPs Quantitative competent death USA Weak
notifications. Senior medical
students are primed to learn
death notification and do not
require a pre-exposure.
Each of the four modalities
demonstrated significantly
improved teamwork
knowledge and attitudes, but
no modality was
Medical students; Manikin , Role- demonstrated to be superior.
Quantitative USA Strong
Nursing students play Institutions should feel free
to utilise educational
modalities, which are best
supported by their resources
to deliver interdisciplinary
teamwork training.
Participating in a 4-hour SP
workshop exhibit superior
CAM knowledge as assessed
by SP checklist, open-ended
exercises, and multiple-
Medical students SPs Quantitative USA Strong
choice items. It appears that
practice with SPs assists in
acquisition and application of
CAM knowledge and
deferential counselling skills.
Instruction involving high-
fidelity human simulation is
a viable teaching strategy to
Nursing students Manikin Quantitative improve basic knowledge USA Weak
acquisition as one essential
attribute needed for
professional competence.
Using mini-scenarios on the
human patient simulator,
Nursing students Manikin Descriptive USA Very weak
faculty members can foster
critical thinking and expose

Horton, N., et al. (2013). "A
standardized patient counseling rubric
for a pharmaceutical care and
communications course." American
Journal of Pharmaceutical Education
77(7): 152.
Howard, V. M. (2007). "A comparison
of educational strategies for the
acquisition of medical-surgical nursing
knowledge and critical thinking skills:
Human patient simulator vs. the
interactive case study approach."
Dissertation Abstracts International
Section A: Humanities and Social
Sciences 68(6-A): 2259.
Howard, V. M., et al. (2010). "Human
patient simulators and interactive case
studies: a comparative analysis of
learning outcomes and student
perceptions." CIN: Computers,
Informatics, Nursing 28(1): 42-48.
Hoyer, C. B., et al. (2009). "Junior
physician skill and behaviour in
resuscitation: a simulation study."
Resuscitation 80(2): 244-248.
To restructure a required
pharmaceutical care and
communications course to
place greater emphasis on
communication skills and
include a high-stakes
assessment.
To determine whether the use
of the human patient
simulator (HPS) as an
educational intervention with
nursing students was more
effective than the use of
interactive case studies (ICS)
with respect to knowledge
gain and critical thinking
abilities
To investigate the value of
human patient simulators as
an innovative teaching
method for nursing students.
To describe physician
behaviour as team leaders in
a simulated cardiac arrest
during inter-hospital transfer.
The goal was to pinpoint
deficits in knowledge and
skill integration and make
recommendations for
improvements in education.
students to critical situations
in a nonthreatening
environment.
The 2010 course revision
improved students'
medication counseling
abilities and readiness to
Pharmacy practice. Major course
OSCE Quantitative USA Weak
students revisions should be
undertaken only after input
from all stakeholders and
with data to support the need
for change.
The use of simulation
technology in undergraduate
nursing education,
demonstrated the
effectiveness of the use of
simulation as an innovative
teaching strategy, validated
the nursing students' positive
Nursing students Manikin Mixed methods USA Strong
experience with respect to
simulation, and confirmed
the cost-benefit ratio with
respect to the resources
needed to integrate
simulation into an
undergraduate nursing
curriculum.
No significant difference was
found in student scores
among the three types of
nursing programs that
participated in the study.
Data obtained from a
Nursing students Manikin Mixed methods USA Strong
questionnaire administered to
participants indicated that
students responded favorably
to the use of human patient
simulators as a teaching
method
Junior doctors Manikin Quantitative Junior physicians performed Denmark Strong
well with respect to the
treatment given and the
delegation of tasks.
However, variations in the
time of initiation it took for
each treatment indicated lack
of leadership skills. It is
imperative that the education

Hravnak, M., et al. (2005). "Expanding
acute care nurse practitioner and clinical
nurse specialist education: invasive
procedure training and human
simulation in critical care." AACN
Clinical Issues 16(1): 89-104.
Hudson, J. N. and A. L. Tonkin (2008).
"Clinical skills education: outcomes of
relationships between junior medical
students, senior peers and simulated
patients." Medical Education 42(9):
901-908.
Hunziker, S., et al. (2010). "Brief
leadership instructions improve
cardiopulmonary resuscitation in a high-
fidelity simulation: a randomized
controlled trial.[Erratum appears in Crit
Care Med. 2010 Jun;38(6):1510]."
Critical Care Medicine 38(4): 1086-
1091.
Husebo, S. E., et al. (2011). "Educating
for teamwork--nursing students'
coordination in simulated cardiac arrest
situations." Journal of Advanced
Nursing 67(10): 2239-2255.
Hussainy, S. Y., et al. (2012). "A virtual
practice environment to develop
To describe the critical care
technical skills training
mechanisms and use of a
High-Fidelity Human
Simulation (HFHS)
Laboratory in the acute care
nurse practitioners and
clinical nurse specialists
programs at the University of
Pittsburgh School of Nursing
To explored whether senior
medical students are
effective tutors for their
junior peers in clinical skills
education, and how the
participants in the learning
triad (tutors, learners and
SPs) perceive the learning
environment created in peer-
assisted learning (PAL).
To compare leadership
instruction with a general
technical instruction in a
high-fidelity simulated
cardiopulmonary
resuscitation scenario.
To explore and describe the
communicative modes
students employ to
coordinate the team in a
simulation-based
environment designed for
resuscitation team training.
To develop communication
skills in second-year
of physicians includes
training in leadership
Critical care technical skills
training and the use of
simulation in the curriculum
have had a favourable
response from students and
Nursing students Manikin Descriptive USA Very weak
preceptors at the University
of Pittsburgh School of
Nursing, and have enhanced
faculty's ability to prepare
advanced practice nurses.
With appropriate support,
volunteer Year 6 student
tutors are as effective as
graduate doctors for small-
Medical students SPs Quantitative group structured tutorials in Australia Strong
clinical skills. Educational
relationships were forged
between all participants in
the learning triad
Video-assisted leadership
and technical instructions
after a simulated
cardiopulmonary
resuscitation scenario
showed sustained efficacy
after a 4-months duration.
Medical students Manikin Quantitative Switzerland Strong
Leadership instructions were
superior to technical
instructions, with more
leadership utterances and
better overall
cardiopulmonary
resuscitation performance
Simulation-based
environments offer a
promising solution in nursing
education for training the
coordination necessary in
resuscitation teams as they
Nursing students Manikin Descriptive Norway Weak
give the opportunity to
practice the complex
interplay of verbal and non-
verbal communication modes
that would otherwise not be
possible.
Pharmacy The VPE provided an
Role-play Descriptive Australia Weak
students effective context for

communication skills in pharmacy
students." American Journal of
Pharmaceutical Education 76(10): 202.
Hutchinson, S. W., et al. (2011).
"Implementing a multidisciplinary
disaster simulation for undergraduate
nursing students." Nursing Education
Perspectives 32(4): 240-243.
Huwendiek, S., et al. (2009). "Design
principles for virtual patients: a focus
group study among students." Medical
Education 43(6): 580-588.
Hwang, J. Y. (2013). "Checklist maker,
standardised patient and rater." Medical
Education 47(5): 529.
Ironside, P. M., et al. (2009). "Fostering
patient safety competencies using
multiple-patient simulation
experiences." Nursing Outlook 57(6):
332-337.
Isherwood, J., et al. (2013). "Teaching
digital rectal examination to medical
students using a structured workshop-a
point in the right direction?" Journal of
Surgical Education 70(2): 254-257.
Jabeen, D. (2013). "Use of simulated
patients for assessment of
communication skills in undergraduate
medical education in obstetrics and
gynaecology." Jcpsp, Journal of the
pharmacy students using a
virtual practice environment
(VPE) and to assess students'
and tutors' (instructors')
experiences.
To describe curriculum
enhancement activities that
led to the implementation of
a disaster simulation
To examine what students
perceive as the ideal features
of virtual patient (VP) design
in order to foster learning
with a special focus on
clinical reasoning.
To presents the results from a
program aimed at developing
checklists and utilisation of
SPs to enhance clinical
performance
To examined the impact of
multiple-patient simulation
experiences on the
development of nursing
students' patient safety
competencies in the final
semester of their
baccalaureate or associate
degree nursing program
To examine a program
teaching Digital rectal
examination (DRE)
To compare the effectiveness
of simulated patients with
real patients through
undergraduate students'
results of Mini-CEX
communication skills
development classes.
Classroom didactic content,
followed by a simulated
learning experience, was
found to be an effective
Nursing students Not stated Descriptive USA Very weak
teaching strategy for
preparing undergraduate
nursing students in disaster
preparedness.
Students perceived the
design principles identified
Medical students VPs Qualitative Germany Weak
as being conducive to their
learning.
The results showed that
students were able to learn
more about the doctor's
Medical students Role-play Descriptive South Korea Weak
responsibilities by role-
playing as patients than by
role-playing as doctors.
The findings of this study
contribute to the science of
nursing education by
providing evidence for
nursing educators related to
Nursing students Not stated Quantitative the impact of multiple- USA Weak
patient simulations on
improving and documenting
students' patient safety
competencies before their
entry into the workforce.
The overwhelming feedback
to the program is extremely
favorable and demonstrates
Task trainer, that medical students clearly
Medical students Quantitative UK Weak
OSCE benefit from a structured,
interactive, and hands-on
educational workshop in
DRE
Undergraduate students were
more in favour of using
Medical students SPs, Mini-CEX Mixed methods simulated patients encounters Pakistan Strong
for evaluation of
communication skills. There

College of Physicians & Surgeons -
Pakistan 23(1): 16-19.
Jane Cook, M. (2012). "Design and
initial evaluation of a virtual pediatric
primary care clinic in Second Life()."
Journal of the American Academy of
Nurse Practitioners 24(9): 521-527.
Jeffries, P. R., et al. (2011). "Multi-
center development and testing of a
simulation-based cardiovascular
assessment curriculum for advanced
practice nurses." Nursing Education
Perspectives 32(5): 316-322.
Jensen, R. (2013). "Clinical reasoning
during simulation: comparison of
student and faculty ratings." Nurse
Education in Practice 13(1): 23-28.
Jenson, C. E. and D. M. Forsyth (2012).
"Virtual reality simulation: using three-
dimensional technology to teach nursing
students." CIN: Computers, Informatics,
Nursing 30(6): 312-318; quiz 319-320.
Johannesson, E., et al. (2013).
"Students' experiences of learning
manual clinical skills through
simulation." Advances in Health
Sciences Education 18(1): 99-114.
encounters and their
opinions.
To present an example of an
innovative educational
strategy using a theoretical
framework for the design and
evaluation of a virtual world
simulation for family nurse
practitioner (FNP) students.
To develop, implement, and
evaluate outcomes of a
cardiovascular assessment
curriculum for advanced
practice nurses at four
institutions
To examine the Lasater
Clinical Judgment Rubric
(LCJR), when used to
evaluate nursing students'
clinical reasoning during
simulated patient care
scenarios.
To review the importance of
virtual reality simulation as a
computerized teaching
strategy.
To investigate the students'
experiences and thoughts
about their learning through
simulation skills training.
were no significant
differences between students’
performance on real and
simulated patients.
Virtual-world simulations
have the potential to provide
a safe environment for
students to practice clinical
decision making for
paediatric patients. However,
Nursing students VR Descriptive USA Very weak
attention to the context,
pedagogy, learner, and the
capabilities of the technology
is essential to provide a
quality educational
experience.
Students who received the
simulation-based training
showed statistically
significant pre-to-post-test
Nursing students Manikin; OSCE Quantitative USA Weak
improvement in cognitive
knowledge and
cardiovascular assessment
skills.
To promote more realistic
self-appraisals, students may
need more opportunities to
self-assess clinical reasoning
Nursing students SPs Quantitative behaviours in conjunction USA Weak
with feedback on
performance from faculty
throughout the nursing
program.
Innovative teaching
strategies, such as virtual
reality simulation, address
barriers of increasing patient
Nursing students VR Descriptive acuity, high student-to- USA Very weak
faculty ratio, patient safety
concerns from faculty, and
student anxiety and can offer
rapid feedback to students.
The simulator was seen as a
facilitator to learning the
manual skills. The study
design, with students
Nursing students Task trainer Qualitative Sweden Very weak
working in pairs combined
with video recording, was
found to enhance
opportunities for reflection.
 To determine the effect of
Johnson, E. A., et al. (2012). "Geriatrics expert role modelling on
in simulation: role modeling and clinical nursing students' clinical
judgment effect." Nursing Education judgment in the care of a
Perspectives 33(3): 176-180. simulated geriatric hip
fracture client.
To investigate (1) if nursing
students improved their work
Johnsson, A. C. E., et al. (2006). technique when assisting a
"Evaluation of nursing students' work SP from bed to wheelchair
technique after proficiency training in after proficiency training,
patient transfer methods during and (2) whether there was a
undergraduate education." Nurse correlation between the
Education Today 26(4): 322-331. nursing students' work
technique and the SPs’
perceptions of the transfer.
Josefyk, M. E. (2014). "High-fidelity
simulation and the nurse educator's To evaluate the students' and
perception." Dissertation Abstracts nurse educator's perceptions
International: Section B: The Sciences and satisfaction with the use
and Engineering 74(8-B(E)): No of HFS.
Pagination Specified.
To study the feasibility of a
Joud, A., et al. (2010). "Feasibility of a
new portable computer-based
computerized male urethral
male urethral catheterization
catheterization simulator." Nurse
simulator, Urecath (Melerit
Education in Practice 10(2): 70-75.
Urecath Vision).
To determine the
effectiveness of obstetrics
Jude, D. C., et al. (2006). "Simulation
simulator training for
training in the obstetrics and
medical students by
gynecology clerkship." American
comparing measures of
Journal of Obstetrics & Gynecology
confidence in normal
195(5): 1489-1492.
obstetrics skills of students
with and without training.
Junger, J., et al. (2005). "Effects of To evaluate curriculum
basic clinical skills training on objective reform in medical education
structured clinical examination in improving students'
performance." Medical Education clinical and communication
39(10): 1015-1020. skills.
Kamdar, G., et al. (2013). "Qualitative To evaluated the impact of
Findings provide support for
combining expert role
modelling with clinical
Nursing students SPs Mixed methods USA Weak
simulation to improve
students' clinical judgment in
the care of older adults.
Nursing students improved
their work technique after
training in patient transfer
Nursing students SPs Mixed methods methods, and the work Sweden Weak
technique affected the
simulated patients'
perceptions of the transfer.
Educators viewed the use of
HFS as an appropriate and
Nursing students Manikin (HPS) Quantitative USA Weak
useful tool in the education
of the nursing student
The male urethral
catheterization simulator
prototype Urecath has
advantages in its present
Registered nurses; shape but to be an alternative
Nurse assistants; Task trainer Mixed methods to existing training options Sweden Weak
Nursing students for practicing male urethral
catheterization, it should be
complemented with a tactile
mode and degrees of
difficulty
Students who practiced
deliveries on an obstetrics
Medical students Task trainer Quantitative simulator report higher levels USA Weak
of confidence in their skills
to perform vaginal deliveries
Curriculum reform
promoting communication
Skill training, and basic clinical skills are
Medical students bedside, test with Quantitative effective and lead to an Germany Strong
OSCE, MCQ improved performance in
history taking and physical
examination skills.
Junior doctors Task trainer Qualitative Just-in-time training USA Weak

evaluation of just-in-time simulation-
based learning: the learners'
perspective." Simulation in Healthcare:
The Journal of The Society for Medical
Simulation 8(1): 43-48.
Kameg, K., et al. (2010). "The impact of
high fidelity human simulation on self-
efficacy of communication skills."
Issues in Mental Health Nursing 31(5):
315-323.
Kaplan, A. G., et al. (2012).
"Genitourinary exam skills training
curriculum for medical students: a
follow-up study of comfort and skill
utilization." Journal of Endourology
26(10): 1350-1355.
Kaplan, B. and D. Ura (2010). "Use of
multiple patient simulators to enhance
prioritizing and delegating skills for
senior nursing students." Journal of
Nursing Education 49(7): 371-377.
Kaplan, B. G., et al. (2011). "Design
and implementation of an
interdisciplinary pediatric mock code
for undergraduate and graduate nursing
students." CIN: Computers, Informatics,
Nursing 29(9): 531-538.
simulation-based Just-in-time
training (JITT) on interns'
infant lumbar puncture (LP)
success rates.
To compare the effectiveness
of two educational delivery
methods, traditional lecture
and high fidelity human
simulation (HFHS)
To evaluate a genitourinary
skills training (GUST)
curriculum for incoming
third year medical students
(MS3).
To evaluate a simulation
based learning experience
that sought to increase
student confidence and
enhance student ability to
safely and effectively
prioritize, delegate, and
implement care for numerous
patients.
To discuss and evaluate an
interdisciplinary course that
used pediatric mock code
simulation.
improved procedural
confidence with infant LP,
but work place busyness and
instructor lack of support or
unawareness were barriers to
JITT performance. Optimal
LP JITT would occur with
improved contextual fidelity.
The results of this study
support the use of HFHS to
assist in enhancing
Nursing students Manikin Not stated undergraduate students' self- USA Weak
efficacy in communicating
with patients who are
experiencing mental illness.
MS3 described improved
comfort with the GU skills at
all time points during follow-
up. This was particularly
Medical students Task trainer Quantitative USA Strong
important because both MS3
and MS4 reported using their
skills infrequently during
their clinical training years.
Students reported through
Likert surveys to either
"agree" or "strongly agree"
that the SBL was well
organized (87%, n = 84),
prompted realistic
expectations (59%, n = 57),
the scenarios were believable
(73%, n = 71), case studies
increased understanding
Nursing students Manikin Quantitative (66%, n = 64), and that the USA Weak
SBL experience increased
understanding of prioritizing
and delegating care (69%, n
= 67). Seventy-eight percent
(n = 76) reported "more
confidence in ability to work
as a team" and 55% (n = 52)
reported "more confidence in
prioritizing and delegating
care."
Nursing students Manikin Descriptive The simulation was rated USA Weak
very highly for realism,
enjoyment, concept
clarification in debriefing,
increasing knowledge base,
ability to function in the

