Article Review: Effectiveness of Simulation-Based Education Programs

This article review analyzes a study protocol for a randomized controlled trial evaluating the effectiveness, cost-effectiveness, and student experience of a simulation-based education training program (STOP-Falls) aimed at preventing falls among hospitalized inpatients. The study, conducted within Peninsula Health in Victoria, Australia, involved nursing, medicine, physiotherapy, and other allied health students. The research employed a cross-over randomized controlled trial design with concurrent economic evaluations and qualitative data analysis. The primary outcome was the rate of falls, and the study assessed changes in student knowledge, skills, and attitudes through surveys and interviews. The results showed that simulation-based nursing techniques are effective in assessing learning domains and improving healthcare assessment of falls among patients. The article highlights the importance of simulation in improving clinical outcomes, enhancing patient safety, and providing students with opportunities to practice and receive feedback. The review also discusses the study design, simulation process, and recommendations for improving simulation-based education strategies, emphasizing the need for technical expertise, clear roles, and alignment with frameworks like CONSORT and STROBE.

RUNNING HEAD;SIMULATION BASED LEARNING
UNIVERSITY:
NAME:
ASSIGNMENT

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Title of Article
Establishing the effectiveness, cost-effectiveness and student experience of a
Simulation-based education Training program On the Prevention of Falls (STOP-Falls)
among hospitalised inpatients: a protocol for a randomised controlled trial
Authors
1. Cylie Williams1,2,
2. Kelly-Ann Bowles2,3,
3. Debra Kiegaldie4,
4. Stephen Maloney2,
5. Debra Nestel5,
6. Jessica Kaplonyi1,
7. TerryHaines2
Author affiliations
1. Peninsula Health, Allied Health, Frankston, Victoria, Australia
2. Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
3. Allied Health Research Unit, Monash Health, Cheltenham, Victoria, Australia
4. Monash Health, Medical Education and Simulation, Clayton, Victoria, Australia
5. Monash University, School of Rural Health, HealthPEER, Clayton, Victoria,
Australia
Institution where research conducted:
Health institutions within the wards of Peninsula Health Victoria, Australia
Description of Study: (prospective/observational/etc)
Study Population
The study population entailed all Monash University, undertaking nursing, medicine,
physiotherapy, occupational therapy, dietetics and social work, who have been placed on
intervention or control wards at Peninsula Health.
Study Methods
This study employed a cross over randomized controlled trial having concurrent
economic evaluations. Further random allocation of eight health services in Peninsula health
Victoria Australia was used.
Data was analyzed using stata, statistical soft ware. Quantitative information on student

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knowledge, skills and attitudes outcomes were made comparable between groups and within
intervention group.
Qualitative data was analyzed thematically establishing the relationship between
interviewer and interviewee.
Evaluation tools/methods
Outcome measures have employed primary and secondary outcome.
Primary outcome
- rate of falls per 1000 occupied bed days
- proportion of patients who experiences more falls
- rate of falls resulting in serious injury or linked to death occurring per 1000 occupied
days
this data will be collected from the hospital by RA using a computerized hospital
incident reporting tool, manual searching of the medical records and interviews. This
reporting tool is based on studies indicating that falls can be under reported while using
hospital incidence reporting tool.
Change outcomes measures
After the intervention, practice change was assessed using end of placement survey tool
where by students were asked to make reports on the occasions they provided three categories
of safe Recovery Program, the following questions were raised;
i) Explaining to the patient on the nature of fall in hospital through, where, when and why
criteria.
ii) Assessment of patient self perceived risks status of falling in hospital
iii)Instances of offering the patient to set their own goals aimed at reducing the risk of fall
while at the hospital.
Assessment of data on enablers and barriers related to students providing safe care
recovery program on clinical placement were collected using end of placement and end of
study interview.
Interview among key informant interview were assessed also. Change in knowledge
process was measured using self report surveys, among the study participants on knowledge
on when the falls occur and common employed strategies.
Results:
The results of this study showed that simulation based nursing techniques are effective
in assessing learning domains, having pooled random effects and standardized mean

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difference of 0.70, sub group analysis showed that effect sizes were higher for fidelity
simulations at 0.86. In cognitive outcomes, the effect size as indicated for high fidelity
simulation was indicated as 0.80 and standardized patients was 0.73 having largest effect
sizes on affective outcomes high fidelity. the intervention on students improved the domains
of health care assessment on falls among patients.
Conclusions:
The results shows that simulation nursing education is effective as a educational
intervention and have strong education effects on learners so as to reduce falls among
hospitals patients. The education based simulation is effective in improving nursing care
approach towards reducing the number of falls among the patients who are hospitalized.
Article analysis
Quality of the study
Clinical education approaches are aimed at integrating nursing theoretical knowledge
into practice towards improving health status. Simulation based module is aimed at ensuring
that there is utilization of pedagogical approach to health care practice, by providing
appropriate techniques to provide opportunities for effective clinical skills through real life
experience experiences.
Simulation based approaches are geared towards using the patients as simulators. This
article has utilized patients as simulators, aimed at improving the practices of nurses and
helping them in enabling adoption of effective skills, (Cook, 2014).
This study has brought about is providing immediate feedback to the patients, providing
feedback , repetitive practice and integrating simulation process into the learning process of
learners thus offering an opportunity of individualizing learning process.
Description of simulation process entails those ranging from low to high fidelity
simulations. Many simulation methods and various educational levels can be adapted to suit
the environment. The study has constructed a simulation technique for prevention of falls in
the hospital. The effect size for this simulation process is essential in improving clinical
outcomes of the patients towards reduction of the fall, through nursing education, (McGaghie
et al, 2010).
Study design
The study has used cross over study design which is a longitudinal in nature as a
subjects receive various treatments. Many crossover treatments are observation however few
are controlled experiments. This study has utilized randomized controlled cross over designs.
This kind of design is essential in health care practice in that subjects are randomly assigned

