Teaching and Learning

Simulation has been described as “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” (Gaba,2004 pp.12).

Simulation education is a bridge between classroom learning and real life clinical experience. It offers a scheduled, valuable learning experience that may be difficult to obtain while on clinical placement. This teaching strategy is used to mirror, anticipate or amplify real situations with guided experience in a fully interactive way and allows for consistent training and evaluation in areas such as technical and non-technical skills, teamwork, and professionalism. The safe environment accommodates training of a clinical skill, cognitive thinking and behavioural communication.

Simulation can facilitate a range of learners from novices to experts. Beginners can gain confidence in a controlled, safe environment while experts can practice to perfect a skill without causing harm to patients. Simulation can also be used as an evaluation tool in the form of Objective Structured Clinical Examinations (OSCE).

Types of simulation you may come across during your training include:

Task trainers focus on a specific task or procedure to provide training in a technical skill, for example, catheterisation.

Manikins are ‘plastic people’ which can range from low to high fidelity. Its range in use can be from a small number of specific tasks to algo rhythms to mimic the functions of a real person, for example breathing and breath sounds, pulses, heart rate, pupillary size.

Standardised patients are people trained to model a clinical condition and or mannerisms associated with the condition. Standardised patients can be used very effectively in assessing communication and interpersonal skills.

Hybrid simulation is where task trainers are combined with virtual or standardised patients, for example strapping a cannulation task trainer to a standardised patients arm.

Screen based simulations take the form of virtual patients or serious games. It is generally delivered via a computer or mobile device. It provides knowledge and has an interactive.

Debriefing following clinical nursing simulation plays a critical role in student learning. Debriefing had been defined as “facilitated or guided reflection in the cycle of experiential learning” (Fanning et al. 2007) that occurs after the simulated event. A variety of methods can be implemented including verbal feedback or video assisted verbal discussion. It allows the student the opportunity to explore the events as they occurred, and critique their performance in an objective, non-judgmental atmosphere. 

Objective Structured Clinical Examinations (OSCEs) are a way to access clinical skills of nursing and midwifery students. These examinations are labeled as objective because all students are tested on same material/skill—rubrics are often used which makes marking more standardised. Examinations are structured because each station has a specific task. They often test clinical skill and judgment, physical examination and communications skills. (OSCEs can be used for education and examination.) Students start with basic cases and increase with complexity throughout the programme. The cases are designed to match the objectives of the stage outcomes of the programmes. 

The use of role-play can enable an interactive learning environment by imitating real clinical situations. It involves placing students in the role of the patient and/or in the role of the nurse, facilitating the opportunity to think in another person’s shoes. It allows the opportunity to not only focus on the practical psychomotor skills but the non-technical skills that are also involved and key to patient care, such as comprehensive patient education, awareness of patient’s psychological needs and patient empathy. Role play depicts a teaching and learning strategy whereby students attain knowledge through examination and query rather than direct instruction. The principle of role play as an educational philosophy aspires to develop analytical and critical thought, cooperative and self-directed learning and the integration of theoretical knowledge and skills (McCourt & Beake, 2009). These skills epitomise the key principles of the nursing and midwifery profession.

Role Modelling is another essential teaching and learning strategy in clinical education. The use of role modelling in education has its roots in social learning theory models e.g. Bandura. Role modelling is well established within clinical health sciences education (e.g. nursing, midwifery, medicine) as one of the most effective ways to socialise a student into both the clinical care setting, and into the established behaviours and identity of their chosen profession (Sternszus & Creuss 2016). The Nursing & Midwifery Board of Ireland (2015) also identify role modelling as a key activity of the registered nurse/midwife who is a ‘preceptor’ for the student nurse/midwife on their clinical placement by ‘demonstrating best practice and sharing clinical expertise’. The art of midwifery and nursing practice in action is best experienced by the student when they shadow a registered nurse/midwife using their intuition and interpersonal skills, and demonstrating our core professional values in each client/patient interaction. The clinical skills lab setting offers our students the opportunity to see clinical teaching staff role-modelling in simulations, the behaviours and attitudes that demonstrate our professional values i.e. care, compassion, commitment.

Group work is an effective method to motivate students, encourage active learning, and develop key critical-thinking, communication, and decision-making skills. It also prepares the nursing or midwifery student for working within teams in the clinical setting. For this reason, group work is regularly used in the clinical skills labs. Students are divided into groups and allocated a patient (mannequin or a person role playing) and expected to use a problem-solving approach in addressing the holistic needs of the patient. The clinical skills lab facilitator supervises the groups closely and encourages all individuals within the group to participate and, guides them in the delivery of best practice and safe care.

Using demonstration in the clinical skills lab, the facilitator performs the tasks step-by-step allowing the nursing and midwifery student to observe and enabling them to carry out the task with guidance/independently under supervision. During the demonstration, the student is informed of all relevant information as to why this approach is best practice and includes problem shooting. Therefore, creating an effective way to assist students in understanding important concepts and principles while offering hands-on inquiry based learning.