Kaplan, B. G., et al. (2012). "Use of an
emergency preparedness disaster
simulation with undergraduate nursing
students." Public Health Nursing 29(1):
44-51.
Karabilgin, O. S., et al. (2012).
"Assessing medical student competency
in communication in the pre-clinical
phase: objective structured video exam
and SP exam." Patient Education &
Counseling 87(3): 293-299.
Kardong-Edgren, S., et al. (2012).
"Findings from a nursing student CPR
study: implications for staff
development educators." Journal for
Nurses in Staff Development - JNSD
28(1): 9-15.
Kelly, L. P., et al. (2013). "Teaching
ophthalmoscopy to medical students
(the TOTeMS study)." American
Journal of Ophthalmology 156(5):
1056-1061.e1010.
Kern, D. H., et al. (2011). "Simulation-
based teaching to improve
cardiovascular exam skills performance
among third-year medical students."
Teaching & Learning in Medicine
23(1): 15-20.
Kesten, K. S. (2011). "Role-play using
SBAR technique to improve observed
communication skills in senior nursing
students." Journal of Nursing Education
50(2): 79-87.
To report of an educational
strategy to prepare nursing
students to respond to
disasters.
To present the structure,
process and results of the
objective structured video
exam and One-Station SP
exam that have been used to
assess second year medical
students' communication
skills.
To report a secondary data
analysis of a year-long study
with 606 nursing students
involving brief monthly CPR
practice with voice-activated
manikins versus no practice.
To determine medical
student preferences for
learning the ocular fundus
examination and to assess
their accuracy using different
examination modalities.
To evaluate whether the
addition of simulation offers
added benefit over training
utilising SPs only.
To evaluate data from
undergraduate nursing
students (N = 115) on their
performance using a
standardized communication
tool SBAR (Situation,
Background, Assessment,
and Recommendation).
clinical setting, and
increasing confidence in
caring for a critically ill
infant.
Effective outcome and the
intervention has been
Nursing students Not stated Descriptive USA Not applicable
incorporated into the
undergraduate curriculum.
Both exams need measures to
improve them, such as
SPs; OTHER
increasing the number of
Medical students (Video based Quantitative Turkey Strong
video cases or stations, and
exam)
further standardisation of
raters.
Findings indicate that even
with monthly practice and
accurate voice-activated
manikin feedback, some
Nursing students Task trainer Quantitative USA Strong
students could not perform
CPR correctly. Implications
of these findings for staff
educators are discussed.
Students preferred fundus
photographs for both
learning and examining the
ocular fundus. Identification
Medical students Manikin; SP Quantitative of ocular fundus features was USA Strong
more accurate on
photographs compared to
examination by direct
ophthalmoscopy.
The use of simulation in
addition to SP teaching can
Medical students SP; Manikin Quantitative improve students' USA Strong
performance of cardiac
examination skills.
Nursing students Role-play Quantitative Findings suggest role-play USA Weak
may have a place in teaching
communication skills in
nursing schools as well as
continuing education and
training in hospitals and
other health care settings.
Interdisciplinary
communication training may
 provide even more effective
learning.
Positive aspects included
client assessment in an
Kidd, L. I., et al. (2012). "Effectiveness To assess the effectiveness of
environment where mistakes
of a second life() simulation as a a Second Life (SL) virtual
were without consequence,
teaching strategy for undergraduate simulation as a teaching
Nursing students VR Descriptive working from home, and USA Weak
mental health nursing students." Journal strategy for undergraduate
novelty. Drawbacks were
of Psychosocial Nursing & Mental mental health nursing
dressing and manoeuvring
Health Services 50(7): 28-37. students.
the avatar and lack of
realism.
To evaluate The Virtual
Patient, an interactive
multimedia learning resource
Kiegaldie, D. and G. White (2006).
using a critical care clinical
"The virtual patient-Development, The article reports the
scenario for postgraduate
implementation and evaluation of an project's development, design
nursing students, was
innovative computer simulation for Nursing students VR; VPs Descriptive features, and user-evaluation Australia Not applicable
developed to enhance
postgraduate nursing students." Journal data, concluding with design
flexible access to learning
of Educational Multimedia and recommendations.
experiences and improve
Hypermedia 15(1): 31-47.
learning outcomes in the
management of critically ill
patients.
To implement a laboratory
Students' awareness of the
Kiersma, M. E., et al. (2009). session into the first-year
pharmacist's role in
"Laboratory session to improve first- pharmacy curriculum that
medication error reduction
year pharmacy students' knowledge and would provide active- Pharmacy
Role-play Descriptive improved and confidence in USA Weak
confidence concerning the prevention of learning experiences in the students
their ability to recognize,
medication errors." American Journal of recognition, resolution, and
prevent, and communicate
Pharmaceutical Education 73(6): 99. prevention of medication
medication errors increased
errors.
To evaluate the
King, A. E. A., et al. (2013).
implementation of
"Improving collaboration among Medical students; The study suggests that
simulation-based scenarios to
medical, nursing and respiratory therapy Nursing students; simulated scenarios can help
train students within nursing, Not stated Descriptive USA Weak
students through interprofessional Respiratory interprofessional
respiratory therapy and
simulation." Journal of Interprofessional therapy students collaboration.
medical fields in
Care 27(3): 269-271.
interprofessional practice
To determine whether
Kirkman, T. R. (2013). "High fidelity undergraduate nursing Transfer of learning was
simulation effectiveness in nursing students were able to transfer demonstrated and the use of
students' transfer of learning." knowledge and skills learned Nursing students Manikin (HFS) Quantitative HFS was found to be an USA Strong
International Journal of Nursing from classroom lecture and a effective learning and
Education Scholarship 10: 1-6. HFS clinical to the traditional teaching method.
clinical setting.
Kirkpatrick, J. M. (2008). "Relation of To investigate relationships This study provided support
nursing students' motivational state and between learners' for the use of the ARCS
Nursing students E-learning Descriptive USA Weak
learning effort to motivational appeal motivational state, the (Attention, Relevance,
and learning outcomes in the use of an amount of learning effort Confidence and Satisfaction)

interactive computer-based multimedia
program." Dissertation Abstracts
International Section A: Humanities and
Social Sciences 69(1-A): 190.
Kirwin, J. L., et al. (2013). "A simulated
hospital pharmacy module using an
electronic medical record in a
pharmaceutical care skills laboratory
course." American Journal of
Pharmaceutical Education 77(3): 62.
Kleinert, H. L., et al. (2007).
"Improving student dentist
competencies and perception of
difficulty in delivering care to children
with developmental disabilities using a
virtual patient module." Journal of
Dental Education 71(2): 279-286.
Kneebone, R. L., et al. (2005). "Blurring
the boundaries: scenario-based
simulation in a clinical setting." Medical
Education 39(6): 580-587.
Knobe, M., et al. (2012). "Arthroscopy
or ultrasound in undergraduate anatomy
education: a randomized cross-over
controlled trial." BMC Medical
Education 12: 85.
expended, the perceived
motivational appeal, and the
learning outcomes in a
computer-based learning
(CBL) program designed
with embedded motivational
strategies.
To implement and evaluate
the effects of a simulated
hospital pharmacy module
using an electronic medical
record on student confidence
and abilities to perform
hospital pharmacist duties.
To evaluate an interactive,
multimedia, virtual patient
module was designed and
developed on compact disc
(CD-ROM) student dentists.
To explore the potential of
locating quasi-clinical
scenarios, where inanimate
models attached to simulated
patients within a real clinical
setting, allowing participants
to experience the challenges
of the workplace while
ensuring patient safety. An
innovative portable digital
recording device (the 'Virtual
Chaperone') is evaluated for
use in clinical settings.
To investigate whether
musculoskeletal ultrasound
(MSUS) or arthroscopic
methods can increase the
anatomical knowledge
uptake.
model as a framework for the
design of motivational
strategies in a computer-
based learning program
A simulated hospital
pharmacy module improved
pharmacy students' hospital
Pharmacy practice skills and their
Not stated Quantitative USA Weak
students perceived comfort and
confidence in completing the
typical duties of a hospital
pharmacist.
This study demonstrated that
an interactive, multimedia
(CD-ROM), virtual patient
Dentist students VPs Descriptive learning module for student USA Weak
dentists is potentially an
effective tool in meeting this
need.
Scenario-based teaching
within an authentic clinical
environment is feasible and
perceived by participants to
be educationally useful. This
approach blurs traditional
Medical students SPs; Task trainers Qualitative UK Strong
boundaries between skills
laboratory teaching and
clinical practice and may
offer considerable
advantages in training for
clinical procedures.
Medical students Task trainer; Quantitative The additional Germany Strong
OSCE implementation of
arthroscopy tutorials to the
dissection course during the
undergraduate anatomy
training is profitable and
attractive to students with
respect to complex joint
anatomy. Simultaneous
teaching of basic-skills in
musculoskeletal ultrasound
should be performed by
medical experts, but seems to
be inferior to the arthroscopic
2D-3D-transformation, and is

Knudson, M. M., et al. (2008). "Trauma
training in simulation: translating skills
from SIM time to real time." Journal of
Trauma-Injury Infection & Critical Care
64(2): 255-263; discussion 263-254.
Kuiper, R., et al. (2008). "Debriefing
with the OPT model of clinical
reasoning during high fidelity patient
simulation." International Journal of
Nursing Education Scholarship 5:
Article17.
Kumalasari, C. D., et al. (2011).
"Simulation followed by a reflection
and feedback session in medical
education." International Journal of
Information and Communication
Technology Education 7(2): 46-56.
Kuznar, K. A. (2010). "Effects of high-
fidelity human patient simulation
experience on self-efficacy, motivation
and learning of first semester associate
degree nursing students." Dissertation
Abstracts International Section A:
Humanities and Social Sciences 70(7-
A): 2356.
L. Kinsman, P. B., R. Cant, R.
Champion, S. Cooper, R. Endacott, T.
McConnell, Henry, K. Missen, J. Porter
and J. Scholes (2012). "The FIRST
2ACT simulation program improves
nursing practice in a rural Australian
hospital." Australian Journal of Rural
Health 20(5): 270-274.
La Rochelle, J. S., et al. (2011).
"Authenticity of instruction and student
performance: a prospective randomised
trial." Medical Education 45(8): 807-
817.
To evaluate training of
surgical residents to manage
critically injured patients in a
timely fashion.
To describe a project that
uses a structured debriefing
activity, the Outcome Present
State-Test Model of clinical
reasoning following high
fidelity patient simulation,
To examine surgical
residents' perception of their
learning after participation in
a simulation followed by a
reflection and feedback
session.
To determine how associate
degree nursing students' self-
efficacy, motivation, and
learning in the simulated
environment compare to
nursing educational
experiences without
simulation.
To measure the impact of the
Feedback Incorporating
Review and Simulation
Techniques to Act on
Clinical Trends (FIRST 2
ACT) simulation program on
nursing observations and
practice relevant to patient
deterioration in a rural
Australian hospital.
To investigate the
relationship between the
authenticity of instructional
formats and outcome
measures within a pre-
clerkship clinical reasoning
course
regarded by students as more
difficult to learn.
A trauma curriculum
incorporating simulation
shows promise in developing
Junior doctors Manikin Quantitative USA Strong
crisis management skills that
are essential for evaluation of
critically injured patients.
The arguments for using high
fidelity patient simulation in
the current educational
environment has obvious
Nursing students Manikin (HPS) Descriptive USA Very weak
short-term benefits, however,
the long term benefit of
developing clinical expertise
remains to be discovered.
Three areas of perceived
learning were identified: (1)
dealing with complexity; (2)
Junior doctors Not stated Mixed methods USA Strong
dealing with distractions;
and, (3) improvement of
teamwork skills.
Simulation was found to be
an acceptable learning
Nursing students Manikin (HPS) Mixed methods USA Strong
strategy for novice associate
degree nursing students.
FIRST(2) ACT was
associated with measurable
Nurses Not stated Quantitative Australia Strong
improvements in nursing
practice
Medical students SPs; E-learning Quantitative Increasing the authenticity of USA Strong
instructional formats does
not appear to significantly
improve clinical reasoning
performance in a pre-
clerkship course. Medical
educators should balance
increases in authenticity with
factors such as cognitive
 load, subject area and learner
experience when designing
new instructional formats
Internship Boot Camp is a
To describe Internship Boot
Laack, T. A., et al. (2010). "A 1-week unique learning environment
Camp, an innovative course
simulated internship course helps that is recalled by
specifically designed to
prepare medical students for transition SPs; Manikin; participants as the most
prepare fourth-year medical Medical students Mixed methods USA Weak
to residency." Simulation in Healthcare: Task trainers helpful, of all components of
students for the transition
The Journal of The Society for Medical their medical school
from medical school to
Simulation 5(3): 127-132. education, in preparation for
internship.
internship.
The workshop produced a
modest gain in student
Lai, N. M., et al. (2012). "Teaching knowledge on neonatal
To assess the effectiveness of
medical students neonatal resuscitation: resuscitation at the end of
a workshop in improving
knowledge gained and retained from a their medical course. The
knowledge immediately post- Medical students Manikin Quantitative UK Weak
brief simulation-based training students' overall gain in
training and at the end of the
workshop." Education for Health 25(2): knowledge was below
year.
105-110. expectation, and evaluation
appeared to be their weakest
domain
The results suggest that the
value of extended mannequin
simulation training in the
Laiou, E., et al. (2011). "The effects of case of LMA placement is
laryngeal mask airway passage To compare the effectiveness limited. Educators
simulation training on the acquisition of in vivo of two LMA considering simulation for
Medical students Manikin Quantitative UK Strong
undergraduate clinical skills: a placement simulation courses the training of practical skills
randomised controlled trial." BMC of different durations. should reflect on the extent
Medical Education 11: 57. to which the in vitro
simulation mimics the skill
required and the degree of
difficulty of the procedure.
Meeting cognitive learning
objectives remained an
important reason for
Lang, V. J., et al. (2013). "The evolving adopting VPs, whereas
To understand needs and
role of online virtual patients in internal meeting regulatory
implementation strategies for
medicine clerkship education Medical students VPs Descriptive requirements decreased USA Weak
virtual patients for effective
nationally." Academic Medicine 88(11): significantly in importance.
curriculum planning.
1713-1718. Opportunities remain for
more systematically
integrating VPs into
clerkship curricula.
Lapkin, S. and T. Levett-Jones (2011). To conduct a cost–utility The cost analysis indicated
"A cost-utility analysis of medium vs. analysis that of medium and that to obtain equivalent
high-fidelity human patient simulation high fidelity manikins in clinical reasoning,
Nursing students Manikin Quantitative Australia Strong
manikins in nursing education." Journal nursing education. The knowledge acquisition and
of Clinical Nursing 20(23-24): 3543- analysis sought to determine student satisfaction scores, it
3552. whether the extra costs required $AU1Æ21 (US$

LaRochelle, J. S., et al. (2012). "Impact
of increased authenticity in instructional
format on preclerkship students'
performance: a two-year, prospective,
randomized study." Academic Medicine
87(10): 1341-1347.
Lasater, K. (2007). "High-fidelity
simulation and the development of
clinical judgment: students'
experiences." Journal of Nursing
Education 46(6): 269-276.
Leach, J. L. (2010). "Traditional versus
high-fidelity simulation-based learning
to teach vital sign assessment."
Dissertation Abstracts International:
Section B: The Sciences and
Engineering 70(9-B): 5433.
Lee, C. A., et al. (2011). "Standardized
patient-narrated web-based learning
associated with high-fidelity
manikins can justify the
differences, if any, in the
outcomes of clinical
reasoning, knowledge
acquisition and student
satisfaction.
To address whether
increasingly authentic
instructional formats are
more effective in improving
pre-clerkship medical
students' performance.
To examine the experiences
of students in one nursing
program's first term of using
high-fidelity simulation as
part of its regular curriculum.
To determine the differential
effect of a simulated learning
experience and traditional
instruction to improve
competency on the
assessment of vital signs
among sophomore nursing
students.
To describe an innovative
web-based SP module using
1Æ14; €0Æ85) using
medium-fidelity as compared
with $AU6Æ28 (US$6Æ17;
€4Æ40) for high-fidelity
manikins per student. Based
on the results of the cost-
utility analysis, medium-
fidelity manikins are more
cost effective requiring one-
fifth of the cost of high-
fidelity manikins to obtain
the same effect on clinical
reasoning, knowledge
acquisition and student
satisfaction.
The authors could not
demonstrate that increased
authenticity of the
instructional format resulted
in improved learner
Medical students SPs; OSCE Quantitative performance. However, they USA Strong
believe that there may be
some benefit to tailoring
preclerkship clinical
education based on students'
ability.
On the basis of these
experiences, it seems that
high-fidelity simulation has
potential to support and
Nursing students Manikin Qualitative affect the development of USA Weak
clinical judgment in nursing
students and to serve as a
value-added adjunct to their
clinical practice.
This study extends the
literature on simulation by
providing evidence for the
importance of measuring
clinical learning outcomes
and the usefulness of high
Nursing students Manikin Qualitative fidelity manikins and clinical USA Strong
scenarios to collect outcome
data on competence. This
study used a Competency
Validation Tool to measure
competence in the
assessment of vital signs.
Students who watched an
Medical students SPs; E-learning Quantitative USA Weak
optional web-based SP

modules improve students'
communication skills on a high-stakes
clinical skills examination." Journal of
General Internal Medicine 26(11):
1374-1377.
Lee, J. D., et al. (2008). "Working with
patients with alcohol problems: a
controlled trial of the impact of a rich
media web module on medical student
performance." Journal of General
Internal Medicine 23(7): 1006-1009.
Leeper, H., et al. (2007). "A student-
designed and student-led sexual-history-
taking module for second-year medical
students." Teaching & Learning in
Medicine 19(3): 293-301.
LeFlore, J. L., et al. (2012). "Can a
virtual patient trainer teach student
nurses how to save lives--teaching
nursing students about pediatric
respiratory diseases." Simulation in
Healthcare: The Journal of The Society
for Medical Simulation 7(1): 10-17.
Lefroy, J., et al. (2011). "Some like it
hot: medical student views on choosing
the emotional level of a simulation."
Medical Education 45(4): 354-361.
Lehmann, R., et al. (2013). "An
innovative blended learning approach
using virtual patients as preparation for
detailed SP and faculty
commentary to teach
communication skills.
To assess the impact on
performance with an SP vs.
traditional lecture.
To describe a sexual-history-
taking module that was
initiated, designed, and
presented by 2nd-year
medical students for their
peers as part of the required
Introduction to Clinical
Medicine (ICM) course.
To compare the achievement
of learning outcomes of
undergraduate nursing
students when a virtual
patient trainer or a traditional
lecture was used to teach
paediatric respiratory
content.
To determine the impact of
giving junior medical
students control over the
level of emotion expressed
by a simulated patient (SP) in
a teaching session designed
to prepare students to handle
emotions when interviewing
real patients on placements.
To investigate how students
and tutors perceive a blended
learning approach using
module prior to the CPX
performed higher than those
who did not on
communication skills. The
web-based module appears to
be an effective CPX
preparatory activity to
enhance communication
performance.
A web module for alcohol
use interview skills reached a
greater proportion of
voluntary learners and was
Medical students SPs; E-learning Quantitative associated with equivalent USA Weak
overall performance scores
and higher brief intervention
skills scores on a SP
encounter.
Medical students can
successfully create and
implement a curriculum
Medical students Role-play Descriptive USA Weak
module for their peers in a
sensitive area such as sexual
history taking.
Although the virtual patient
trainer experience produced
statistically better outcomes,
the differences may not be
clinically significant. The
results suggest that a virtual
Nursing students VR Quantitative USA Strong
patient trainer may be an
effective substitute for the
achievement of learning
outcomes that are typically
met using a traditional
lecture format.
The emotional level control
was a useful innovation for
most students and may
Medical students SPs Qualitative UK Weak
potentially be used in any
first encounter with
challenging simulation.
The overall acceptance of the
Medical students VPs Mixed methods blended learning approach Germany Strong
was high among students and

skills laboratory training: perceptions of
students and tutors." BMC Medical
Education 13: 23.
Leonard, B., et al. (2010). "Nursing
student perceptions of intraprofessional
team education using high-fidelity
simulation." Journal of Nursing
Education 49(11): 628-631.
Levett-Jones, T., et al. (2011).
"Examining the impact of high and
medium fidelity simulation experiences
on nursing students' knowledge
acquisition." Nurse Education in
Practice 11(6): 380-383.
Levett-Jones, T., et al. (2011). "The
development and psychometric testing
of the Satisfaction with Simulation
Experience Scale." Nurse Education
Today 31(7): 705-710.
Lewis, R. A. (2010). "The effect of
virtual clinical gaming simulations on
student learning outcomes in medical-
surgical nursing education courses."
Dissertation Abstracts International:
Section B: The Sciences and
Engineering 71(2-B): 924.
Liachopoulou, A. P., et al. (2008).
virtual patients (VPs) as
preparation for skills
training.
To evaluate an
intraprofessional team
learning program that used
clinical simulation scenarios.
To measure and compare
knowledge acquisition in
nursing students exposed to
medium or high fidelity
human patient simulation
manikins.
To report the development
and psychometric testing of
the Satisfaction with
Simulation Experience Scale,
an instrument designed to
measure and compare
differences in satisfaction
levels between nursing
students exposed to medium
and high fidelity human
patient simulation manikins.
To determine what the
effects of virtual clinical
simulation instruction were
on the learning outcomes of
students in higher education
medical-surgical nursing
education courses.
To evaluate the change in
tutors. VPs proved to be a
convenient cognitive
preparation tool for skills
training.
Intraprofessional educational
experiences provide rich
learning opportunities for
both third-year and fourth-
Nursing students Manikin Quantitative year nursing students. In Canada Weak
addition, simulation provides
a context within which to
support intraprofessional
nursing student education.
The results of this study raise
questions about the value of
investing in expensive
simulation modalities when
the increased costs associated
with high fidelity manikins
may not be justified by a
Nursing students Manikin Quantitative Australia Strong
concomitant increase
learning outcomes. This
study also suggests that
multiple-choice questions
may not be the most
appropriate measure of
simulation effectiveness.
The results of this study
indicate that simulation is
highly valued by students,
irrespective of the level of
fidelity. This raises questions
Nursing students Manikin Mixed methods about the value of investing Australia Strong
in expensive simulation
modalities. The Satisfaction
with Simulation Experience
Scale was reliable and valid
for this cohort.
Findings revealed that
students who received virtual
clinical simulation
instruction significantly
demonstrated (p = .000) for
Nursing students VR Quantitative USA Strong
medical-surgical content
mastery and 100% of
students’ demonstrated
positive growth (p = .000) in
perceived competency.
Nurses; Nursing Task trainer Quantitative Educational courses and Greece Strong

