Virtual Patient Simulation is as Effective as Hands-On Simulation for Enhancing Clinical Nursing Performance: Randomized Controlled Trial
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Abstract
Aim:
The use of virtual patients has grown substantially in healthcare education. A computer-based virtual patient was developed as a refresher training course to reinforce clinical performance in assessing and managing deteriorating patients. The aim of this study is to determine the effectiveness of the virtual patient simulation when compared with hands-on experience on patient simulator for improving and retaining clinical performances, following a high-fidelity simulation course on rescuing a patient in deteriorating situation.
Methodology:
A virtual patient simulation that focuses training on rescuing a patient in deteriorating situation (RAPIDS) was developed based on the features of simulation identified by a systematic review. 1 A randomized controlled study was conducted. Fifty-seven third year nursing students were randomized to either Virtual Patient or Patient Simulator for a 2-hr refresher training course on rescuing a patient in deteriorating situation using. The Virtual Patient group independently received the virtual patient simulation. The Patient Simulator group received the hands-on simulation using patient simulator in group of six and facilitated by an instructor. Despite the different learning contexts, both groups were guided by the same learning frameworks using ABCDE (Airway, Breathing, Circulation, Disability & Expose/Examine) and SBAR (Situation, background, Assessment & Recommendation) mnemonics. These frameworks were also used as outcome measures to evaluate the participants’ performance through the use of the RAPIDS-tool. 2 The participants from both groups undertook the simulation-based assessment prior to (pre-test), one day after (immediate post-test) and 2.5 months after (retention post-test) their intervention. A survey was conducted asking participants’ perception from the Virtual Patient group on their learning experience.
Results:
Following the intervention, the Virtual Patient (p < 0.001) and Patient Simulator groups (t = p < 0.05), demonstrated significant increase in the immediate post-scores from the baseline test scores. Similarly, the retention post-test scores for the Virtual Patient (p < 0.05) and Patient Simulator (p < 0.01) were significantly higher from the pre-test scores. The Virtual Patient group has significant decreased (p < 0.05) in the retention post-test scores when compared with immediate post-test scores. No significant differences were found between the immediate and retention post-test scores for the Patient Simulator. Between-group comparison indicated no significant difference between the Virtual Patient and Patient Simulators for both the immediate and retention post-tests after controlling the pre-test scores. On the survey, the virtual patient simulation was rated highly positive.
Conclusion:
Our finding did not demonstrate superiority of any learning strategy. Virtual patient simulation appears to be as effective as the hands-on simulation for improving clinical performance in assessing and managing clinical deterioration. While the use of virtual patient simulation produced the best immediate performance improvement, the hands-on simulation was associated with better retention of performance. Although hands-on simulation exhibits a high level of interactivity and realism, it is limited by the costs, the presence of a trained instructor and the small number of learners it can accommodate at one time. Virtual Patient does not require the presence of a trained instructor and can be used by large group of learners at anytime and anywhere.
The use of virtual patients has grown substantially in healthcare education. A computer-based virtual patient was developed as a refresher training course to reinforce clinical performance in assessing and managing deteriorating patients. The aim of this study is to determine the effectiveness of the virtual patient simulation when compared with hands-on experience on patient simulator for improving and retaining clinical performances, following a high-fidelity simulation course on rescuing a patient in deteriorating situation.
Methodology:
A virtual patient simulation that focuses training on rescuing a patient in deteriorating situation (RAPIDS) was developed based on the features of simulation identified by a systematic review. 1 A randomized controlled study was conducted. Fifty-seven third year nursing students were randomized to either Virtual Patient or Patient Simulator for a 2-hr refresher training course on rescuing a patient in deteriorating situation using. The Virtual Patient group independently received the virtual patient simulation. The Patient Simulator group received the hands-on simulation using patient simulator in group of six and facilitated by an instructor. Despite the different learning contexts, both groups were guided by the same learning frameworks using ABCDE (Airway, Breathing, Circulation, Disability & Expose/Examine) and SBAR (Situation, background, Assessment & Recommendation) mnemonics. These frameworks were also used as outcome measures to evaluate the participants’ performance through the use of the RAPIDS-tool. 2 The participants from both groups undertook the simulation-based assessment prior to (pre-test), one day after (immediate post-test) and 2.5 months after (retention post-test) their intervention. A survey was conducted asking participants’ perception from the Virtual Patient group on their learning experience.
Results:
Following the intervention, the Virtual Patient (p < 0.001) and Patient Simulator groups (t = p < 0.05), demonstrated significant increase in the immediate post-scores from the baseline test scores. Similarly, the retention post-test scores for the Virtual Patient (p < 0.05) and Patient Simulator (p < 0.01) were significantly higher from the pre-test scores. The Virtual Patient group has significant decreased (p < 0.05) in the retention post-test scores when compared with immediate post-test scores. No significant differences were found between the immediate and retention post-test scores for the Patient Simulator. Between-group comparison indicated no significant difference between the Virtual Patient and Patient Simulators for both the immediate and retention post-tests after controlling the pre-test scores. On the survey, the virtual patient simulation was rated highly positive.
Conclusion:
Our finding did not demonstrate superiority of any learning strategy. Virtual patient simulation appears to be as effective as the hands-on simulation for improving clinical performance in assessing and managing clinical deterioration. While the use of virtual patient simulation produced the best immediate performance improvement, the hands-on simulation was associated with better retention of performance. Although hands-on simulation exhibits a high level of interactivity and realism, it is limited by the costs, the presence of a trained instructor and the small number of learners it can accommodate at one time. Virtual Patient does not require the presence of a trained instructor and can be used by large group of learners at anytime and anywhere.
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