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to different forms of treatment of study. When the clinical trial is repeated, it calls for
collection of same measurements over multiple times for each subject case, (Issenberg et al,
2005).
In this treatment all the subjects have received the same treatment, thus creating
balance effect; with all the subjects receive same treatment with same equal number
participation. Further the subjects used in this study are serving as their controls thus limiting
the number of covariates. Cross over trials are often associated to study duration, as the risks
need to persist for long for subject exposure status. However a drawback which was not
highlighted in the study is the effect of crossover effects which may alter the response other
treatment offered by the medical students offering the care. With critical analysis of the
study, effect of the carry effects could not be observed as the risks for patients could not
have any significant impact on the overall study design. The study utilized wash out effect to
mitigate on the cross over effect during the consecutive application of simulation application
which is usually long enough to offer wearing of treatment effects, thus duration of stay
played central role in assigning the wash out effect on the study participants, (Waxman,
2010).
Thus research design allowed for answering of the research question on assessing the
simulation education strategies on medical health care staff and further usage of medical
students on placements serves an appropriate and ideal opportunity for assessment of the
education based simulation strategy.
Simulation based training program
Educational strategy of offering medical skills has been increasingly been utilized to
teach various skills to health and clinical professionals and students alike. The various
modalities employed in facilitated this kind of study is key in ensuring that education effect is
utilized in nursing health care. Various avenues of simulation based techniques have been
employed, (Cheng et al, 2014). These include those pertaining to procedural training models
and manikin simulated patients. Studies have shown that simulation based education
techniques have an impact in improving patient outcomes, procedure based tasks like catheter
and air way management. On the other end simulated patients have the ability to be given an
opportunity to given feedback to health professionals or even students. Simulated subjects are
crucial for raising the patient profiling and have characteristics of demonstrating wide range
of emotional and mental state thus improving patient engagement, (Lorello et al, 2014).
The study has used ill patients who are at risk of fall in hospitals as stimulants, while
the medical students on placement have been offered an opportunity in assessing and

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improving the education strategies so as to prevent falls and improve patient risks assessment.
With the current changes in placement of students, safety of the patients, the experience of
the students play critical role in ensuring that problems such as falls in hospitalized patients
are handled effectively and patients are thought on self management aspects. Thus this
clinical simulation based approach is geared towards ensuring effective practice of students
on clinical process and improving response in real life situations post placement.
Evaluation of effectiveness on SBE
Clinical based simulations are key in ensuring that application of teaching
methodologies which mimic real life is put to be learnt. Simulation of learning aspects is
linked to philosophical contemporary theories of constructivism. The medical students who
are the learners in the study are able to learn and understand how to manage and tackle falls
among hospitals patients. Simulation based using education model approaches are essential
in ensuring that health education and mental state of the participants is improved, they
enhance the memory status and improve the overall efficacy of health education, thus the
conversion of this factors are key in effective cognitive process, (Juni et al, 2001).
This study for the purposes of effectiveness has utilized patients as subjects while the
medical team students as simulators. This gives an opportunity for exposure to patients, for
acquisition of necessary skills and reduction of falls in hospitals. Further it incorporates
provision and acquisition of necessary skills which develop health professionals and
improves their skills, knowledge and attitude while offering protection to the patient. Nursing
education though simulated process, it allows exposure of the students in order for feting
necessary practical skills, this further is geared towards providing the patient with the
necessary safety and well being during the illness process. Simulation progresses are crucial
in that they provide the relevant skills. In the study this was evident in the manner that there
the simulation process was aimed at reducing hospitals fall thus improving overall care
process to the patient. This gives room for other health care staff to have opportunity for the
development of refining skills using simulation technology process.
Thus simulation based intervention in this study is crucial in providing key and relevant
nursing concepts and patient care process. Thus equipping the participants or the users with
key tools and resources is paramount t in ensuring effective simulation process. This study
showed improved status of patient’s occurrence with falls, thus signaling the effectiveness of
the intervention.
Improvement of effective simulation process
Improvement of simulation process entails the use of other skills which play key role in

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ensuring effective simulation process. There is need to include technical and functional
expertise in the simulation based education in the study, improving problem solving skills
and improving interpersonal and communication skills. These improvement aspects portray a
common share of the thread in that they posses active listening and possession of skills and
knowledge, (Begg et al, 1996).
Common mishaps that occur in simulation process include lack of focused
understanding on roles and responsibilities, absence of clear and defined roles, process that
incorporate back up plans and efficient of duties to be done. In the simulation based
education intervention in the study, improvements can be made on linking roles and sharing
responsibilities with team members and motivating members for 100% efficiency on tasks
given and assigned in the care process.
Simulation based education strategies recommendation
The use of simulation techniques and approaches are rapidly and progressively
expanding the scope of knowledge. This has prompted the use of CONSORT, referring to
consolidated standards of reporting trials framework and STROBE, referring strengthening
the reporting of observational studies in epidemiology. Adopting CONSORT framework is
key so to improve the reporting processes. The CONSORT checklist contains checklist
elements which entrench quality aspects, (Plint et al, 2006). This SBE thus need to be
modified so as to sit changing trends of care process. The use of STROBE process on the care
process is key towards ensuring inclusion of both clinical and educational approaches,
(Cheng et al 2006). Thus adoption of SBE which suits the intervention is key so as to
maximize effect of intervention. Thus SBR has to align itself though incorporating of clear
and concise interventions which produce the expected effect.

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