"Nurses' training and confidence on
deep venous catheterization."
Technology & Health Care 16(3): 159-
169.
Liaw, S. Y., et al. (2012). "Recognizing,
responding to and reporting patient
deterioration: transferring simulation
learning to patient care settings."
Resuscitation 83(3): 395-398.
Liaw, S., et al. (2010). "Developing
clinical competency in crisis event
management: An integrated simulation
problem-based learning activity."
Advances in Health Sciences Education
15(3): 403-413.
Lie, D., et al. (2010). "Longitudinal
development of medical students'
communication skills in interpreted
encounters." Education for Health:
Change in Learning & Practice 23(3): 1-
12.
Lin, J. Y., et al. (2009). "Training
medical students in bag-valve-mask
technique as an alternative to
mechanical ventilation in a disaster
surge setting." Prehospital & Disaster
Medicine 24(5): 402-406.
Linden, L. L. (2008). "The effect of
clinical simulation and traditional
teaching versus traditional teaching
alone on critical thinking of nursing
students." Dissertation Abstracts
International: Section B: The Sciences
self-confidence of one team
of students who were trained
with a simulator on deep
venous catheterization and
the correlation of their self-
confidence with their
performance recorded by the
simulator.
To explore nursing students'
experiences of how a
simulation program has
prepared them to transfer
their performance to clinical
practice, in their encounters
with deteriorating patients in
ward.
To evaluate the integration of
a simulation based learning
activity on nursing students'
clinical crisis management
performance in a problem-
based learning (PBL)
curriculum.
To describe longitudinal skill
development of medical
students for the interpreted
encounter.
To evaluate the rapid training
of medical students and their
ability to provide effective
manual ventilation using the
bag-valve-mask technique.
To compare the effect of
clinical simulation in
addition to traditional
teaching versus traditional
teaching methodologies
alone on the cognitive
simulators are useful
educational tools that are
likely to shorten but in no
case can efface the early
students
phase of the learning curve in
clinical setting, substituting
the clinical training of
inexperienced users.
The findings provide an
understanding of how a
simulation program may
impact on the nursing
students' performances in
Nursing students SPs Qualitative clinical practice, which is Singapore Strong
useful information for future
improvement of programs to
optimise learning and
transfer effective care to
patient care settings.
Incorporation of simulation
learning activities into
problem-based discussion
appeared to be an effective
Nursing students SPs Descriptive Singapore Weak
educational strategy for
teaching nursing students to
assess and manage crisis
events.
Over time students showed a
pattern of overrating their
own skills compared with
trained observers. Faculty
Medical students SPs Quantitative who teach students should USA Strong
focus on specific behaviours
that are most likely to decay
without reinforcement and
practice.
Medical students can be
rapidly trained and be
utilized as a potential
resource to carry out the
Medical students Not stated Descriptive USA Weak
potentially lifesaving task of
manual ventilation using the
BVM technique in a disaster
situation
Demonstration of the
effectiveness of clinical
simulation transforms the
Nursing students Not stated Quantitative USA Strong
signature pedagogy of
nursing education from the
two-step process of theory

and Engineering 69(6-B): 3513.
Lindquist, L. A., et al. (2008).
"Teaching medication reconciliation
through simulation: a patient safety
initiative for second year medical
students." Journal of General Internal
Medicine 23(7): 998-1001.
Linssen, T., et al. (2007). "Simulating
the longitudinal doctor-patient
relationship: Experiences of simulated
patients in successive consultations."
Medical Education 41(9): 873-878.
Littlewood, K. E., et al. (2013). "High-
fidelity simulation is superior to case-
based discussion in teaching the
management of shock." Medical
Teacher 35(3): e1003-1010.
Liu, L., et al. (2010). "Tracheal
intubation of a difficult airway using
Airway Scope, Airtraq, and Macintosh
laryngoscope: a comparative manikin
study of inexperienced personnel."
Anesthesia & Analgesia 110(4): 1049-
1055.
Lofaso, D. P., et al. (2011). "Design and
effectiveness of a required pre-clinical
simulation-based curriculum for
fundamental clinical skills and
procedures." Medical Education Online
16.
Loukas, C., et al. (2010). "A virtual
reality simulation curriculum for
intravenous cannulation training."
aspects of critical thinking of
nursing students during their
first clinical course.
To discuss the design and
implementation of an
interactive learning exercise
to teach second year medical
students about medication
reconciliation
To explore the experiences of
SPs in a new, longitudinal SP
program in which SPs met
the same Year 3 students
('GP') in 4 consecutive
consultations during the year.
To compare the effectiveness
of high-fidelity medical
simulation with Case-based
discussion (CBD) in an
undergraduate medical
curriculum for shock.
To evaluate ease of use of the
Airway Scope (AWS)
(Pentax-AWS, Hoya Corp.,
Tokyo, Japan) and the
Airtraq (ATQ) (Prodol,
Vizcaya, Spain) compared
with the Macintosh
laryngoscope (ML) by
inexperienced personnel in a
simulated manikin difficult
airway.
To evaluate the replacement
its traditional Introduction in
to Clinical Medicine (ICM)
course with the Science and
Practice of Medicine (SPM)
course.
To evaluate the learning
curves of novice and
intermediate users during a
and clinical learning to
theory, simulation and
clinical application
The Medication
Reconciliation Simulation is
the first to specifically target
medication reconciliation as
a curriculum topic for
Medical students Not stated Descriptive medical students. Students USA Very weak
praised the entertaining
simulation and felt it
provided a very meaningful
experience on the patient
safety topic.
Longitudinal feedback is
now possible; it may be of
higher quality and of benefit
Medical students SPs Qualitative to SPs as well. These Netherlands Strong
findings suggest new
possibilities for SP-based
education and research.
Better understanding of
Medical students Manikin Quantitative shock following simulation USA Strong
than after CBD was found.
Both the AWS and ATQ may
be suitable devices for
difficult intubation by
Medical students Manikin Quantitative Japan Weak
inexperienced personnel in
this manikin simulated
scenario
The CSL design is not to
replace real clinical patient
experiences. It's to provide
early exposure, medial
Medical students Task trainers Quantitative USA Weak
knowledge, professionalism
and opportunity to practice
skills in a patient free
environment.
Medical students Significant learning curves
and recent VR Quantitative for novice and intermediate Greece Weak
graduates students were demonstrated

Academic Emergency Medicine 17(10):
1142-1145.
Lucisano, K. E. (2013). "Use of human
patient simulation to teach difficult
airway management and improve
patient safety in the nurse anesthesia
student." Dissertation Abstracts
International Section A: Humanities and
Social Sciences 74(1-A(E)): No
Pagination Specified.
Luctkar-Flude, M., et al. (2012).
"Evaluating high-fidelity human
simulators and standardized patients in
an undergraduate nursing health
assessment course." Nurse Education
Today 32(4): 448-452.
Lumley, S. (2013). "An hour on call:
Simulation for medical students."
Medical Education 47(11): 1125.
MacDowall, J. (2006). "The assessment
and treatment of the acutely ill patient--
the role of the patient simulator as a
teaching tool in the undergraduate
programme." Medical Teacher 28(4):
326-329.
MacLaren, J. E., et al. (2008). "Training
nursing students in evidence-based
techniques for cognitive-behavioral
pediatric pain management." Journal of
Nursing Education 47(8): 351-358.
VR simulation-based
curriculum for intravenous
(IV) cannulation.
To determine if scenario-
based training (SB) was more
effective than task-based
(TB) training in teaching a
difficult airway algorithm to
nurse anaesthesia student
To evaluate three
experiential modalities for
practicing health assessment
skills: high-fidelity human
simulators (HFS), SPs (SP)
and community volunteers
(CV)
To describe the 'hour on call'
simulation program where
medical students are given a
hands-on experience on
being a junior doctor.
To evaluate a protocol for the
assessment and treatment of
the acutely ill patient in a
reproducible and controlled
environment.
To evaluate the effects of a
didactic training program for
nursing students involving
developmentally appropriate
strategies for cognitive-
behavioural pain
management in children.
after following the VR
simulation-based curriculum.
Competencies acquired
during this educational
course may provide an
important advantage for
training prior to actual
clinical practice.
Mixed evidence showed that
scenario-based training may
offer specific advantages,
including improved didactic
knowledge and compliance
Nursing students Manikin Quantitative with a complex algorithm USA Strong
compared to task-based
training, in teaching
management of the patient
with a difficult airway to
novice anaesthesia providers.
Significantly lower
satisfaction with HFS may
reflect learners' perceived
Nursing students Manikin; SPs Quantitative lack of realism. However, Canada Weak
HFS may provide a low-
stress opportunity for novice
learners to practice skills
The 'hour on call' simulation
addresses this problem by
providing students with
realistic on-call scenarios,
Medical students SPs Descriptive allowing them to practice this UK Not applicable
full skill set and build
confidence in their decision
making in a safe
environment.
The SimMan allows students
to gain knowledge and skills
in a vital area of clinical
Medical students Manikin Mixed methods UK Weak
practice, which had been
poorly covered within the
curriculum.
These results suggest that a
brief training program in
cognitive-behavioural pain
management can improve
Nursing students Role-play Qualitative USA Weak
nursing students' knowledge
of cognitive-behavioural pain
management strategies and
ability to implement them.

Maloney, S., et al. (2013). "The effect
of student self-video of performance on
clinical skill competency: a randomised
controlled trial." Advances in Health
Sciences Education 18(1): 81-89.
Marken, P. A., et al. (2010). "Human
simulators and standardized patients to
teach difficult conversations to
interprofessional health care teams."
American Journal of Pharmaceutical
Education 74(7): 120.
Marriott, J. (2007). "Use and evaluation
of "virtual" patients for assessment of
clinical pharmacy undergraduates."
Pharmacy Education: An International
Journal of Pharmaceutical Education
7(4): 341-349.
Marriott, J., et al. (2012). "The
Pharmville community: a curriculum
resource platform integrating context
and theory." American Journal of
Pharmaceutical Education 76(9): 178.
Marshall, S. D., et al. (2012).
"Telephone referral education, and
evidence of retention and transfer after
six-months." BMC Medical Education
12: 38.
Marshall, S., et al. (2009). "The
teaching of a structured tool improves
the clarity and content of
interprofessional clinical
communication." Quality & Safety in
Health Care 18(2): 137-140.
To examine the impact of
student self-video on the
attainment of clinical skills.
To design and implement a
demonstration project to
teach interprofessional teams
how to recognize and engage
in difficult conversations
with patients.
To evaluate an assessment
task, where pharmacy
students choose their own
individual "virtual" patient
using a purpose-designed
computer program and
respond to a clinical
scenario.
To develop and implement a
resource platform consisting
of a fictional community of
people to augment learning
in an undergraduate
pharmacy program and to
refine patient contact skills.
To determine the longer-term
effectiveness of an education
session employing a
structured method to teach
referral-making skills to
medical students.
To determine if the teaching
of a communication tool,
ISBAR (Identify, Situation,
Background, Assessment,
Recommendation), a
modification of SBAR
(Situation, Background,
Assessment,
Recommendation), improved
the content and clarity of a
The results of this study
demonstrate that greater
clinical skill competency is
Physiotherapy achieved when traditional
Self-video Quantitative Australia Strong
students tutoring methods are
supplemented with student
self-video of performance
tasks.
Simulation is an effective
Pharmacy
technique to teach
students; Nursing
SPs; Manikin Qualitative interprofessional teams how USA Weak
students; Junior
to engage in difficult
doctors
conversations with patients.
Students reported that the
assignment was relevant to
Pharmacy
VPs Descriptive the subject and the Australia Very weak
students
assessment improved their
learning.
Pharmville is an instructional
resource that links
Pharmacy
VPs Descriptive professionalism and Australia Very weak
students
academic study, and provides
context for student learning.
A brief education session
improved telephone
communication in a
simulated environment above
baseline for over six months,
Medical students Manikin Quantitative achieved functional retention Australia Strong
of the acronym over a seven
to eight month period and
resulted in self-reports of
transfer of the learning into
practice.
The teaching of a structured
method of communication
improved the communication
during telephone referral in a
simulated clinical setting.
Medical students Manikin Quantitative Australia Strong
This research has
implications for how
healthcare professionals are
taught to communicate with
each other.

Massias, L. A. (2010). "Influencing
critical thinking in nursing education:
Comparing high-fidelity simulations
and traditional clinical training."
Dissertation Abstracts International:
Section B: The Sciences and
Engineering 70(8-B): 4764.
Mathews, J. L., et al. (2011). "Role-
reversal exercise with Deaf Strong
Hospital to teach communication
competency and cultural awareness."
American Journal of Pharmaceutical
Education 75(3): 53.
Mavis, B., et al. (2006). "Faculty,
students, and actors as standardized
patients: expanding opportunities for
performance assessment." Teaching &
Learning in Medicine 18(2): 130-136.
McCallum, J., et al. (2011). "Exploring
nursing students' decision-making skills
whilst in a Second Life clinical
simulation laboratory." Nurse Education
Today 31(7): 699-704.
telephone referral in an
immersive simulated clinical
scenario conducted in real
time.
To compare the effectiveness
of a simulated hospital
experience and a traditional
hospital experience on the
critical thinking skills of
second year nursing students
enrolled in the Maternal-
Child course of a pre-
licensure associate-degree
program.
To implement a role-reversal
exercise to increase first-year
pharmacy students'
awareness of communication
barriers in the health care
setting, especially for deaf
and hard-of-hearing patients
To evaluate the expanded
preclinical formative
assessments, our medical
school has implemented
additional simulated
encounters using faculty
members and students in
addition to actors to portray
SPs (SP). This report focuses
on the implementation of this
strategy.
To explore nursing students'
decision-making skills
through the use of a 3D
virtual environment such as
Second Life.
Implications for nursing
education and the nursing
profession include expanded
use of simulations in nursing
Nursing students Manikin Quantitative curriculum and a cautious USA Weak
increase in the number of
hours that can be used as a
substitution for clinical
experience.
The role-reversal exercise
was an effective method of
teaching students that the
Pharmacy delivery of health care is
Role-play Descriptive USA Weak
students dependent on adequate
communication between
health care providers and the
patient.
Students and faculty
benefited from their SP
experience. A combination of
SP types can provide a broad
range of cost-effective
preclinical learning
experiences. Students,
Medical students SPs Descriptive faculty, and actors as SPs USA Strong
each have specific strengths
and weaknesses related to
cost, training needs, feedback
quality, and simulation
fidelity. The goals of the
encounter should guide the
choice of SP type.
Further work is required for
students to practice decision-
making skills. With further
Nursing students VR Qualitative development the innovative UK Very weak
3D virtual worlds such as
Second Life could provide
this experience.

McConville, S. A. and A. M. Lane
(2006). "Using on-line video clips to
enhance self-efficacy toward dealing
with difficult situations among nursing
students." Nurse Education Today
26(3): 200-208.
McCoy, C. E., et al. (2011).
"Prospective randomized crossover
study of simulation vs. didactics for
teaching medical students the
assessment and management of
critically ill patients." Journal of
Emergency Medicine 40(4): 448-455.
McEvoy, M., et al. (2012). "Teaching
professionalism through virtual means."
The clinical teacher 9(1): 32-36.
McGlynn, M. C., et al. (2012). "How
we equip undergraduates with
prioritisation skills using simulated
teaching scenarios." Medical Teacher
34(7): 526-529.
McGovern, M. M., et al. (2006). "Use
of standardized patients in,
undergraduate medical genetics
education." Teaching & Learning in
Medicine 18(3): 203-207.
McIlvried, D. E., et al. (2008). "The use
of role-play to enhance medical student
understanding of genetic counseling."
Genetics in Medicine 10(10): 739-744.
To evaluate the effectiveness
of video clip materials that
showed examples of nurses
dealing with potentially
difficult and delicate patient
groups for enhancing nursing
student's self-efficacy to
effectively communicate
with the above-mentioned
patient groups.
To compare SIM-based
training to traditional
didactic lecture (LEC) for
teaching medical students to
assess and manage critically
ill patients with myocardial
infarction (MI) and
anaphylaxis
To evaluate students'
perceived effectiveness of an
online interactive virtual
patient developed to augment
a personal professional
development curriculum, and
to identify factors that would
maximise the associated
educational benefits
To equip undergraduates
about to become Foundation
year one doctors with the
prioritisation skills.
To study the effectiveness of
a SP program in increasing
the competence of medical
students in assessing genetic
risks and communicating
genetic information to
patients.
To discuss a project that
sought to enhance
understanding of genetic
counselling.
Using video clips that show
students effectively coping
with adverse situations
Nursing students VPs; E-learning Quantitative UK Strong
provide an effective teaching
approach for enhancing self-
efficacy.
SIM training is superior to
didactic lecture for teaching
fourth-year medical students
Medical students Manikin Quantitative USA Strong
to assess and manage
simulated critically ill MI
and anaphylaxis patients.
It is possible to improve
approaches to teaching and
learning professionalism by
Health exploring students' views on
professional VPs Qualitative innovative teaching Ireland Weak
students developments designed to
augment personal
professional development
curricula.
Simulated teaching is a
relatively easy yet effective
way to teach prioritisation
Medical students Role-play Descriptive and other skills. The authors UK Weak
believe that their methods
could be adapted for other
teaching groups or material.
The use of SPs in
undergraduate medical
genetics education may be
Medical students SPs Descriptive one means for increasing the USA Weak
confidence of medical
students in skills that are
related to genetic encounters.
Medical students Role-play Quantitative The project proved overall USA Weak
valuable in improving
medical student
understanding of genetic
counselling and may be
applied to a variety of
medical education settings to

Meechan, R., et al. (2011). "Do
medicines OSCEs improve drug
administration ability?" British Journal
of Nursing 20(13): 817-822.
Mehta, N., Boynton, C., Boss, L.,
Morris, H., & Tatla, T. (2013).
Multidisciplinary difficult airway
simulation training: two year evaluation
and validation of a novel training
approach at a District General Hospital
based in the UK. [Validation Studies].
European Archives of Oto-Rhino-
Laryngology, 270(1), 211-217. doi:
http://dx.doi.org/10.1007/s00405-012-
2131-3
Meier, A. H., Boehler, M. L.,
McDowell, C. M., Schwind, C.,
Markwell, S., Roberts, N. K., & Sanfey,
H. (2012). A surgical simulation
curriculum for senior medical students
based on TeamSTEPPS. [Research
Support, Non-U.S. Gov't]. Archives of
Surgery, 147(8), 761-766. doi:
http://dx.doi.org/10.1001/archsurg.2012
.1340
Meyer, M. N., Connors, H., Hou, Q., &
Gajewski, B. (2011). The effect of
simulation on clinical performance: a
junior nursing student clinical
comparison study. [Comparative Study
Multicenter Study
Research Support, Non-U.S. Gov't].
Simulation in Healthcare: The Journal
of The Society for Medical Simulation,
6(5), 269-277. doi:
http://dx.doi.org/10.1097/SIH.0b013e31
To examine the efficacy of
the early introduction of a
medicines management
'objective structured clinical
examination' (OSCE) into an
undergraduate adult nursing
students' programme of
education and to determine if
the acquisition of applied
drug/pharmacology
knowledge and drug
administration of medicines
had improved prior to
qualification.
To devise and assess a
multidisciplinary simulated
course in training junior
doctors for possible difficult
airway scenarios.
To investigate whether the
existing Team Strategies and
Tools to Enhance
Performance and Patient
Safety (TeamSTEPPS)
curriculum can effectively
teach senior medical students
team skills.
To evaluate the effects of a
theory-driven paediatric
simulation curriculum on
nursing students' clinical
performance.
improve patient care.
The authors of this study
conclude that early
introduction of clinical
examinations, namely
OSCEs with an integrated
Nursing students OSCE Quantitative approach to pharmacology UK Weak
and medicines management
teaching, does facilitate and
improve students drug
administration and applied
pharmacology ability.
Participants felt an
improvement in clinical
knowledge, teamwork,
leadership and non-technical
skills, as well as the mutual
understanding and respect
Junior doctors Manikin Quantitative between related medical and UK Weak
non-medical team members.
In addition, audit of airway
mortality showed a reduction
in inpatient airway related
mortality following the
course.
Self-evaluation scores
improved and the increase
was significant for all of the
TeamSTEPPS competencies
and highest for leadership
Role-play;
Medical students Quantitative skills. The curriculum led to USA Weak
Manikin
improved self-evaluation and
multiple-choice scores as
well as improved team skills
during simulated immersive
patient encounters.
Nursing students Not stated Quantitative Faculty rated students with USA Strong
patient simulation experience
higher than those who had
not yet attended simulation.
On item-level analysis,
therapeutic skills were
positively impacted by
simulation. Students who had
time in simulation achieved
higher scores more quickly
than those without simulation

