Comparison of Manikin-Based High Fidelity Simulation to Synchronous Screen-Based Virtual Simulation (1090-003629) (Research Abstract Professor Rounds: Group 5)
Start time: Friday, January 29, 2021, 10:00 AM End time: Friday, January 29, 2021, 11:00 AM Session Type: Research Abstracts (Completed Studies)
High-fidelity simulation in nursing education is supported by a growing body of research1,2. Virtual simulation (V-sim) is an alternative strategy to consider if high-fidelity simulation is not feasible or cost effective3. Foronda et al. define V-sim as “clinical simulation offered on a computer, the internet, or in a digital learning environment including single or multiuser platforms”4. There is support for using V-sim to improve knowledge, skill, performance, confidence, and clinical judgment5. A significant problem is the lack of a clear definition of V-sim5. Many studies have defined and operationalized the concept of V-sim quite differently. Often the simulations were conducted asynchronously, used avatars, or did not incorporate real-time instructor led debriefing6. No studies were found that directly compared existing high-fidelity manikin-based simulations to versions of the same simulations delivered synchronously as a V-sim. This study was designed to address that gap.
This study used a quasi-experimental design. Prior to campus closure, students participated in high-fidelity manikin-based simulations on sepsis and cirrhosis with GI bleed. The transition to remote learning required an alternative. The existing simulations were converted to a synchronous, virtual format using the same learning objectives. Photos, video clips, and audio clips were embedded in a Power Point to replace the interaction with the manikin. Sessions were held on Zoom. A Prebrief was done describing expectations, safe learning environment, and fiction contract. Learners were provided with a shift report and chart. Assessment findings were presented when students asked. The cases unfolded in the same manner as in the lab. Each session was followed by an in-depth debriefing. The same instructor facilitated and debriefed all sessions. After each session, students completed a 20 item Likert scale evaluation. Responses were compared between groups using independent sample t-tests.
The sample consisted of senior nursing students in a medical-surgical course. A total of 31 students participated in the manikin sim and 38 participated in the vSim. The instrument asked students to evaluate the sim in terms of their perception of the sim and their own learning on 20 items. Items addressed multiple learning outcomes including preparation to care for patients, realism, ability to recognize changes in conditions, learning of pathophysiology, pharmacology, and classroom information, assessment skills, teamwork, communication skills, and effectiveness of debriefing. Each item is rated on a 7 point scale from strongly disagree to strongly agree. Independent sample t-tests were used to compare groups and there were no significant differences on any item except “developed better understanding of pathophysiology” was rated higher in the manikin group.
Converting face to face, manikin simulations to a virtual format was challenging. We wanted to maintain the focus on students independently interpreting patient data and making clinical judgments. Findings indicate that synchronous vSim is a viable alternative when a high-fidelity manikin is not available. It was surprising that there was no difference on items related to realism or assessment skills between the two formats. Development of the vSims incorporated a strong emphasis on conceptual fidelity. The case details were carefully researched and supported by the chart documents and assessment data that was presented as the sims unfolded. It appears that conceptual fidelity was more important than physical fidelity in obtaining learner buy-in. Real time facilitation followed by synchronous debriefing also were unique elements to these vSims. Replication of these results using participant randomization and additional instruments to evaluate learning outcomes is recommended.