8223a048
Mikkelsen, J., Reime, M. H., & Harris,
A. K. (2008). Nursing students' learning
of managing cross-infections--scenario-
based simulation training versus study
groups. [Comparative Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't].
Nurse Education Today, 28(6), 664-
671. doi:
http://dx.doi.org/10.1016/j.nedt.2007.11
.003
Mittal, M. K., Morris, J. B., & Kelz, R.
R. (2011). Germ simulation: a novel
approach for raising medical students
awareness toward asepsis. [Comparative
Study
Research Support, Non-U.S. Gov't].
Simulation in Healthcare: The Journal
of The Society for Medical Simulation,
6(2), 65-70. doi:
http://dx.doi.org/10.1097/SIH.0b013e31
8206953a
Mollo, E. A., Reinke, C. E., Nelson, C.,
Holena, D. N., Kann, B., Williams, N., .
. . Kelz, R. R. (2012). The simulated
ward: ideal for training clinical clerks in
an era of patient safety. Journal of
Surgical Research, 177(1), e1-6. doi:
http://dx.doi.org/10.1016/j.jss.2012.03.0
50
Moreno-Ger, P., Torrente, J.,
Bustamante, J., Fernandez-Galaz, C.,
Fernandez-Manjon, B., & Comas-
Rengifo, M. D. (2010). Application of a
low-cost web-based simulation to
improve students' practical skills in
medical education. [Comparative Study
Research Support, Non-U.S. Gov't].
International Journal of Medical
Informatics, 79(6), 459-467. doi:
http://dx.doi.org/10.1016/j.ijmedinf.201
0.01.017
To determine the most
efficient teaching strategies
for managing cross-
infections and determining
the teachers’ role by
comparing three different
teaching methods; scenario-
based study groups with and
without teacher and
simulation training.
To test the hypothesis that
students would demonstrate
proficiency comparable to
surgery residents after
training with germ
simulation, which was
developed for teaching hand
hygiene principles and
aseptic technique in urinary
catheterization (UC).
To investigate feasibility of
and clinical clerk opinions
regarding a novel simulated
floor management course to
teach patient care concepts
required on the surgical
wards.
To investigate the
employment of low-cost
simulation (practical
exercises through a web-
based e-learning
environment) and study the
effects of such a simulation
in terms of impact on the
laboratory session, learning
outcomes and student
satisfaction.
and maintained high
performance levels.
The findings indicated that
scenario-based simulation
training made the students
more aware of how complex
Nursing students Manikin Qualitative Norway Strong
each scenario was. Events
occurred that they had not
expected, and this lead to a
better recollection of details.
Students reported a
heightened awareness of the
Medical students Not stated Quantitative importance of hand hygiene USA Weak
and aseptic precautions
during UC.
Most clinical clerks thought
that the simulated floor
management course
Medical students Manikin Quantitative improved their understanding USA Weak
of medical management of
surgical issues and their
documentation skills.
Medical students E-learning Quantitative The simulation was well Spain Strong
environment received by students in the
experimental group (EG),
who felt more comfortable
during the laboratory session,
and it helped them to
perform the exercise better,
obtaining more accurate
results, which indicates more
effective training. EG
students perceived the
procedure as easier to
perform, but did not report an
improvement in the
perceived difficulty in using
the equipment. The increased
reliability demonstrates that
low-cost simulations are a

Morgan, P. J., Cleave-Hogg, D.,
Desousa, S., & Lam-McCulloch, J.
(2006). Applying theory to practice in
undergraduate education using high
fidelity simulation. [Evaluation
Studies]. Medical Teacher, 28(1), e10-
15.
Morrison, A. M., & Catanzaro, A. M.
(2010). High-fidelity simulation and
emergency preparedness. [Evaluation
Studies
Research Support, Non-U.S. Gov't].
Public Health Nursing, 27(2), 164-173.
doi: http://dx.doi.org/10.1111/j.1525-
1446.2010.00838.x
Mortsiefer, A., Rotthoff, T., Schmelzer,
R., Immecke, J., Ortmanns, B., in der
Schmitten, J., . . . Karger, A. (2012).
Implementation of the interdisciplinary
curriculum Teaching and Assessing
Communicative Competence in the
good complement to the
laboratory sessions.
There was a statistically
significant improvement in
performance on the
pharmacology written test.
Simulation team performance
also statistically improved
To determine if experiential and a good correlation
education using high-fidelity between checklist and global
simulation improves rating scores were
Medical students Manikin Quantitative Canada Strong
undergraduate performance demonstrated in all but one
scores on simulation-based scenario. Student evaluation
and written examinations. of the experience was
extremely positive. High-
fidelity simulation can be
used to allow students to
apply theoretical knowledge
to practice in a safe and
realistic environment.
The students' quantitative
evaluation of the experience
indicated that 90.36%
thought the purpose of the
experience was clear, 91.5%
thought the importance of
delivering safe care during a
public health emergency was
stressed, and 79.5% thought
To describe a public health the pre-simulation briefing
emergency simulation and post-simulation
exercise with undergraduate debriefing helped them
Nursing students Not stated Mixed methods USA Weak
senior nursing students understand and participate in
enrolled in a public health the drill. Qualitatively, the
clinical course. students' reflections of the
exercise indicated that
although they initially felt
overwhelmed and anxious,
they realised the importance
of participating in emergency
preparedness and recognised
their ability to apply nursing
skills learned in previous
courses.
To describe the development Introducing interdisciplinary
of the CoMeD project communication training and
(communication in medical a corresponding OSCE into
Medical students SPs Quantitative Germany Very weak
education Düsseldorf) project the 4th year medical
and report results of its curriculum is feasible.
evaluation by medical Embedding communication

fourth academic year of medical studies
(CoMeD). [Research Support, Non-U.S.
Gov't]. GMS Zeitschrift Fur
Medizinische Ausbildung, 29(1),
Doc06. doi:
http://dx.doi.org/10.3205/zma000776
Mould, J., White, H., & Gallagher, R.
(2011). Evaluation of a critical care
simulation series for undergraduate
nursing students. [Clinical Trial].
Contemporary Nurse, 38(1-2), 180-190.
doi:
http://dx.doi.org/10.5172/conu.2011.38.
1-2.180
Moule, P., Wilford, A., Sales, R., &
Lockyer, L. (2008). Student experiences
and mentor views of the use of
simulation for learning. [Evaluation
Studies]. Nurse Education Today, 28(7),
790-797. doi:
http://dx.doi.org/10.1016/j.nedt.2008.03
.007
Moulton, C.-a., Tabak, D., Kneebone,
R., Nestel, D., MacRae, H., & LeBlanc,
V. R. (2009). Teaching communication
skills using the integrated procedural
performance instrument (IPPI): a
randomized controlled trial.
[Randomized Controlled Trial
Research Support, Non-U.S. Gov't].
American Journal of Surgery, 197(1),
113-118. doi:
http://dx.doi.org/10.1016/j.amjsurg.200
8.09.006
Mounsey, A. L., Bovbjerg, V., White,
L., & Gazewood, J. (2006). Do students
develop better motivational
interviewing skills through role-play
with standardised patients or with
student colleagues? [Randomized
Controlled Trial
Research Support, U.S. Gov't, P.H.S.].
Medical Education, 40(8), 775-780.
teaching in a clinical context
and involvement of
clinicians, as lecturers seem
to be important factors for
students.
ensuring practical relevance
and achieving high
acceptance by medical
students.
Multiple scenario simulations
are effective in improving
To assess self-reported
Manikin; SPs: BN students' confidence and
confidence and competence
Nursing students OTHER Not stated competence related to critical Australia/WA Very weak
using scenario-based
(Moulage) care practice and is an
simulations.
enjoyable experience for
students.
Both students and mentors
Phase 1 investigated whether
positively received
simulation could support the
simulation, as it was apparent
development of a range of
that it offered scope for
clinical skills amongst pre-
interdisciplinary learning that
registration adult and
could be broadened to inter-
children’s nursing students.
Nursing students Not stated Mixed methods professional applications. UK Strong
The second phase of the
The study also identified that
study gathered mentors’
the use of simulation could
views and experiences of the
provide scope for
use of simulation in the
collaborative working
preparation of students for
between education providers
practice.
and clinical staff.
The experimental group
performed significantly
To assess the effectiveness of
better on the communication
using Integrated Procedural
scores following feedback
Performance Instrument
Medical students SPs Hybrid Quantitative compared with the control Canada Very strong
(IPPI) format as a teaching
group. No differences in
tool for communication
scores for technical skills
skills.
post-intervention were
demonstrated.
To determine whether using
standardised patients to teach
There was no significant
motivational interviewing (in
difference between the
smoking cessation
Medical students SPs; Role-play Quantitative control and intervention USA Very strong
counselling) to Year 3
groups in the final analyses
medical students would be
of the interviews.
more effective than using
student role-plays.

Myden, C. A., Anglin, C., Kopp, G. D.,
& Hutchison, C. R. (2012). Computer-
assisted surgery simulations and
directed practice of total knee
arthroplasty: educational benefits to the
trainee. [Research Support, Non-U.S.
Gov't]. Computer Aided Surgery, 17(3),
113-127. doi:
http://dx.doi.org/10.3109/10929088.201
2.671365
Naeve-Velguth, S., Christensen, S. A.,
& Woods, S. (2013). Simulated patients
in audiology education: student reports.
[Comparative Study]. Journal of the
American Academy of Audiology,
24(8), 740-746. doi:
http://dx.doi.org/10.3766/jaaa.24.8.10
Nau, J., Halfens, R., Needham, I., &
Dassen, T. (2010). Student nurses' de-
escalation of patient aggression: a
pretest-posttest intervention study.
[Evaluation Studies]. International
Journal of Nursing Studies, 47(6), 699-
708. doi:
http://dx.doi.org/10.1016/j.ijnurstu.2009
.11.011
Naylor, R. A., Hollett, L. A., Valentine,
R. J., Mitchell, I. C., Bowling, M. W.,
Ma, A. M., . . . Scott, D. J. (2009). Can
medical students achieve skills
proficiency through simulation training?
American Journal of Surgery, 198(2),
277-282. doi:
http://dx.doi.org/10.1016/j.amjsurg.200
8.11.036
Nesbitt, J. C., St Julien, J., Absi, T. S.,
Ahmad, R. M., Grogan, E. L., Balaguer,
J. M., . . . Putnam, J. B. (2013). Tissue-
To compared the following
surgical skill courses: a
conventional tibiofemoral
total knee arthroplasty
(TKA) station, two different
tibiofemoral computer-
assisted surgery (CAS)
stations, and a CAS and
conventional patellar
resection station.
To survey audiology students
who had completed a
simulated patient counselling
experience as part of their
graduate coursework at
Central Michigan University,
to learn about their
experiences and views of this
instructional format.
To examine the influence of
an aggression management
training program for nursing
students on their
performance in de-escalating
aggressive patients.
To determine whether third-
year medical students can
become proficient in open
technical skills through
simulation laboratory
training.
To assess the impact of
dedicated instruction and
deliberate practice on fourth-
Four themes emerged:
confidence, awareness,
deepening knowledge and
changed perspectives. The
residents’ attitudes to CAS
changed from negative
before the course to neutral
Medical students VR Mixed methods or positive afterwards. The Canada Strong
junior resident group
completed 23% of tasks in
the pre-course skills test and
75% of tasks on the post-test
(p < 0.01), compared to 45%
of tasks completed by the
senior resident group.
Students reported positive
perceptions of simulated
patient experiences. These
data support the continued
use of simulated patients as a
method of instruction for
Audiology audiology counselling
SPs Quantitative USA Very weak
students education for breaking
difficult news, and suggest a
potential value of using
simulated patient interactions
for training counselling skills
in other clinical situations
and scenarios.
The trained students
managed scenario A
significantly better than the
Nursing students SPs Quantitative Germany Strong
untrained students. Similar
results were found for
scenario B.
Objective scores and trainee
self-ratings suggest that this
structured curriculum using
Medical students Task trainers Quantitative simulator training allows USA Strong
junior medical students to
achieve proficiency in basic
surgical skills.
Dedicated instruction of
Medical students Task trainers Quantitative fourth-year medical students USA Strong
with deliberate and
based coronary surgery simulation:
medical student deliberate practice can
achieve equivalency to senior surgery
residents. [Comparative Study
Randomized Controlled Trial]. Journal
of Thoracic & Cardiovascular Surgery,
145(6), 1453-1458; discussion 1458-
1459. doi:
http://dx.doi.org/10.1016/j.jtcvs.2013.02
.048
Nestel D, Campbell D. (In press)
Transferring procedural skills from
simulation to clinical practice: A mixed
methods evaluation. International
Jounral of Clinical Skills.
Nestel, D., & Kidd, J. (2005). Peer
assisted learning in patient-centred
interviewing: the impact on student
tutors. [Research Support, Non-U.S.
Gov't]. Medical Teacher, 27(5), 439-
444.
Nestel, D., & Tierney, T. (2007). Role-
play for medical students learning about
communication: guidelines for
maximising benefits. [Evaluation
Studies]. BMC Medical Education, 7, 3.
Newby, J. P., Keast, J., & Adam, W. R.
(2010). Simulation of medical
emergencies in dental practice:
development and evaluation of an
undergraduate training programme.
year medical students’
proficiency in performing a
coronary anastomosis using a
porcine heart model,
compared with nonsimulator-
trained senior general
surgery residents.
To compare approaches to
supporting students in the
development of intravenous
infusion skills using a
stepwise model.
To report the evaluation of a
peer assisted learning (PAL)
project on student tutors.
To explore students'
experiences with the aim of
producing guidelines for
maximising the benefits of
role-play within this learning
context.
To discuss a comprehensive
simulation based training
program for final year
undergraduate dental
students and assessed student
distributed practice of
microvascular techniques
using a porcine end-to-side
coronary artery anastomosis
simulation model results in
performance comparable to
that of senior general surgery
residents.
STEPS supported the transfer
of learning from simulation
to clinical practice. Teaching
technical and professional
skills relevant for procedural
Task trainers; SPs;
Medical students Mixed methods skills in one program was Australia Strong
Hybrid simulation
highly valued. The DOPS
rating form provided a link
between learning in
simulation and performing in
clinical settings
The self-report evaluations
strongly suggest that
participating in a PAL
project has substantial
benefits for student tutors
that included both
Medical students SPs Mixed methods UK Strong
interviewing and facilitation
skills. Objective measures
revealed no change in
patient-centred interviewing
skills after participating in
the project.
Students reported the key
aspects of helpful role-play
were opportunities for
observation, rehearsal and
discussion, realistic roles and
alignment of roles with other
Medical students Role play Mixed methods UK Strong
aspects of the curriculum.
Unhelpful aspects were those
that evoked strong negative
emotional responses and
factors that contributed to a
lack of realism.
Student responses supported
simulation training,
Scenario based
Dentistry students Quantitative evidenced by the following Australia/VIC Very weak
simulation
selected questionnaire
responses: achieved greater

Australian Dental Journal, 55(4), 399-
404. doi:
http://dx.doi.org/10.1111/j.1834-
7819.2010.01260.x
Nicholas, L., Toren, K., Bingham, J., &
Marquart, J. (2013). Simulation in
dermatologic surgery: a new paradigm
in training. Dermatologic Surgery, 39(1
Pt 1), 76-81. doi:
http://dx.doi.org/10.1111/dsu.12032
Nikendei, C., Kraus, B., Schrauth, M.,
Weyrich, P., Zipfel, S., Herzog, W., &
Junger, J. (2007). Integration of role-
playing into technical skills training: a
randomized controlled trial. [Evaluation
Studies
Randomized Controlled Trial
Research Support, Non-U.S. Gov't].
Medical Teacher, 29(9), 956-960.
Nilsson, T. A., Hedman, L. R., &
Ahlqvist, J. B. (2007). A randomized
trial of simulation-based versus
attitudes towards training.
To evaluate the perceived
efficacy of obtaining
dermatologic procedural
skills using simulators
To investigate the effects of
role-playing with respect to
the realism of a training
situation and students’
objective performance.
To compare learning
outcome regarding
interpretative skill after
confidence in managing
emergencies; prefer lecture
to simulation; simulation
training is important in
undergraduate teaching.
Overall, 93.9% strongly
agreed that simulators are
helpful in acquiring
procedural skills. More than
three-quarters of participants
agreed that simulators are
useful in acquiring, refining,
assessing, and learning these
skills. Many participants
further thought that simulator
use would be beneficial in
learning anatomy and
trouble-shooting techniques.
Junior doctors; Manikin; An overwhelming majority
Quantitative USA Very weak
Dermatology staff Cadaveric of those surveyed believed
that training on simulators
would be helpful in learning
various dermatologic
procedures; 90.9% of
participants thought that
training using simulators
should be, at least in part, a
mandatory component of
residency. It was felt that this
training should be conducted
at the beginning of residency,
with additional with sessions
held throughout training.
The physician's role was
regarded to be significantly
more realistic when
performing role-plays.
Assessment of videotaped
sessions showed that
practising technical skills by
Medical students Role-play Quantitative Germany Very strong
performing role-plays
resulted in significantly
better patient-physician
communication whereas
students’ technical
performance did not differ
between groups.
The proficiency test results
Dentistry students VR Quantitative were significantly higher Sweden Strong
after training for the

conventional training of dental student
skill at interpreting spatial information
in radiographs. [Clinical Trial
Comparative Study Randomized
Controlled Trial Research Support,
Non-U.S. Gov't]. Simulation in
Healthcare: The Journal of The Society
for Medical Simulation, 2(3), 164-169.
doi:
http://dx.doi.org/10.1097/SIH.0b013e31
811ec254
Ohtake, P. J., Lazarus, M., Schillo, R.,
& Rosen, M. (2013). Simulation
experience enhances physical therapist
student confidence in managing a
patient in the critical care environment.
Physical Therapy, 93(2), 216-228. doi:
http://dx.doi.org/10.2522/ptj.20110463
Onovo, G. N. (2014). Human patient
simulations: Evaluation of self-efficacy
and anxiety in clinical skills
performance. [Dissertation].
Dissertation Abstracts International
Section A: Humanities and Social
Sciences, 74(7-A(E)), No Pagination
Specified.
Osbourne, A. (2012). Improving the
standardized patient experience.
[Comparative Study]. Journal of the
American Podiatric Medical
Association, 102(6), 477-484.
training in the simulator vs.
after conventional training.
To examine the effect of
participation in simulation-
based management of a
patient with critical illness in
an ICU setting on levels of
confidence and satisfaction
in physical therapist students.
To evaluate the self-
efficacy/self-confidence and
anxiety levels in clinical
skills performance of
undergraduate nursing
students, pre use and post use
of Human Patients
Simulations (HPS), as a
teaching and learning
strategy in maternity nursing.
To seek the views of
podiatric medical students at
KSUCPM who have
completed the SP rotation to
see how they felt their time
in the course was used and
whether they felt that the
experimental group, but not
for the control group.
Univariate variance analysis
of difference in proficiency
test score revealed a
significant interaction effect
between training group and
(Mental Rotations Test)
MRT-A category; in the
experimental group there was
a stronger training effect
among students with low
level of MRT-A.
Students' confidence in their
technical, behavioural, and
cognitive skill performance
increased from “somewhat
confident” to “confident”
following the critical care
Physiotherapy simulation experience.
Not stated Quantitative USA Weak
students Student satisfaction was
highly positive, with strong
agreement the simulation
experience was valuable,
reinforced course content,
and was a useful educational
tool.
The findings concluded that
HPS reduced anxiety and
increased self-efficacy/self-
confidence in clinical skills
performance and decision-
making of the participants. In
addition, the study found that
the participants had
Nursing students Manikin Quantitative USA Weak
difficulties in tasks
performance with the
following action verbs
associated with the cognitive
domain of Bloom's
taxonomy. The verbs were
Identify, Apply, and
Analyze.
The students answered
positively that the SP rotation
was important in terms of
Medical students SPs Quantitative improving interviewing skills USA Very weak
and worthwhile for future
professional development.
The students agreed that

Paige, J. T., Garbee, D. D., Kozmenko,
V., Yu, Q., Kozmenko, L., Yang, T., . . .
Swartz, W. (2014). Getting a head start:
high-fidelity, simulation-based
operating room team training of
interprofessional students. [Clinical
Trial
Research Support, Non-U.S. Gov't].
Journal of the American College of
Surgeons, 218(1), 140-149. doi:
http://dx.doi.org/10.1016/j.jamcollsurg.
2013.09.006
Palaganas, J. C. (2013). Exploring
healthcare simulation as a platform for
interprofessional education.
[Dissertation]. Dissertation Abstracts
International Section A: Humanities and
Social Sciences, 74(5-A(E)), No
Pagination Specified.
Park, J., MacRae, H., Musselman, L. J.,
Rossos, P., Hamstra, S. J., Wolman, S.,
& Reznick, R. K. (2007). Randomized
controlled trial of virtual reality
simulator training: transfer to live
patients. [Randomized Controlled Trial
Research Support, Non-U.S. Gov't].
American Journal of Surgery, 194(2),
205-211.
Parsh, B. (2010). Characteristics of
effective simulated clinical experience
course was useful to them in
terms of advancing their
podiatric medical education.
To investigate the immediate
impact of conducting
interprofessional student OR
team training using high-
fidelity simulation (HFS) on
students' team-related
attitudes and behaviours.
To examine how the most
commonly used simulation
modalities and IPE teaching
methods (low-technology
versus high-technology;
multiprofessional versus
collaborative team-based
activities; observational
versus active methods; SPs
versus mannequins) affect
participants' post-test scores
in perceived teamwork and
collaboration in pre-licensure
students while controlling for
factors shown previously to
affect these perceptions.
To assess a computer-based
colonoscopy simulator for
effective transfer of skills to
live patients.
To examine nursing student
perceptions of the
there likely was underused
time in the course and even
suggested ways in which
they would make the course
run more efficiently.
Statistically significant gains
from mean pre- to post-
training scores occurred on
11 of the 15 self-efficacy
items. Statistically significant
gains in mean observer
performance scores were
Nursing, nurse present on all 3 subscales of
anaesthetist and Manikin Quantitative the teamwork scale from the USA Strong
medical students first scenario to the second.
A statistically significant
difference was found in
comparisons of mean
observer scores with mean
participant scores for the
team-based behaviours
subscale.
Perceptions of teamwork and
collaboration did not
improve significantly for
high-technology methods
over low-technology
methods; however, the
difference in means between
Health post-test surveys differed
professional SPs; Manikin Quantitative significantly, suggesting that USA Strong
students there was an intervention
effect. Enhanced mannequin-
based simulation
significantly increased
students' perceptions of
teamwork and collaboration
compared to enhanced SP
based simulation.
Residents trained on a
colonoscopy simulator prior
to their first patient-based
colonoscopy performed
Medical students VR Quantitative USA Very strong
significantly better in the
clinical setting than controls,
demonstrating skill transfer
to live patients.
Students identified six
Nursing students Manikin Qualitative USA Strong
themes for SCE instructors:
instructors: interviews with
undergraduate nursing students. Journal
of Nursing Education, 49(10), 569-572.
doi:
http://dx.doi.org/10.3928/01484834-
20100730-04
Paskins, Z., & Peile, E. (2010). Final
year medical students' views on
simulation-based teaching: a
comparison with the Best Evidence
Medical Education Systematic Review.
[Comparative Study]. Medical Teacher,
32(7), 569-577. doi:
http://dx.doi.org/10.3109/01421590903
544710
Patel, V., Aggarwal, R., Osinibi, E.,
Taylor, D., Arora, S., & Darzi, A.
(2012). Operating room introduction for
the novice. [Randomized Controlled
Trial
Research Support, Non-U.S. Gov't].
American Journal of Surgery, 203(2),
266-275. doi:
http://dx.doi.org/10.1016/j.amjsurg.201
1.03.003
Pauly-O'Neill, S., & Prion, S. (2013).
Using integrated simulation in a nursing
program to improve medication
administration skills in the pediatric
population. Nursing Education
Perspectives, 34(3), 148-153.
Petersson, H., Sinkvist, D., Wang, C., &
Smedby, O. (2009). Web-based
interactive 3D visualization as a tool for
improved anatomy learning. Anatomical
Sciences Education, 2(2), 61-68. doi:
http://dx.doi.org/10.1002/ase.76
Phillippi, J. C., Bull, A., & Holley, S. L.
(2013). Expanding primary care
opportunities: simulation for clinical
reasoning. Journal of Nursing
Education, 52(5), 299-302. doi:
http://dx.doi.org/10.3928/01484834-
characteristics of an effective
instructor in the simulated
clinical experience.
To explore in more depth the
features of simulation-based
teaching that undergraduate
medical students value using
the Best Evidence Medical
Education (BEME)
Systematic Review features
that lead to effective learning
as a framework.
To assess the implementation
of a theatre induction
curriculum through a didactic
lecture, an online Second
Life operating room, and a
simulated operating suite.
To determine the overall
influence of a mixed
educational approach on
student knowledge and self-
confidence with paediatric
intravenous medication
administration.
To assess whether students
value a new three-
dimensional (3D)
visualization method as a
learning tool and what value
they gain from its use in
reaching their anatomical
learning objectives.
To discuss the use of
simulated clinical visits to
guide the students through
the clinical reasoning process
in a Family Nurse
Practitioner (FNP) faculty as
Personality, Teaching
Ability, Evaluation, Nursing
Competence, Interpersonal
Relationships, and Realism.
Twelve key themes were
identified, namely, feedback,
integration into curriculum,
learning style, learning
environment, realism,
Medical students Manikin Qualitative teamwork, communication UK Strong
skills, confidence/increased
self-efficacy, anxiety,
performance, perceptions of
foundation year 1 (FY1) and
SimMan® as a resource.
The lecture, Second Life, and
simulated operating suite
groups demonstrated
significant improvements in
all outcome measures. After
Medical students VR; game Quantitative UK Very strong
the intervention, these 3
groups had significantly
higher behaviour, self-report,
and knowledge scores than
the control group.
Results revealed a rise in
knowledge and student self-
reporting of confidence of
Nursing students Manikin Quantitative USA Very weak
essential medication
administration skills for the
paediatric population.
In general, students' attitudes
towards the EVA-program
were positive when
compared with anatomy
textbooks, but results were
Medical students VR Not stated Sweden Weak
not the same with
dissections. Additionally,
knowledge tests suggest a
potentially beneficial effect
on learning.
Low-fidelity simulation
allowed students time to take
Low fidelity a systematic approach to
Nursing students Not stated USA Weak
simulation patient assessment, planning,
and charting. The FNP
“experts” were used to

20130412-02
Pierce, V. C. (2012). Baccalaureate
nursing students' perceptions of clinical
judgment and self-efficacy following
high-fidelity simulation. [Dissertation].
Dissertation Abstracts International
Section A: Humanities and Social
Sciences, 73(4-A), 1295.
Piper, L., & Czekanski, K. (2012). Use
of a simulated administrative decision-
making exercise in an online master's
Nursing Administration course. Journal
of Nursing Education, 51(6), 343-344.
doi:
http://dx.doi.org/10.3928/01484834-
20120323-05
Planas, L. G., & Er, N. L. (2008). A
systems approach to scaffold
communication skills development.
American Journal of Pharmaceutical
Education, 72(2), 35.
Poulton, T., Conradi, E., Kavia, S.,
Round, J., & Hilton, S. (2009). The
replacement of 'paper' cases by
interactive online virtual patients in
problem-based learning. Medical
Teacher, 31(8), 752-758.
primary care experts
program.
To explore the effectiveness
of using multiple high-
fidelity simulation
experiences to increase
perceptions of clinical
judgment and self-efficacy in
baccalaureate nursing
students
To describe a unique role-
playing exercise was
developed in a graduate
Nursing Administration
course focusing on ethical
and informed decision-
making.
To implement a
communication skills
development (CSD) system
and evaluate its effectiveness
in a clinical communications
course.
To evaluate the use of
interactive online virtual
patients (VPs) in a PBL
program in lieu of paper.
critique student chart notes
prior to grading. This
collaborative approach to the
primary care clinical
conference was well received
by students, faculty, and
preceptors and was quick and
inexpensive to implement.
Data analysis revealed a
statistically significant
increase in students'
perceptions of clinical
judgment occurred between
Time 1 and Time 3. Students'
perceptions of self-efficacy
Nursing students Manikin Quantitative also increased significantly USA Weak
from Time 1 to Time 3 and
Time 2 to Time 3.
Regression analysis revealed
a slight positive correlation
between students'
perceptions of self-efficacy
and clinical judgment.
Students demonstrated an
understanding of
acknowledging input from
Nursing students Role-play Not stated USA Very weak
others, as well as the ability
to synthesize points on a
difficult question.
Students' communication
skills improved as evidenced
by assessment scores.
Student and faculty
Medical students SPs Mixed methods comments offered additional USA Strong
evidence of the effectiveness
of SP interviews, learning
strategies, and assessment
methods.
Medical students VPs Mixed methods Both tutors and students UK Weak
believed that the ability to
explore options and
consequences created a more
engaging experience and
encouraged students to
explore their learning. They
regretted the loss of paper
and neither group could see
any value in putting cases

Powell-Laney, S., Keen, C., & Hall, K.
(2012). The use of human patient
simulators to enhance clinical decision-
making of nursing students. Education
for Health, 25(1), 11-15.
Preston, E., Ada, L., Dean, C. M.,
Stanton, R., Waddington, G., &
Canning, C. (2012). The Physiotherapy
eSkills Training Online resource
improves performance of practical
skills: a controlled trial. [Controlled
Clinical Trial]. BMC Medical
Education, 12, 119. doi:
http://dx.doi.org/10.1186/1472-6920-
12-119
Ray, S. M., Wylie, D. R., Shaun Rowe,
A., Heidel, E., & Franks, A. S. (2012).
Pharmacy student knowledge retention
after completing either a simulated or
written patient case. [Comparative
Study
Randomized Controlled Trial].
American Journal of Pharmaceutical
Education, 76(5), 86. doi:
http://dx.doi.org/10.5688/ajpe76586
Re, A. (2012). The impact of human
patient simulation on the attainment of
learning outcomes. [Dissertation].
Dissertation Abstracts International
Section A: Humanities and Social
Sciences, 72(11-A), 4030.
To assess if HPS technology
leads to greater clinical
decision-making ability and
clinical performance
compared to the teaching
modality of a paper and
pencil case study.
To determine whether the
Physiotherapy eSkills
Training Online resource in
addition to usual teaching
improved the performance of
practical skills in
physiotherapy students.
To determine pharmacy
students’ knowledge
retention from and comfort
level with a patient-case
simulation compared with a
written patient case.
Interactions of students with
high fidelity simulations
were examined to determine
if human patient simulation
produced learning outcomes.
online without the options.
Results indicated that
students in the simulation
groups were significantly
more likely to score higher
on the clinical decision-
making exams and to
respond clinically by
performing CPR more
quickly on the manikin than
students in the case study
Nursing students Manikin Quantitative USA Very strong
groups. On the 100-point
exam, the simulation groups
had a 20-point gain, while
the case study groups had a
12-point gain. Students in the
simulation groups provided
CPR to a manikin 30 seconds
faster, on an average. The
differences were statistically
significant.
There was improvement in
OTHER (Included performance of practical
online video-clips skills in students who had
Physiotherapy
of patient- Quantitative access to the Physiotherapy Australia/NSW Very strong
students
therapist eSkills Training Online
simulations) resource in addition to usual
teaching.
Participation in the simulated
patient case did not result in
greater knowledge retention
or comfort level than
Pharmacy participation in the written
Manikin Quantitative USA Strong
students patient case. Students’
knowledge improved post-
intervention regardless of
which teaching method was
used.
This study affirmed that high
fidelity simulation led to the
attainment of learning
Nursing students; outcomes as a direct result of
Respiratory Manikin Mixed methods interacting with the human USA Strong
therapist students patient simulator.
Additionally, the study
statistically validated such
pedagogical factors as

Reddy-Kolanu, G., & Alderson, D.
(2011). Evaluating the effectiveness of
the Voxel-Man TempoSurg virtual
reality simulator in facilitating learning
mastoid surgery. [Comparative Study
Evaluation Studies]. Annals of the
Royal College of Surgeons of England,
93(3), 205-208. doi:
http://dx.doi.org/10.1308/003588411X5
65987
Reilly, A., & Spratt, C. (2007). The
perceptions of undergraduate student
nurses of high-fidelity simulation-based
learning: a case report from the
University of Tasmania. Nurse
Education Today, 27(6), 542-550.
Reising, D. L., Carr, D. E., Shea, R. A.,
& King, J. M. (2011). Comparison of
communication outcomes in traditional
versus simulation strategies in nursing
and medical students. [Comparative
Study
Randomized Controlled Trial]. Nursing
Education Perspectives, 32(5), 323-327.
To compare cadaveric
temporal bone (CTB)
simulation with the Voxel-
Man TempoSurg (VT)
virtual reality simulator in
addressing ten features of
high-fidelity medical
simulators that facilitate
learning
To: (1) investigate the
perceptions of second year
undergraduate nurses and
their academic teachers of
their experiences of high-
fidelity simulation using the
Laerdal Vital Sim Nursing
Kelly and Nursing Anne
technology2 as part of their
preparation for clinical
practice, (2) carry out
curriculum benchmarking
audit
To compare the outcomes in
affective and communication
domains using a traditional
(roundtable) model versus
simulation in nursing and
medical students.
student learning and
satisfaction, student self-
confidence, experiential
learning, and debriefing are
common and quantifiable in
a human patient simulation
classroom.
The VT is better at allowing
repetitive practice, ease of
control of difficulty, and
capturing clinical and
pathological variation. The
VT is as good as CTB in
curriculum integration,
Medical students VR, cadaveric Quantitative UK Very weak
allowing multiple learning
strategies, providing a
controlled environment,
individualising learning and
defining benchmarks. It
appears worse with regards
to face validity and feedback.
Undergraduate nursing
students value the
opportunity to practice
nursing activities in a safe
environment prior to clinical
placement. Students believed
that simulation is an
innovative strategy that
promotes active learning and
Nursing students Manikin Not stated Australia/TAS Weak
has great potential for
developing clinical
competence and increasing
confidence prior to practise.
The academic staff reported a
similar belief about the
potential of high-fidelity
simulation in a case-based
curriculum.
Nursing and Not stated Quantitative The simulation strategy USA Very weak
medical students resulted in statistically higher
levels of stress as identified
by participants. In addition,
nearly all participants
reported having a better
sense of the clinical role, and
with 55% of participants
stating that the experience
changed their view of the
role of the clinical team. This

Rethans, J.-J., Grosfeld, F. J. M., Aper,
L., Reniers, J., Westen, J. H., van
Wijngaarden, J. J., & van Weel-
Baumgarten, E. M. (2012). Six formats
in simulated and standardized patients
use, based on experiences of 13
undergraduate medical curricula in
Belgium and the Netherlands. Medical
Teacher, 34(9), 710-716. doi:
http://dx.doi.org/10.3109/0142159X.20
12.708466
Reynolds, A., Ayres-de-Campos, D.,
Bastos, L., van Meurs, W., &
Bernardes, J. (2008). Impact of labor
and delivery simulation classes in
undergraduate medical learning.
Medical Education Online, 13, 14. doi:
http://dx.doi.org/10.3885/meo.2008.Res
00285
Rezmer, J., Begaz, T., Treat, R., &
Tews, M. (2011). Impact of group size
on the effectiveness of a resuscitation
simulation curriculum for medical
students. [Randomized Controlled
Trial]. Teaching & Learning in
Medicine, 23(3), 251-255. doi:
http://dx.doi.org/10.1080/10401334.201
1.586920
Ricciotti, H. A., Hacker, M. R., De
Flesco, L. D., Dodge, L. E., & Huang,
G. C. (2010). Randomized, controlled
trial of a normal pregnancy virtual
patient to teach medical students
counseling skills. [Randomized
Controlled Trial
Research Support, Non-U.S. Gov't].
Journal of Reproductive Medicine,
55(11-12), 498-502.
To give an overview of the
formats used most in
undergraduate medical
education with SPs,
including a description of the
impact of these formats on
the different aspects of SPs.
To evaluate the impact on
knowledge and learner
satisfaction of adding a
labour and delivery
simulator-based training
module versus a self-study
session to the pre-existing
theoretical class, in the 5th
year undergraduate medical
curriculum.
To assess the impact of
varying group size on
medical students’ subjective
experience of simulation and
on post-simulation exam
performance.
To determine whether
medical students using the
Normal Pregnancy Virtual
Patient program (Harvard
Medical School and Beth
Israel Deaconess Medical
Centre, Boston,
Massachusetts) have better
knowledge and skills in
obstetric counselling than
traditional clerkship students.
initial study indicates that
interprofessional
communication may be
enhanced using simulation.
The working format with SPs
more or less determines the
Belgium/
Medical students SPs Descriptive whole process of selection, Very weak
Netherlands
training, performance, and
logistics of SPs.
Adding a simulator-based
training session for medical
students in management of
labour and delivery to the
theoretical class led to a
higher short-term increase in
Medical students Manikin Quantitative Portugal Very strong
knowledge and student
satisfaction than attending a
self-study session.
Significant differences in
knowledge were no longer
demonstrable at 12-15 days.
There were significant
increases in students’
confidence and knowledge
following simulation. There
were no significant
differences in student
Medical students Not stated Quantitative USA Very strong
perception of the
effectiveness or realism of
the simulation or in
performance on the post-
simulation exam as a
function of group size.
Stratified analyses indicated
the virtual patient group
provided significantly better
preconception counselling
than controls. Overall,
Medical students VP Quantitative USA Very strong
students who completed the
Virtual Patient program
scored higher than those in
traditional clerkship alone,
though not significantly.
 Students had significant and
progressively higher scores
Rickles, N. M., Tieu, P., Myers, L., on the assessment across
Galal, S., & Chung, V. (2009). The baseline, midpoint and final
To determine the quantitative
impact of a standardized patient time points. Students had
and qualitative value of a
program on student learning of Pharmacy significantly higher final
lecture-laboratory course SPs Mixed methods USA Strong
communication skills. [Research students assessment scores across all
with SPs on student
Support, Non-U.S. Gov't]. American subsections than at baseline.
communication skills.
Journal of Pharmaceutical Education, Students and SPs were
73(1), 4. favourable towards the
laboratories and made useful
recommendations.
Riesen, E., Morley, M., Clendinneng, Results from the study
D., Ogilvie, S., & Ann Murray, M. To explore a novel way to indicate that from baseline to
(2012). Improving interprofessional overcome the challenges post-intervention, there was
Recent graduates
competence in undergraduate students associated with scheduling significant improvement in
from nursing,
using a novel blended learning interprofessional learning learners' interprofessional
paramedic, police,
approach. [Evaluation Studies experiences through the use VR Not stated competence across all Canada Weak
and child and
Research Support, Non-U.S. Gov't]. of simulations in a virtual outcomes, and that the
youth service
Journal of Interprofessional Care, 26(4), environment (Web.Alive™) blended learning
programs
312-318. doi: where learners interact as environment provided an
http://dx.doi.org/10.3109/13561820.201 avatars. acceptable way to develop
2.660286 these competencies.
Robinson, J. D., Bray, B. S., Willson, Ninety-three per cent of
M. N., & Weeks, D. L. (2011). Using To evaluate a simulation- student groups correctly
human patient simulation to prepare based educational experience identified the emergency. A
student pharmacists to manage medical focused on medical Pharmacy post-activity survey
Manikin Quantitative USA Weak
emergencies in an ambulatory setting. emergencies in an students instrument was administered,
[Randomized Controlled Trial]. ambulatory pharmacy and 83% of responders
American Journal of Pharmaceutical setting. indicated this activity was
Education, 75(1), 3. effective or very effective.
Learning style significantly
influenced a pre-licensure
nursing student's clinical
judgment within a human
patient computer simulation
Robison, E. S. (2013). Influence of
To examine pre-licensure environment. When the
learning style and learning flexibility on
nursing students' learning learning style variables were
clinical judgment of prelicensure
styles and flexibilities entered into a regression
nursing students within a human patient
relative to clinical judgment model, the variance in
computer simulation environment. Nursing students VPs Quantitative USA Weak
performance to support clinical judgment was
[Dissertation]. Dissertation Abstracts
development of evidence- influenced by the way an
International: Section B: The Sciences
based practice in individual reflects and
and Engineering, 73(12-B(E)), No
implementing simulation. transforms the experience.
Pagination Specified.
The study's findings did not
indicate a significant
relationship between learning
flexibility and clinical
judgment.
Rochester, S., Kelly, M., Disler, R., To describe one approach Nursing students Not stated Qualitative The following themes Australia Weak

White, H., Forber, J., & Matiuk, S.
(2012). Providing simulation
experiences for large cohorts of 1st year
nursing students: evaluating quality and
impact. Collegian: Journal of the Royal
College of Nursing, Australia, 19(3),
117-124.
Rogers, L. (2011). Developing
simulations in multi-user virtual
environments to enhance healthcare
education. British Journal of
Educational Technology, 42(4), 608-
615.
Rull, G., Rosher, R. B., McCann-Stone,
N., & Robinson, S. B. (2006). A
simulated couple aging across the four
years of medical school. Teaching &
Learning in Medicine, 18(3), 261-266.
Russo, S. G., Bollinger, M., Strack, M.,
Crozier, T. A., Bauer, M., & Heuer, J.
F. (2013). Transfer of airway skills from
manikin training to patient: success of
ventilation with facemask or LMA-
Supreme(TM) by medical students.
Anaesthesia, 68(11), 1124-1131. doi:
http://dx.doi.org/10.1111/anae.12367
Rutherford-Hemming, T. (2012).
used to manage a simulation
for 375 1st year nursing
students and to report on the
quality of the experience
from the student's emerged from the data:
perspective. To ensure knowing what to expect;
quality was maintained assuming roles for the
within the large cohort, simulation; authenticity and
aspects of the simulation thinking on your feet; feeling
were assessed against the the RN role; and, preparation
following indicators: for clinical practice.
alignment with curriculum
pedagogy and goals;
preparation of students and
staff; fidelity; and debriefing.
A common theme, which
emerged from this research,
To investigate how a
which is discussed in this
simulation could be
paper, was the student's
optimised in Second Life to
ability to work in an artificial
encourage teamwork and
social structure where they
collaborative problem
Nursing students VR; game Qualitative could actively co-construct Australia Weak
solving based on the habits,
mental models of technical
experiences and perceptions
and interpersonal skills
of nursing students towards
through experiencing human
Second Life as a simulation
interaction in a computer-
platform.
based simulated
environment.
Sessions were rated good to
excellent. Comments were
To present a program which
positive, especially regarding
was designed around a
interactions with the aging
couple that aged from 60 to
couple. Aging Couple Across
90 years over the 4 years of
the Curriculum allowed the
medical school. The woman
Medical students SPs Not stated interweaving of multiple USA Very weak
represents the healthy aging
issues that are characteristic
process, whereas the man
of many geriatric cases.
represents an elder
Students were able to see the
experiencing multiple health
complexity of issues and the
problems.
impact on other family
members.
Conclude that the results
To study the transfer of skills
obtained in manikin studies
learnt on a manikin to the
cannot be transferred directly
clinical situation in novice Medical students Manikin Quantitative Germany Strong
to the clinical situation and
medical students during their
that guidelines should take
anaesthesia rotation.
this into account.
To examine whether a Nurse practitioner SPs Mixed methods The results showed USA Strong

Learning in simulated environments:
effect on learning transfer and clinical
skill acquisition in nurse practitioner
students. Journal of Nursing Education,
51(7), 403-406. doi:
http://dx.doi.org/10.3928/01484834-
20120427-04
Sabus C, Sabata D, Antonacci D. Use of
a virtual environment to facilitate
instruction of an interprofessional home
assessment. Journal of Allied Health.
2011;40(4):199-205.
Scholes J, Endacott R, Biro M, Bulle B,
Cooper S, Miles M, et al. Clinical
decision-making: midwifery students'
recognition of, and response to, post
partum haemorrhage in the simulation
environment. BMC Pregnancy
Childbirth. 2012;12:19.
transfer of learning (i.e.,
growth in clinical
competency) occurred from
the simulation laboratory to
the clinical bedside and if it
did occur, how.
To better understand the
utility of a web-based virtual
environment as a teaching
tool to represent clinical
assessment and interventions
in the home environment
To report the findings of a
study of how midwifery
students responded to a
simulated post partum
haemorrhage (PPH).
significant growth in overall
clinical competency from the
simulation laboratory to the
clinical bedside. A
statistically significant
correlation was noted
between the overall
competency scores of
students students in the simulation
laboratory and the overall
competency scores in the
clinical setting. Three themes
emerged from the students’
responses regarding how the
simulation experience
affected their clinical
competency.
Assignment analysis revealed
contextual and client-centred
recommendations. Student
surveys revealed that
students found the virtual
environment supportive of
learning. Student surveys and
reflection statements were
supportive of the
interprofessional
Physiotherapy collaboration. Use of a
students; virtual environment in
VR Mixed methods USA Weak
Occupational instruction allows an
therapy students authentic means of
representing
interprofessional home
assessment. The virtual
environment allowed a
temporal depiction of home
environment issues and
solutions providing the
unique opportunity for
students to evaluate home
recommendations.
The students' clinical
management of the situation
varied considerably. Students
struggled to prioritize their
Midwifery
SPs; Hybrid Qualitative actions where more than one UK Weak
students
response was required to a
clinical cue and did not
necessarily use mnemonics
as heuristic devices to guide

Schubart JR, Erdahl L, Smith JS, Jr.,
Purichia H, Kauffman GL, Kass RB.
Use of breast simulators compared with
standardized patients in teaching the
clinical breast examination to medical
students. J Surg Educ. 2012;69(3):416-
22.
Schwartz A, Weiner SJ, Harris IB,
Binns-Calvey A. An educational
intervention for contextualizing patient
care and medical students' abilities to
probe for contextual issues in simulated
patients. Jama. 2010;304(11):1191-7.
Schwartz LR, Fernandez R,
Kouyoumjian SR, Jones KA, Compton
S. A randomized comparison trial of
case-based learning versus human
patient simulation in medical student
education. Acad Emerg Med.
To compare learning the
clinical breast examination
(CBE) on a breast palpation
simulator with learning on a
SP with respect to skill
acquisition and comfort
level.
To evaluate an educational
intervention designed to
increase physicians' skills in
incorporating the patient's
context in assessment and
management of care and to
thereby decrease the rate of
contextual errors.
To evaluate the efficacy of
simulation training as
compared with case-based
learning (CBL) among
fourth-year medical students
as measured by observable
their actions. Driven by a
response to single cues they
also showed a reluctance to
formulate a diagnosis based
on inductive and deductive
reasoning cycles. This meant
they did not necessarily
introduce new hypothetical
ideas against which they
might refute or confirm a
diagnosis and thereby
eliminate fixation error. The
students response
demonstrated that a number
of clinical skills require
updating on a regular basis.
Heuristic devices helped the
students to evaluate their
interventions to illuminate
what else could be done
whilst they awaited the
emergency team. They did
not necessarily serve to
prompt the students' or help
them plan care prospectively.
Medical students who
learned the CBE on breast
palpation simulators
performed as well or better
than those who learned on
Medical students SPs Hybrid Quantitative USA Strong
SPs; however, a subgroup
analysis revealed that the
benefit was limited to
students with less clinical
experience.
Medical students who
underwent an educational
Medical students SPs Quantitative intervention were more likely USA Weak
to contextualize care for
individual SPs.
Human patient simulation
(HPS) training, utilizing
computerized,
Medical students Manikin; OSCEs Quantitative USA Strong
physiologically responding
mannequins offers no
advantage to CBL as

2007;14(2):130-7.
Schweller M, Costa FO, Antonio
MARGM, Amaral EM, de Carvalho-
Filho MA. The impact of simulated
medical consultations on the empathy
levels of students at one medical school.
Academic Medicine. 2014;89(4):632-7.
Seago BL, Ketchum JM, Willett RM.
Pelvic examination skills training with
genital teaching associates and a pelvic
simulator: does sequence matter? Simul.
2012;7(2):95-101.
Secomb J, McKenna L, Smith C. The
effectiveness of simulation activities on
the cognitive abilities of undergraduate
third-year nursing students: a
randomised control trial. J Clin Nurs.
2012;21(23-24):3475-84.
Seybert AL, Barton CM. Simulation-
behavioural actions.
To examine the impact of
simulated medical
consultations using SPs (SPs)
on the empathy levels of
fourth- and sixth-year
students.
To evaluate an educational
intervention adding the use
of a pelvic examination
simulator (SIM) to the use of
genital teaching associates
(GTAs) in a pelvic
examination skills
curriculum for second-year
medical students.
To provide evidence on the
effectiveness of simulation
activities on the clinical
decision-making abilities of
undergraduate nursing
students.
To assess the effect of
measured by medical student
performance on a chest pain
objective structured clinical
examination
Although the study results
were obtained via self-report-
a limitation-they suggest that
Medical students SPs Quantitative the effective simulation of Brazil Weak
medical consultations with
SPs may improve medical
students' empathy levels.
When using simulation to
teach the pelvic examination
to novices, SPs seem to be
the better initial training
experience, reducing student
Medical students SPs Quantitative USA Strong
anxiety and improving
learner engagement with
subsequent mechanical
simulation practice of
psychomotor skills.
There was no significant
difference in cognitive
development following two
cycles of simulation
activities. Therefore, it is
reasonable to assume that
two simulation tasks, either
computer-based or
laboratory-based, have no
effect on an undergraduate
student's ability to make
clinical decisions in practice.
However, there was a
Computer-based significant finding for non-
Nursing students Quantitative Australia Strong
simulation English first-language
students, which requires
further investigation. More
longitudinal studies that
quantify the education effects
of simulation on the
cognitive, affective and
psychomotor attributes of
health science students and
professionals from both
English-speaking and non-
English-speaking
backgrounds are urgently
required
Pharmacy Manikin Quantitative Pharmacy students showed USA Weak

based learning to teach blood pressure
assessment to doctor of pharmacy
students. Am J Pharm Educ.
2007;71(3):48.
Seybert AL, Kane-Gill SL. Elective
course in acute care using online
learning and patient simulation. Am J
Pharm Educ. 2011;75(3):54.
Shanks D, Brydges R, den Brok W,
Nair P, Hatala R. Are two heads better
than one? Comparing dyad and self-
regulated learning in simulation
training. Medical Education.
2013;47(12):1215-22.
Sherman JJ, Riche DM, Stover KR.
Physical assessment experience in a
problem-based learning course. Am J
Pharm Educ. 2011;75(8):156.
Shinnick MA, Woo M, Evangelista LS.
Predictors of knowledge gains using
simulation in the education of
prelicensure nursing students. J Prof
Nurs. 2012;28(1):41-7.
Shishani K, Stevens K, Dotson J, Riebe
C. Improving nursing students'
knowledge using online education and
simulation to help smokers quit. Nurse
Educ Today. 2013;33(3):210-3.
simulation-based learning on
doctor of pharmacy
(PharmD) students' ability to
perform accurate blood
pressure assessments and to
measure student satisfaction
with this novel teaching
method.
To enhance students'
knowledge of and critical-
thinking skills in the
management of acutely ill
patients using online
independent learning
partnered with high-fidelity
patient simulation sessions.
To compare the relative
effectiveness and efficiency
of dyad versus directed self-
regulated learning (DSRL)
training of simulation-based
lumbar puncture
To evaluate the impact of a
physical-assessment learning
experience implemented in
the problem-based learning
(PBL) format of the third
year of a doctor of pharmacy
(PharmD) program.
To examine predictors of
knowledge gains using
human patient simulation
(HPS) in the education of
pre-licensure nursing
students
To examine an evidence-
based smoking cessation
education program effect on
nursing students' perceptions
and self-confidence to help
smokers quit smoking.
significant improvement in
clinical skills performance
and in their knowledge of the
pharmacotherapy of
students
hypertension. Students
expressed high levels of
satisfaction with this type of
learning experience.
Participation in an elective
course that combined self-
directed Web-based learning
Pharmacy and hands-on patient
Manikin Qualitative USA Weak
students simulation exercises
increased pharmacy students'
knowledge and critical-
thinking skills in acute care.
The results indicate that
learning in pairs is as
effective as independent
DSRL. Dyad training permits
Junior doctors Task trainer Quantitative Canada Strong
the more efficient use of
simulators as two learners
use the same resources as an
individual.
Use of a simulation
stethoscope in a physical-
assessment learning
experience increased
Pharmacy
Hybrid Quantitative pharmacy students' USA Weak
students
knowledge in performing
pulmonary and
cardiovascular assessment
techniques.
The findings show that HPS
can independently improve
test scores. This study
provides evidence that HPS;
is an effective teaching
Nursing students Manikin Quantitative USA Strong
methodology for pre-
licensure nursing students
regardless of age, learning
style, or critical thinking
ability.
Integration of evidence-based
didactic and practical
smoking cessation program
Nursing students Not stated Quantitative into curricula improves USA Weak
nursing students' clinical
skills in helping smokers to
quit.

Shrader S, Kern D, Zoller J, Blue A.
Interprofessional teamwork skills as
predictors of clinical outcomes in a
simulated healthcare setting. Journal of
Allied Health. 2013;42(1):e1-6.
Shrader S, McRae L, King WMt, Kern
D. A simulated interprofessional
rounding experience in a clinical
assessment course. Am J Pharm Educ.
2011;75(4):61.
Shukla A, Kline D, Cherian A,
Lescanec A, Rochman A, Plautz C, et
al. A simulation course on lifesaving
techniques for third-year medical
students. Simul. 2007;2(1):11-5.
Siassakos D, Draycott T, O'Brien K,
Kenyon C, Bartlett C, Fox R.
Exploratory randomized controlled trial
of hybrid obstetric simulation training
for undergraduate students. Simul.
2010;5(4):193-8.
Siebeck M, Schwald B, Frey C, Roding
S, Stegmann K, Fischer F. Teaching the
rectal examination with simulations:
effects on knowledge acquisition and
inhibition. Medical Education.
2011;45(10):1025-31.
Simmenroth-Nayda A, Weiss C, Fischer
T, Himmel W. Do communication
To examine the relationship
between IP teamwork skills,
attitudes and clinical
outcomes in a simulated
clinical setting.
To implement a simulated
interprofessional rounding
experience using human
patient simulators as a
required activity for third-
year pharmacy students in a
clinical assessment course.
To evaluate a course
developed to meet objectives
previously covered in the
animal laboratory.
To assess whether simulation
is useful for improving
medical students' skills.
To examine the effects of
low-fidelity (LFS) and high-
fidelity (HFS) simulation on
the acquisition of the
necessary knowledge and
inhibition about carrying out
the rectal examination. In
addition, to investigate the
effects of the different
sequencing of the two
simulations (HFS-LFS
versus LFS-HFS).
To analyse whether a
communication course
Interprofessional curricular
models that produce effective
Medical students;
teamwork skills can improve
Pharmacy
student performance in
students; Not stated Quantitative USA Weak
clinical environments and
Physician
likely improve teamwork
assistant students
practice to positively affect
patient care outcomes.
Incorporating a simulated
interprofessional rounding
experience into a required
clinical assessment course
Pharmacy
SPs Quantitative improved student attitudes USA Weak
students
regarding interprofessional
teamwork and was associated
with high student
satisfaction.
This lifesaving techniques
course utilising simulation
technology successfully
covered objectives
previously taught with
Task trainer;
Medical students Quantitative animal vivisection, increased USA Weak
Manikin
students' confidence levels in
performing lifesaving
procedures and was highly
accepted by the medical
students.
High-fidelity simulation can
be used to train and evaluate
learning. The use of patient-
Nursing students Hybrid Quantitative UK Strong
actors during simulation
improves students'
communication skills.
Teaching the rectal
examination with the help of
SPs, who represent an HFS,
can help medical
undergraduate students to
overcome inhibition about
this examination.
Medical students SPs; Manikin Quantitative Germany Weak
Standardised patient
simulation is far more
effective than that achieved
using a manikin, which
represents an LFS. Both
types of simulation support
the acquisition of knowledge.
The communication course
Medical students SPs Quantitative Germany Strong
measurably improved

training programs improve students'
communication skills?--a follow-up
study. BMC Res Notes. 2012;5:486.
Simon EL, Lecat PJ, Haller NA,
Williams CJ, Martin SW, Carney JA, et
al. Improved auscultation skills in
paramedic students using a modified
stethoscope. J Emerg Med.
2012;43(6):1091-7.
Smithburger PL, Kane-Gill SL, Ruby
CM, Seybert AL. Comparing
effectiveness of 3 learning strategies:
simulation-based learning, problem-
based learning, and standardized
patients. Simul. 2012;7(3):141-6.
Smolle J, Prause G, Smolle-Juttner F-
M. Emergency treatment of chest
trauma--an e-learning simulation model
for undergraduate medical students. Eur
J Cardiothorac Surg. 2007;32(4):644-7.
Sookpotarom P, Siriarchawatana T,
Jariya Y, Vejchapipat P. Demonstration
of nasogastric intubation using video
compact disc as an adjunct to the
teaching processes. J Med Assoc Thai.
2007;90(3):468-72.
Soucy EC. The effects of high-fidelity
simulators on nursing students' critical
thinking and self-confidence.
Dissertation Abstracts International
Section A: Humanities and Social
Sciences. 2012;73(4-A):1296.
Souder DM. Teaching interpersonal and
measurably improves the
communicative competence
of third-year medical
students at a German medical
school and whether technical
or emotional aspects of
communication changed
differently.
To test the effectiveness of
the Ventriloscope as a
training device in teaching
heart and lung auscultatory
findings to paramedic
students.
To compare effectiveness of
3 learning strategies:
simulation-based learning,
problem-based learning, and
SPs
To evaluate the effectiveness
of a computer simulation
model on thoracic trauma
management.
To quantitatively evaluate
the effect of the video
compact disc (VCD)
demonstrating nasogastric
intubation on our medical
students' procedural skills.
To investigate the effects of
high-fidelity simulator use on
nursing students' critical
thinking skills and feelings of
self-confidence.
To examine the effectiveness
communication skills,
especially for female
students. These
improvements did not
depend predominantly on an
extension of the interview
time. Obviously, "technical"
aspects of communication
can be taught better than
"emotional" communication
skills.
Simulation training using a
modified stethoscope in
conjunction with SPs allows
for realistic learning of heart
Paramedic and lung sounds. This
Hybrid Quantitative USA Strong
students technique of simulation
training achieved proficiency
and better retention of heart
and lung sounds in a safe
teaching environment.
High-fidelity simulation is an
effective learning strategy.
When it is compared with
Pharmacy SPs and mPBL strategies,
SPs; Manikin Quantitative USA Strong
students students performed better on
knowledge-based quizzes
and had higher levels of
satisfaction.
Computer simulation of chest
trauma emergency treatment
OTHER options is a safe and efficient
Medical students (computer Quantitative learning approach in Austria Weak
simulation model) undergraduate medical
education, which is highly
appreciated by the students.
The medical students were
able to self-improve their
Medical students Manikin Quantitative procedural skills of Thailand Strong
nasogastric intubation after
viewing the VCD.
Study findings suggested that
human patient simulators do
Nursing students Manikin Quantitative increase student critical USA Strong
thinking abilities but not self-
confidence.
Medical students SPs Mixed methods Although three of the four USA Weak

communication feedback skills to
standardized patients: Assessment of a
cognitive model. Dissertation Abstracts
International: Section B: The Sciences
and Engineering. 2009;70(5-B):2804.
Sperling JD, Clark S, Kang Y. Teaching
medical students a clinical approach to
altered mental status: simulation
enhances traditional curriculum. Med.
2013;18:1-8.
Srinivasan M, Hauer KE, Der-
Martirosian C, Wilkes M, Gesundheit
N. Does feedback matter? Practice-
based learning for medical students after
a multi-institutional clinical
performance examination. Medical
Education. 2007;41(9):857-65.
of a training intervention for
SPs to improve their verbal
feedback to medical students.
To measure simulation's
impact on students'
knowledge acquisition,
comfort, and perceived
competence with regards to
the altered mental status
(AMS) patient.
To examine the impact of
receiving feedback via
performance benchmarks on
medical students' self-
assessment after a clinical
performance examination
(CPX).
assessment instruments used
indicated the SPs provided
quality feedback, it cannot be
determined conclusively if
the improved feedback was
the effect of the feedback
intervention in the revised
training protocol. Direct
observations of the
independent raters must be
considered as the SPs had
less than satisfactory scores
on the Quality of SP
Feedback form, indicating a
lower quality of feedback.
Further research with
psychometrically sound
instruments is needed to
delineate variables
contributing to the
knowledge and skills of SPs
as they learn to provide
quality verbal feedback.
Students who participated in
a simulation exercise
performed better on a
knowledge-based test and
reported increased comfort
and perceived competence in
Medical students Manikin Quantitative USA Weak
their clinical approach to
AMS. SBME shows
significant promise for
teaching clinical skills to
medical students during pre-
clinical curriculum.
The accuracy of student self-
assessment was poor after a
CPX, but improved
significantly with
performance feedback
(scores and benchmarks).
Videotape review alone
SPs; OTHER
Medical students Quantitative (without feedback) did not USA Weak
(CPX)
improve self-assessment
accuracy. Practice-based
learning exercises that
incorporate feedback to
medical students hold
promise to improve self-
assessment skills.

Stasi JP. Effects of oncologist
communication style about bad health
and oncologist gender on emotional
arousal, irrational statements,
information recall, and the physician-
patient relationship. Dissertation
Abstracts International: Section B: The
Sciences and Engineering. 2014;74(10-
B(E)):No Pagination Specified.
Steadman RH, Coates WC, Huang YM,
Matevosian R, Larmon BR,
McCullough L, et al. Simulation-based
training is superior to problem-based
learning for the acquisition of critical
assessment and management skills. Crit
Care Med. 2006;34(1):151-7.
Stewart F, Cleland J. The introduction
of standardized clinical surgical
teaching: students' and tutors'
perceptions of new teaching and
learning aids. Medical Teacher.
2008;30(5):508-12.
Stolz D, Langewitz W, Meyer A, Pierer
K, Tschudi P, S'ng CT, et al. Enhanced
didactic methods of smoking cessation
training for medical students--a
randomized study. Nicotine & Tobacco
Research. 2012;14(2):224-8.
To assess the effects of
oncologist gender and three
communication styles
(factual, assertive, and
accusatory) on simulated
patients' verbalisations of
negative and positive affect,
irrational statements,
information recall, and the
perceived oncologist-patient
relationship as they were
receiving a diagnosis.
To determine whether full-
scale simulation (SIM) is
superior to interactive
problem-based learning
(PBL) for teaching medical
students acute care
assessment and management
skills.
To design, implement and
evaluate standardised clinical
surgical teaching for 3rd year
undergraduate medical
students.
To study enhanced didactic
methods of smoking
cessation training for medical
students.
Results showed that the
expected main effects of
communication style on
verbalisations of negative
affect, positive affect, and
irrational statements were not
Medical students SPs Qualitative USA Strong
found. Overall, the findings
suggest that an accusatory
communication style can be
detrimental to information
recall and the oncologist-
patient relationship.
For fourth-year medical
students, simulation-based
learning was superior to
Medical students Manikin Quantitative problem-based learning for USA Strong
the acquisition of critical
assessment and management
skills.
Forced-choice student data
showed a preference for the
subject-specific checklists
but their open comments
acknowledged the checklists'
limitations. Tutors viewed
the subject-specific
checklists as detrimental to
learning and the generic
checklist as not adding value.
Both tutors and students
valued SPs, but more so by
Medical students SPs Quantitative UK Weak
students who had also
received the subject-specific
checklists. Students' and
tutors' views differed on
forced-choice evaluation
forms, but were similar when
open comments were taken
into account. Reviewing
open comments is time-
consuming but there is much
value in including them in
evaluation.
Role-playing and interaction
with real patients are equally
efficient and both more
Medical students Role-play Quantitative Switzerland Strong
powerful learning tools than
web-based learning with or
without a lecture.
 During the initial phase of a
medical emergency, there is
a substantial inter-individual
Streiff S, Tschan F, Hunziker S, variation in the amount of
Buehlmann C, Semmer NK, Hunziker To determine predictors of leadership. Leadership
P, et al. Leadership in medical leadership in a medical Medical students Not stated Quantitative behaviour as assessed by the Switzerland Strong
emergencies depends on gender and emergency. number of leadership
personality. Simul. 2011;6(2):78-83. statements is determined by
gender and personality and
not by knowledge or
experience.
Subramanian A, Timberlake M,
The SS learning modality
Mittakanti H, Lara M, Brandt ML. To determine whether the
demonstrated a significant
Novel educational approach for medical StepStone Interactive
improvement in student
students: improved retention rates using Medical Software (SS)
learning retention compared
interactive medical software compared learning modality is superior Medical students VR Quantitative USA Strong
to traditional didactic lecture
with traditional lecture-based format. to traditional lecture format
format. SS is an effective
[Erratum appears in J Surg Educ. 2012 in medical student learning
web-based medical education
May-Jun;69(3):443]. J Surg Educ. and retention.
tool.
2012;69(2):253-6.
Takayesu, J. K., Farrell, S. E., Evans, A. To critically analyse the Medical students Manikin Mixed methods Six major thematic USA Weak
J., Sullivan, J. E., Pawlowski, J. B., & experience of clinical categories emerged from the
Gordon, J. A. (2006). How do clinical clerkship students exposed to qualitative analysis: The
clerkship students experience simulator- simulator-based teaching, in “Knowledge and
based teaching? A qualitative analysis. order to better understand Curriculum” domain was
[Evaluation Studies student perspectives on its described by 35% of
Research Support, Non-U.S. Gov't]. utility. respondents, who
Simulation in Healthcare: The Journal commented on the
of The Society for Medical Simulation, opportunity for self-
1(4), 215-219. doi: assessment, recall and
http://dx.doi.org/10.1097/01.SIH.00002 memory, basic and clinical
45787.40980.89 science learning, and
motivation. “Applied
Cognition and Critical
Thought” was highlighted by
53% of respondents, who
commented on the value of
decision-making, active
thought, clinical integration,
and the uniqueness of
learning-by-doing.
“Teamwork and
Communication” and
“Procedural/Hands-On
Skills” were each mentioned
by 12% of subjects. 80% of
students, who commented on
the realism, interactivity,
safety, and emotionality of
the experience offered

Tan, A., Ross, S. P., & Duerksen, K.
(2013). Death is not always a failure:
outcomes from implementing an online
virtual patient clinical case in palliative
care for family medicine clerkship.
[Evaluation Studies]. Medical
Education Online, 18, 22711. doi:
http://dx.doi.org/10.3402/meo.v18i0.22
711
Ten Eyck, R. P., Tews, M., & Ballester,
J. M. (2009). Improved medical student
satisfaction and test performance with a
simulation-based emergency medicine
curriculum: a randomized controlled
trial. [Comparative Study
Randomized Controlled Trial]. Annals
of Emergency Medicine, 54(5), 684-
691. doi:
http://dx.doi.org/10.1016/j.annemergme
d.2009.03.025
To address the need for more
formal curriculum in EOL
care, an online virtual patient
(VP) clinical case in
Palliative Care into the
2010–2011 Year Three
Family Medicine Clerkship
rotation curriculum was
developed and implemented.
To determine the effect of a
simulation-based curriculum
on fourth-year medical
student test performance and
satisfaction during an
emergency medicine
clerkship.
observations on the
“Teaching/Learning
Environment”; here they also
offered feedback on format,
logistics, and instructors.
Finally, “Suggestions for
Use/Place in Undergraduate
Medical Education” were
provided by 22% of subjects,
who primarily recommended
more exposure. On a simple
rating scale, 94% of students
rated the quality of the
simulator session as
“excellent,” whereas 91%
felt the exercises should be
“mandatory.”
The group knowledge score
increased significantly from
a pre-course average, post-
course average. The students’
self-assessed comfort level
increased significantly with
all aspects of EOL
management from pre-course
to post-course. Nearly,
91.1% of the students rated
the VP realism as ‘Good to
Medical students VP Mixed methods Canada Strong
Excellent’, 86% rated the
case as educationally
beneficial. Nearly 59.3% of
students felt emotionally
engaged with the VP.
Qualitative feedback found
that the case content was
very useful and realistic, but
that the interface was
sometimes awkward to
navigate.
Medical students Not stated Quantitative Significantly fewer questions USA Very strong
were missed for material
presented in simulation
format compared with group
discussion. Those in the
experimental group scored
higher than the control
group. Students rated
simulation as more stressful,
but also more enjoyable,
more stimulating, and closer

Ten Eyck, R. P., Tews, M., Ballester, J.
M., & Hamilton, G. C. (2010).
Improved fourth-year medical student
clinical decision-making performance as
a resuscitation team leader after a
simulation-based curriculum.
[Randomized Controlled Trial].
Simulation in Healthcare: The Journal
of The Society for Medical Simulation,
5(3), 139-145. doi:
http://dx.doi.org/10.1097/SIH.0b013e31
81cca544
Theroux, R., & Pearce, C. (2006).
Graduate students' experiences with
standardized patients as adjuncts for
teaching pelvic examinations.
[Comparative Study
Evaluation Studies
Research Support, Non-U.S. Gov't].
Journal of the American Academy of
Nurse Practitioners, 18(9), 429-435.
Thompson, B. M., Teal, C. R., Scott, S.
M., Manning, S. N., Greenfield, E.,
Shada, R., & Haidet, P. (2010).
Following the clues: teaching medical
students to explore patients' contexts.
To determine the impact of
simulation-based instruction
on student performance in
the role of emergency
department resuscitation
team leader.
To explore graduate nurse
practitioner students’
perceptions of their
experiences when learning to
perform pelvic examinations
in the laboratory and
performing them in
subsequent clinical rotations
with voluntary peer
examination, and the other
two groups were taught by
SPs (SPs)
To evaluate a program that
uses SPs to increase medical
students’ knowledge and
skills in identifying
contextual issues.
to the actual clinical setting
compared with group
discussion.
The mean post intervention
case performance was
significantly better for the
students allocated to
simulation instruction
compared with the group
discussion students for four
outcomes including a
decrease in mean time to (1)
order an intravenous line; (2)
initiate cardiac monitoring;
Medical students Not stated Quantitative USA Very strong
(3) order initial laboratory
tests; and (4) initiate blood
pressure monitoring. Paired
comparisons of each
student’s initial and follow-
up simulations demonstrated
significant improvement in
the same four areas, in mean
time to order an abdominal
radiograph and in obtaining
an allergy history.
All groups reported feeling
anxious while learning pelvic
exam techniques and in
subsequent clinical
experiences. SPs provided
immediate feedback to
students, decreased their
feelings of anxiety, and
increased their confidence in
performing examinations.
Nursing students SPs Mixed methods USA Weak
Students who were taught
pelvic examination
techniques by SPs rated their
learning experiences more
positively and reported a
better understanding of exam
techniques than students who
learned to perform exams by
voluntary examination of
classmates.
SP encounters, coupled with
activities designed to trigger
Medical students SPs Mixed methods reflection, can help students USA Weak
identify patients’ contextual
clues. Students’ confidence
[Evaluation Studies
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.].
Patient Education & Counseling, 80(3),
345-350. doi:
http://dx.doi.org/10.1016/j.pec.2010.06.
035
Tokunaga, J., Takamura, N., Ogata, K.,
Setoguchi, N., Matsuoka, T., & Sato, K.
(2011). Preparation of simulation
programs regarding excess-dose drug
administration and acute-phase
condition changes and its evaluation by
students. [Research Support, Non-U.S.
Gov't]. Yakugaku Zasshi - Journal of
the Pharmaceutical Society of Japan,
131(4), 655-659.
Tokunaga, J., Takamura, N., Ogata, K.,
Yoshida, H., Setoguchi, N., Matsuoka,
T., . . . Sato, K. (2010). Vital sign
monitoring using human patient
simulators at pharmacy schools in
Japan. [Evaluation Studies
Research Support, Non-U.S. Gov't].
American Journal of Pharmaceutical
Education, 74(7), 132.
Torain, L. J. (2012). Use of Human
Patient Simulators as an alternative
teaching tool for clinical site
experiences in baccalaureate nursing
programs. [Dissertation]. Dissertation
Abstracts International Section A:
Humanities and Social Sciences, 73(3-
A), 894.
Traynor, M., Gallagher, A., Martin, L.,
& Smyth, S. (2010). From novice to
expert: using simulators to enhance
practical skill. British Journal of
Nursing, 19(22), 1422-1426.
To discuss a program that
promote the acquisition of
basic skills of vital-sign
checking and physical
assessment to evaluate the
patient condition/drug
efficacy or prevent adverse
reactions to drugs.
To develop, implement, and
assess an experience-based
education program using
human patient simulators to
instruct pharmacy students in
monitoring vital signs to
identify drug treatment
effects and adverse events.
To determine if the use of the
Human Patient Simulator
(HPS) in a nursing laboratory
can be used as an effective
alternative teaching tool for
the clinical site experience in
a baccalaureate-nursing
program.
To report (1) on the
introduction of simulation
(using a high fidelity patient
simulator) into an
undergraduate-nursing
curriculum
in Northern Ireland to
develop confidence and
proficiency without
compromising patient safety,
(2) on how the students
in eliciting patient clues
significantly increased after
the intervention. The results
suggest that some contextual
clues were more difficult for
students to elicit.
Evaluation of the student for
these program contents
increased significantly
(p<0.01). These programs
can be downloaded via the
Emergency-care Internet. Experience
Pharmacy simulator regarding excess-dose drug
Quantitative Japan Very weak
students equipped with a administration/condition
personal computer changes with an emergency-
care simulator is useful for
checking patients' vital signs,
evaluating the drug efficacy,
and confirming adverse
reactions to drugs.
Students successfully learned
how to monitor routes of
drug administration, vital
signs, and pathological
Pharmacy
Manikin Quantitative conditions. There was a Japan Very weak
students
significant increase in
students' recognition of the
importance of vital-sign
monitoring.
Results of the study indicated
no significant differences
Nursing students Manikin Quantitative between the two groups on USA Strong
pre-test and post-test
measurements.
Students' responses showed
that the simulation helped
them to gain a perspective on
the role of a qualified nurse
and also enhanced their
Nursing students Manikin Quantitative understanding of the Northern Ireland Weak
relationship between theory
and practice. Students also
reported that they valued the
experience as a means of
highlighting gaps in their

Tsai, M.-H., Lu, F.-H., & Frankel, R.
M. (2013). Learning to listen: Effects of
using conversational transcripts to help
medical students improve their use of
open questions in soliciting patient
problems. Patient Education and
Counseling, 93(1), 48-55. doi:
http://dx.doi.org/10.1016/j.pec.2013.03.
022
Turner, M. K., Simon, S. R., Facemyer,
K. C., Newhall, L. M., & Veach, T. L.
(2006). Web-based learning versus
standardized patients for teaching
clinical diagnosis: a randomized,
controlled, crossover trial. [Comparative
Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't].
Teaching & Learning in Medicine,
18(3), 208-214.
Ulbrich, T., Hamer, D., & Lehotsky, K.
(2012). Second-year pharmacy students'
perceptions of adhering to a complex
simulated medication regimen.
[Comparative Study]. American Journal
of Pharmaceutical Education, 76(1), 11.
doi:
http://dx.doi.org/10.5688/ajpe76111
Urbankova, A. (2010). Impact of
computerized dental simulation training
on preclinical operative dentistry
perceived the impact of this
experience on their clinical
practice.
To report effects of a
‘bottom-up’ pedagogy using
doctor–patient conversation
transcripts to improve
medical students’ use of open
questions in soliciting patient
problems.
To compare the efficacy,
student preference, and cost
of a Web-based (WB)
program versus a SP (SP)
encounter for teaching
clinical diagnosis skills to
2nd-year medical students.
To conduct a simulated
medication regimen with 2nd
year pharmacy students to
determine their anticipated
versus actual difficulty in
adhering to it.
To compare eight hours of
adjunctive computerized
dental simulator (CDS)
knowledge, but it also had
given them confidence for
future clinical practice.
Across the full encounter,
use of general and
psychosocial open questions
increased significantly after
training. The high rates of
narrowly focused opening
questions (52% of initial
position questions, 74% of
Medical students Role-play; SPs Quantitative second position questions, Taiwan Strong
and 85% of third position
questions) prior to training
were reduced to 11%, 15%,
and 15% respectively after
training. Students also shifted
from a micro (narrow) to a
macro (broad) pattern of
questioning.
WB and SP training
produced similar scores on
both the Abdominal Pain
checklist and Headache
checklist. WB training
produced a higher score on
Medical students SPs Quantitative USA Very strong
the Abdominal Pain SOAP
note, but not the Headache
SOAP note. Students rated
the SP format higher than the
WB format on all 7
preference measures.
The 69 (96%) students who
participated in the study
missed on average 16% of all
simulated medication doses
and noted that adhering to
the complex medication
OTHER (A
regimen was more difficult
Pharmacy simulated
Quantitative than they had anticipated. USA Weak
students medication
Eighty-nine per cent of
regimen)
students agreed or strongly
agreed the project was
valuable in developing
empathy towards patients
taking complex medication
regimens.
Dentistry students OTHER Not stated CDS-trained students USA Very strong
(Computerized performed significantly
dental simulator) better than controls on exams

examination scores. [Randomized
Controlled Trial
Research Support, Non-U.S. Gov't].
Journal of Dental Education, 74(4),
402-409.
van Schaik, S. M., Plant, J., Diane, S.,
Tsang, L., & O'Sullivan, P. (2011).
Interprofessional team training in
pediatric resuscitation: a low-cost, in
situ simulation program that enhances
self-efficacy among participants.
[Research Support, N.I.H., Extramural].
Clinical Pediatrics, 50(9), 807-815. doi:
http://dx.doi.org/10.1177/00099228114
05518
Velde, B. P., Lane, H., & Clay, M.
(2009). Hands on learning: the use of
simulated clients in intervention cases.
Journal of Allied Health, 38(1), E17-21.
Vincent, D. S., Sherstyuk, A., Burgess,
L., & Connolly, K. K. (2008). Teaching
mass casualty triage skills using
immersive three-dimensional virtual
reality. Academic Emergency Medicine,
15(11), 1160-1165. doi:
http://dx.doi.org/10.1111/j.1553-
2712.2008.00191.x
training at two different time
points to traditional teaching
alone.
To discuss an in situ,
simulation-based
interprofessional team-
training program around
paediatric emergencies for
physicians, nurses,
respiratory therapists, and
pharmacists at their
institution and performed an
analysis of the program’s
impact on self-efficacy in
resuscitation skills among
paediatric residents and
nurses.
To describe the use of
standardised clients in a
simulation learning
experiences and the
responses of occupational
therapy students to the
instructional modality.
The authors measured the
acquisition of triage skills by
novice learners after
exposing them to three
sequential scenarios (A, B,
and C) of five simulated
patients each in a fully
immersed three-dimensional
1 and 2 and were higher but
not significantly so on exam
3. There were no differences
between CDS groups. These
results suggest that eight
hours of CDS training
administered early in the
preclinical operative
dentistry may improve
student performance.
The results showed that with
a design based in best
principles of team training
and simulation education,
interprofessional team
training is feasible and
Junior doctors;
Not stated Not stated sustainable. The program had USA Very weak
Nurses
a beneficial effect on self-
efficacy in resuscitation
skills among both residents
and nurses at the authors’
institution and received
widespread acceptance.
Qualitative data was
analysed and resulted in the
following themes: "I felt like
a therapist", "I integrated
knowledge and applied my
skills with the help of my
partner", and "The
experience could be
Occupational enhanced". On a survey,
SPs Mixed methods USA Weak
therapy students students rated the live
simulated learning
experience higher than all
other instructional methods
presented. Included are
recommendations for
structuring activities using
simulated clients and future
research.
Triage scores and
intervention scores improved
significantly during Scenario
B (p < 0.001). Time to
Medical students VR Quantitative USA Strong
complete each scenario
decreased significantly from
A (8:10 minutes) to B (5:14
minutes; p < 0.001) and from

Vukanovic-Criley, J. M., Boker, J. R.,
Criley, S. R., Rajagopalan, S., & Criley,
J. M. (2008). Using virtual patients to
improve cardiac examination
competency in medical students.
[Randomized Controlled Trial
Research Support, N.I.H., Extramural].
Clinical Cardiology, 31(7), 334-339.
doi: http://dx.doi.org/10.1002/clc.20213
Vyas, D., McCulloh, R., Dyer, C.,
Gregory, G., & Higbee, D. (2012). An
interprofessional course using human
patient simulation to teach patient safety
and teamwork skills. American Journal
of Pharmaceutical Education, 76(4), 71.
doi:
http://dx.doi.org/10.5688/ajpe76471
Wagenschutz, H., Ross, P., Purkiss, J.,
Yang, J., Middlemas, S., & Lypson, M.
(2011). Standardized Patient Instructor
VR environment. The
hypothesis was that learners
would improve in speed,
accuracy, and self-efficacy.
To evaluate whether VPEs
improve Cardiac examination
(CE) skills, and whether any
improvements are retained.
To assess the effectiveness of
human patient simulation to
teach patient safety, team-
building skills, and the value
of interprofessional
collaboration to pharmacy
students.
To explore comfort levels of
third-year medical (M3)
students through two health
B to C (3:58 minutes; p <
0.001). Self-efficacy
improved significantly in the
areas of prioritizing
treatment, prioritizing
resources, identifying high-
risk patients, and beliefs
about learning to be an
effective first responder.
The Intervention group
improved significantly in
overall mean scores. The
Control group did not
improve. The Intervention
group improved inspection,
auscultation, and knowledge
(all statistically significant);
control group showed no
Medical students VP Quantitative improvement. Fourteen USA Very strong
months after the study, 8
students from the
intervention group were re-
tested and mean scores
improved further with
statistical significance;
controls showed
improvement on re-testing,
but it was not significant.
Pharmacy students’ scores on
8 of 30 items on a post-
simulation survey of
knowledge, skills, and
attitudes improved over pre-
simulation scores. Students’
scores on 3 of 10 items on a
team building and
interprofessional
Pharmacy
Manikin Quantitative communications survey also USA Strong
students
improved after participating
in the simulation exercise.
Over 90% of students
reported that simulation
increased their understanding
of professional roles and the
importance of
interprofessional
communication.
The use of SPIs is a viable
Medical students SPs Quantitative approach to exposing USA Very weak
medical students and future

(SPI) interactions are a viable way to
teach medical students about health
behavior counseling. Patient Education
& Counseling, 84(2), 271-274. doi:
http://dx.doi.org/10.1016/j.pec.2010.07.
047
Walker, S. (2009). A comparison of
perceived self-efficacy and learner
satisfaction between human patient and
standardized patient simulations.
[Dissertation]. Dissertation Abstracts
International: Section B: The Sciences
and Engineering, 70(2-B), 944.
Walsh, S. A. (2011). The effects of
pattern recognition based simulation
scenarios on symptom recognition of
myocardial infarction, critical thinking,
clinical decision-making, and clinical
judgment in nursing students.
[Dissertation]. Dissertation Abstracts
International: Section B: The Sciences
and Engineering, 72(5-B), 2709.
behaviour counselling (HBC)
interactions with SP
Instructors (SPIs) in tobacco
cessation (TCC) and
nutrition and physical
activity (NPA).
To compare perceived self-
efficacy and learner
satisfaction between 91
undergraduate nursing
students participating in
human patient simulator
(n=51) and SP (n=40)
simulations.
To test an educational
intervention using theories of
pattern recognition to
develop CT in MI and
improve nursing students’
clinical decision-making and
clinical judgment using high
fidelity patient simulation.
doctors to health behaviour
counselling, and increasing
comfort level with such
skills. The SPI experience
ensures that HBC
opportunities are available
and contain meaningful
feedback on performance.
The human patient simulator
students were statistically
more self-efficacious than
the SP students. There was
Nursing students Manikin; SPs Quantitative USA Weak
no statistically significant
difference between the two
groups when measuring
learner satisfaction.
Nursing students Manikin Mixed methods Students who were given USA Very strong
prototypes for MI using
simulation significantly
improved critical thinking as
measured by pattern
recognition in MI compared
with the non-simulation
control group. Qualitative
findings showed that students
receiving the experimental
simulation with a non-MI
scenario and feedback-based
debriefing had greatest gains
in clinical reasoning which
included development of
clinical decision-making
using analytic hypothetico-
deductive and Bayesian
reasoning processes and
learned avoidance of
heuristics. Students receiving
the experimental simulation
learned to identify salient
symptom cues, analysed data
more complexly, and
reflected on their simulation
experience in a way which
students reported improved
learning. Students who were
given MI only simulation
scenarios developed
deleterious heuristics and
showed fewer gains in
clinical reasoning, though

Wamsley, M., Staves, J., Kroon, L.,
Topp, K., Hossaini, M., Newlin, B., . . .
O'Brien, B. (2012). The impact of an
interprofessional standardized patient
exercise on attitudes toward working in
interprofessional teams. [Comparative
Study
Research Support, Non-U.S. Gov't].
Journal of Interprofessional Care, 26(1),
28-35. doi:
http://dx.doi.org/10.3109/13561820.201
1.628425
Wanggren, K., Fianu Jonassen, A.,
Andersson, S., Pettersson, G., &
Gemzell-Danielsson, K. (2010).
Teaching pelvic examination technique
using professional patients: a controlled
study evaluating students' skills.
[Comparative Study
Controlled Clinical Trial
Research Support, Non-U.S. Gov't].
Acta Obstetricia et Gynecologica
Scandinavica, 89(10), 1298-1303. doi:
http://dx.doi.org/10.3109/00016349.201
0.501855
Wanggren, K., Pettersson, G.,
Csemiczky, G., & Gemzell-Danielsson,
K. (2005). Teaching medical students
gynaecological examination using
professional patients-evaluation of
students' skills and feelings. [Evaluation
Studies
Research Support, Non-U.S. Gov't].
Medical Teacher, 27(2), 130-135.
Watson, K., Wright, A., Morris, N.,
McMeeken, J., Rivett, D., Blackstock,
F., . . . Jull, G. (2012). Can simulation
replace part of clinical time? Two
parallel randomised controlled trials.
[Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't].
Medical Education, 46(7), 657-667. doi:
http://dx.doi.org/10.1111/j.1365-
2923.2012.04295.x
To describe the
interprofessional SP exercise
(ISPE) and evaluates its
impact on students' attitudes
toward working in
interprofessional teams.
To compare the skills in
pelvic examination technique
between students who have
had training with
professional patients and a
control group of students
trained using clinical
patients.
To evaluate the outcome,
attitudes and feelings
towards the use of
professional patients and to
gain knowledge on how to
further develop the method.
To investigate if simulation
can replace part of clinical
time
both simulation groups
demonstrated greater critical
thinking ability than the non-
simulation control group.
Students' attitudes toward
team-based care improved
significantly on the team
value and team efficiency
subscales of the ATHCT.
Interprofes-sional
SPs Mixed methods There were significant USA Weak
students
differences in attitudes
toward team-based care by
profession. Faculty and
student satisfaction with the
ISPE was high.
Students who had training
with professional patients
were more skilled in
performing a pelvic
Medical students SPs Mixed methods examination and better Sweden Very strong
prepared to examine their
own patients than students
trained using clinical
patients.
In conclusion students,
teachers and professional
patients found this training
program with professional
patients to be of great value.
Medical students SPs Quantitative Sweden Strong
It was felt that the teaching
session reduced stress and
anxiety; the students were
relieved, calmer and more
secure after the training.
Physiotherapy SPs; Role-play; Quantitative Students’ achievement of Australia Very strong
students Task trainers; clinical competencies was no
Manikin worse in the SLE groups than
in the Traditional groups in
either RCT. These RCTs
provide evidence that clinical
education in an SLE can in
part (25%) replace clinical
time with real patients
without compromising
students’ attainment of the

Welk, A., Maggio, M. P., Simon, J. F.,
Scarbecz, M., Harrison, J. A., Wicks, R.
A., & Gilpatrick, R. O. (2008).
Computer-assisted learning and
simulation lab with 40 DentSim units.
[Research Support, Non-U.S. Gov't].
International Journal of Computerized
Dentistry, 11(1), 17-40.
Westberg, S. M., Adams, J., Thiede, K.,
Stratton, T. P., & Bumgardner, M. A.
(2006). An interprofessional activity
using standardized patients. American
Journal of Pharmaceutical Education,
70(2), 34.
Westberg, S. M., Bumgardner, M. A.,
Brown, M. C., & Frueh, J. (2010).
Impact of an elective diabetes course on
student pharmacists' skills and attitudes.
American Journal of Pharmaceutical
Education, 74(3), 49.
To explore efficient ways to
use and to manage a
computer-assisted dental
simulation lab with 40
DentSim units
To describe the development
and implementation of an
interprofessional activity
using SPs.
To assess the impact of an
elective diabetes course on
student pharmacists' skills
and attitudes about diabetes
management.
professional competencies
required to practise.
The indirect knowledge
retention rate / incidental
learning rate of the
preparation exercises in the
sense of computer-assisted
problem-oriented learning
regarding anatomy,
preparation procedures, and
cavity design was promising.
The wide- ranging number of
prepared teeth needed to
acquire the necessary skills
shows the varied individual
OTHER learning curves of the
(Computer- students. The acceptance of,
Dentistry students Quantitative USA Weak
assisted dental and response to, additional
simulation lab) elective training time in the
computer-assisted simulation
lab were very high.
Integrating the DentSim
technology into the existing
curriculum is a way to
improve dental education,
but it is also a challenge for
both teachers and the
students. It requires a shift in
both curriculum and
instructional goals that have
to be revaluated and
optimized continuously.
Despite multiple challenges,
an interprofessional activity
involving multiple health
professionals from multiple
Pharmacy institutions can be
students; Medical successfully implemented.
SPs Not stated USA Very weak
students; Nursing Feedback from pharmacy
students. students indicated that this
activity increased students'
awareness and ability to
work as members of the
health professional team.
OTHER (1-week Students' confidence in
Pharmacy simulation of performing and teaching
Mixed methods USA Weak
students living as a diabetes self-management
diabetic patient) skills significantly improved.

Williams, B., Brown, T., & Archer, F.
(2009). Can DVD simulations provide
an effective alternative for paramedic
clinical placement education?
[Evaluation Studies
Research Support, Non-U.S. Gov't].
Emergency Medicine Journal, 26(5),
377-381. doi:
http://dx.doi.org/10.1136/emj.2008.060
723
Williams, B., French, J., & Brown, T.
(2009). Can interprofessional education
DVD simulations provide an alternative
method for clinical placements in
nursing? [Evaluation Studies
Research Support, Non-U.S. Gov't].
Nurse Education Today, 29(6), 666-
670. doi:
http://dx.doi.org/10.1016/j.nedt.2009.02
.008
Wilson, M., Shepherd, I., Kelly, C., &
Pitzner, J. (2005). Assessment of a low-
To evaluate the usability of
DVD simulations, the impact
on student learning
satisfaction and the potential
for using DVD simulations to
reduce the clinical placement
burden on the current
healthcare system.
To evaluate the usability of
DVD simulations, the impact
on student learning, clinical
placement orientation, and
the potential for using DVD
simulations to reduce the
clinical placement burden on
the health care system with
nursing students.
To assess the user-
friendliness of a low-fidelity
Overall, paramedic students
positively perceived the
DVD simulations with
relation to learning
satisfaction and information
processing quality. The
simulations maintained
students’ attention and
concentration and provided
clinical authenticity and
relevance to practice. A
number of themes emerged
from the focus group data
Paramedic OTHER (DVD
Mixed methods including the impact on Australia Weak
students simulation)
employment, greater
appreciation of healthcare
teamwork and notion of
interdisciplinary teamwork,
the fact that DVD
simulations have the capacity
to replace some clinical
placement rotations and
should be integrated into
standard curriculum, and that
varying amounts of learning
wastage occur during clinical
placements.
Overall, nursing students
perceived the DVD
simulations positively in
relation to learning attention,
learning potential, clinical
relevance to practice and
information processing
quality. The following
themes emerged from the
focus groups: provided
OTHER (DVD
Nursing students Mixed methods familiarisation for clinical Australia Weak
simulation)
placements, learning wastage
occurs in varying amounts,
simulations could replace
some clinical placement
rotations, supportive of
multidisciplinary approach
and integration, and
simulations should have
pedagogical integration into
weekly clinical cases.
Nurses reported that most of
Nurses Manikin Mixed methods Australia Very weak
the components and

fidelity human patient simulator for the
acquisition of nursing skills.
[Comparative Study
Evaluation Studies]. Nurse Education
Today, 25(1), 56-67.
Wiskin, C., Roberts, L., & Roalfe, A.
(2011). The impact of discussing a
sexual history in role-play simulation
teaching on pre-clinical student attitudes
towards people who submit for STI
testing. [Randomized Controlled Trial].
Medical Teacher, 33(6), e324-332. doi:
http://dx.doi.org/10.3109/0142159X.20
11.575902
Wood, R. Y., & Toronto, C. E. (2012).
Measuring critical thinking dispositions
of novice nursing students using human
patient simulators. [Randomized
Controlled Trial]. Journal of Nursing
Education, 51(6), 349-352. doi:
http://dx.doi.org/10.3928/01484834-
20120427-05
human patient simulator as a
precursor to developing and
evaluating nurses' health
assessment knowledge and
skills.
To identify whether
facilitated simulations
featuring a sexual history
scenario affected change in
students’ attitudes towards
people who need STI testing.
To assess the influence of
human patient simulator
(HPS) practice on critical
thinking dispositions in a
sample of novice
baccalaureate nursing
students.
functions (appearance,
movement, procedures and
sounds) of Nursing Anne
Complete were realistic,
better than existing training
products, and suitable for
teaching purposes.
Additional comments
included suggestions for
improvement. Overall, the
results indicated that this
manikin is a very useful
training product for nursing
education.
There were no significant
differences in attitude, either
in negative or positive
direction, observed between
control and intervention
groups. Ethnicity was a
significant variable, with
white-British students self-
reporting more positive
attitudes. Twenty five per
cent students admitted
Medical students SPs Quantitative UK Very strong
personal STI exposure.
Again response varied
significantly between ethnic
groups (the white-British
group reporting 4× the
exposure). Females reported
more positive attitudes than
males, most marked in
relation to ‘willingness to
date’ someone who admitted
to STI testing.
Nursing students Manikin Quantitative No between-group USA Very strong
differences were found on
overall or subscale Critical
Thinking Disposition
Inventory (CCTDI) mean
scores. Within-group
differences for the HPS
practice group were
significant for overall scores
and the truth seeking and
judiciousness or maturity of
judgment subscales. This
preliminary data analysis
suggests disposition gains for

Wotton, K., Davis, J., Button, D., &
Kelton, M. (2010). Third-year
undergraduate nursing students'
perceptions of high-fidelity simulation.
[Evaluation Studies]. Journal of Nursing
Education, 49(11), 632-639. doi:
http://dx.doi.org/10.3928/01484834-
20100831-01
Wunschel, M., Leichtle, U., Wulker, N.,
& Kluba, T. (2010). Using a web-based
orthopaedic clinic in the curricular
teaching of a German university
hospital: analysis of learning effect,
student usage and reception. [Research
Support, Non-U.S. Gov't]. International
Journal of Medical Informatics, 79(10),
716-721. doi:
http://dx.doi.org/10.1016/j.ijmedinf.201
0.07.007
Yardley, S., Irvine, A. W., & Lefroy, J.
(2013). Minding the gap between
communication skills simulation and
authentic experience. Medical
Education, 47(5), 495-510. doi:
http://dx.doi.org/10.1111/medu.12146
To examine third-year
students’ perceptions about
the implementation of high-
fidelity simulation into an
existing clinical course.
To describe the usage of a
web-based virtual outpatient
clinic in the teaching
curriculum of undergraduate
medical students, its effect
on learning success, and
student reception.
To address two questions: (1)
How do new undergraduate
medical students understand
contemporaneous
interactions with simulated
and authentic patients?; and
(2) How and why do student
perceptions of differences
individual students practicing
critical assessment skills
using HPS.
Students perceived high-
fidelity simulation as
enjoyable, with an
appropriate degree of
challenge yet possessing
congruency with concepts
studied in the course.
Students’ transient feelings
of confusion were interpreted
as a natural component of the
Nursing students Manikin Not stated problem solving process as Australia Weak
they analysed, clustered, and
interpreted cues to respond to
rapid changes in the
simulated patient’s clinical
condition. Debriefing was
viewed as an important
component and assisted in
clarifying students’
knowledge and rationale for
practice.
Regarding learning success,
it was found that the
examination results were
significantly better after
using the system. Eighty per
cent of the students enjoyed
dealing with the virtual
patients emphasizing the
completeness of patient
Medical students Virtual world Quantitative Germany Strong
cases, the artistic graphic
design and the expert
comments available, as well
as the good applicability to
real cases. Eighty-seven per
cent of the students graded
the virtual orthopaedic clinic
as appropriate to teach
orthopaedic content.
It was identified that students
generate knowledge and
meaning from their simulated
and authentic experiences
Medical students SPs Mixed methods UK Strong
relative to each other and that
the resultant learning differs
in quality according to
meaning created by

Yuasa, M., Bell, C. L., Inaba, M.,
Tamura, B. K., Ahsan, S., Saunders, V.,
& Masaki, K. (2013). "You're being
paged!" outcomes of a nursing home
on-call role-playing and longitudinal
curriculum. [Research Support, Non-
U.S. Gov't
Research Support, U.S. Gov't, P.H.S.].
Journal of the American Geriatrics
Society, 61(11), 1976-1982. doi:
http://dx.doi.org/10.1111/jgs.12515
Zavertnik, J. E., Huff, T. A., & Munro,
C. L. (2010). Innovative approach to
teaching communication skills to
nursing students. [Controlled Clinical
Trial
Research Support, Non-U.S. Gov't].
Journal of Nursing Education, 49(2),
65-71. doi:
http://dx.doi.org/10.3928/01484834-
20090918-06
Zendejas, B., Cook, D. A., & Farley, D.
between simulated and
authentic patient interactions
shape their learning?
To describe and evaluate the
effectiveness of a novel
structured role-playing
didactic session followed by
an on-call nursing home
(NH) longitudinal clinical
experience.
To assess the effectiveness of
a learner-centred simulation
intervention designed to
improve the communication
skills of pre-professional
sophomore nursing students.
To determine how varying
comparing and contrasting
contemporaneous
experiences. Three themes
were identified that clarify
how and why the contrasting
of differences is an important
process for learning
outcomes. These are
preparedness, responsibility
for safety, and perceptions of
a gap between theory and
practice.
Significant improvements
were found in overall mean
attitudes and skills scores.
For all learners, the greatest
improvements were seen in
“comfort in managing
residents at the NH,”
“managing feeding or
gastrostomy tube
dislodgement,” “identifying
different availability of
medications, laboratory
Junior doctors and
studies, and procedures in
faculty; Nursing
Role-play Quantitative NH,” and “describing steps USA Weak
students; Other
to send NH residents to the
learners
emergency department.”
Geriatric medicine fellows'
attitudes and skills improved
significantly after the
longitudinal clinical
experience. The faculty
survey demonstrated
improved documentation,
communication, and fellows'
management of on-call
problems after curriculum
implementation.
The intervention group
performed better than the
control group in all four
tested domains related to
Nursing students SPs Quantitative communication skills, and USA Very strong
the difference was
statistically significant in the
domain of gathering
information.
Medical students; Simulation-based Quantitative The change in scores from USA Strong
 pre-test to post-test varied
with statistical significance
between the 2 groups. The
mean post-test score was
8.24 (standard error [SE],
0.29) for the teaching-last
group and 6.68 (SE, 0.27) for
R. (2010). Teaching first or teaching the teaching-first group
last: does the timing matter in (mean difference, 1.56; 95%
the timing of instruction,
simulation-based surgical scenarios? confidence interval, 0.79–
either before (teaching first)
[Comparative Study 2.33). Both teaching-last and
or after (teaching last) the
Research Support, N.I.H., Extramural]. Junior doctors scenarios teaching-first group
simulation, affects
Journal of Surgical Education, 67(6), participants preferentially
knowledge outcomes of
432-438. doi: rated debriefings and
surgical trainees.
http://dx.doi.org/10.1016/j.jsurg.2010.0 scenarios, respectively, as the
5.001 better learning experience.
Participants who received
instruction after simulated
scenarios achieved higher
mean knowledge scores than
those who received
instruction before simulated
scenarios.
Table 3: Number of papers by respondent group

Respondent group Number of papers

Audiology students 1
Dentistry students 15
Junior doctors 10
Medical students 218
Midwifery 3
Nursing students 119
Occupational therapy students 2
Paramedic students 3
Pharmacy students 36
Physiotherapy 5
Combination (e.g. Medical and nursing students etc.) 27
Table 4: Number of papers by simulation modality

Simulation modalities Number of papers

Cadaveric 1
Games 1
Manikin 92
Simulated patients (SPs) 92
Virtual patients (VPs) 24
Virtual reality (VR) 19
Role-play 21
Task trainers 21
Hybrid 3
OSCE 16
Computer-based simulation 6
Others (e.g. 1-week simulation of living as a diabetic patient) 21
Multiple (e.g. Manikins and SPs; Manikins and VR; Manikins, SPs 72
and Task trainers etc)
Not stated 39
Table 5: Number of papers by study design

Study design Number of papers

Descriptive 34
Mixed methods 66
Qualitative 45
Quantitative 277
Not stated 17
Table 6: Number of papers by quality rating

Study design Number of papers

Very strong 30
Strong 167
Weak 167
Very weak 72
Not applicable 3