Simulation
Clinical simulation practise framework Hossein Khalili BIEN and International Partnership & Projects, School of Nursing, Fanshawe College, London, Ontario, Canada
CSP holds great potential to derive a positive transformation in students’ transition into the workplace
SUMMARY Background: Historically, simulation has mainly been used to teach students hands-on skills in a relatively safe environment. With changes in the patient population, professional regulations and clinical environments, clinical simulation practise (CSP) must assist students to integrate and apply their theoretical knowledge and skills with their critical thinking, clinical judgement, prioritisation, problem solving, decision making, and teamwork skills to provide holistic care and treatment to their patients.
Context: CSP holds great potential to derive a positive transformation in students’ transition into the workplace, by associating and consolidating learning from classrooms to clinical settings, and creating bridges between theory and practice. For CSP to be successful in filling the gap, the design and management of the simulation is crucial. Innovation: In this article a new framework called ‘Clinical simulation practise framework: A knowledge to action strategy in health professional education’ is being introduced that aims to assist educators and curriculum
developers in designing and managing their simulations. This CSP framework theorises that simulation as an experiential educational tool could improve students’ competence, confidence and collaboration in performing professional practice in real settings if the CSP provides the following three dimensions: (1) a safe, positive, reflective and fun simulated learning environment; (2) challenging, but realistic, and integrated simulated scenarios; and (3) interactive, inclusive, interprofessional patient-centred simulated practise.
32 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 32–36
tct_12291.indd 32
1/14/2015 3:44:12 PM
INTRODUCTION The use of simulation has a longstanding history in health professional education.1 Historically, simulation has mainly been used to teach students hands-on (psychomotor) skills in a relatively safe environment.1,2 Learned during laboratory practise, these skills were seen to be key for skill acquisition among students before entering the clinical setting. With current changes in student and patient populations, professional regulations and clinical environments, however, many educational and professional experts believe that skill laboratories are no longer sufficient (although necessary) in preparing students for the transition to a demanding ever-changing workplace.1–5 Students in the health professions, like professionals in the field, are required to take on increasingly complex care management in real workplaces that ‘require a much higher level of critical thinking and clinical judgement skills than in the past’.1 With the advancement of both simulation technology and educational pedagogy, educators and curriculum developers have been provided with an opportunity to extend students’ clinical practice experiences by creating simulated ‘real-life’ clinical settings during their educational tenure.1–3 Clinical simulation practise (CSP), like real clinical practice, requires students to integrate and apply their critical thinking, clinical judgement, prioritisation, problem solving, decision making and teamwork abilities, along with their theoretical knowledge and hands-on skills, to provide holistic care and treatment to their patients.1–4
Students in the health professions, are required to take on increasingly complex care management
complexity. Computerised human patient simulators (HPSs), with an increased level of sophistication and realism, provide highfidelity simulation with realistic lifelike manikins. HPS manikins have the ability to produce physical findings, like heart sounds and pulses, throughout the body, and different physiological actions, including responding to student interventions, breathing, blinking, crying and urinating, similar to patients in a clinical setting.1,6 The use of HPSs in some professional programmes has been seen to be too expensive to adopt because
of the computer programming, technologists, and training for staff and educators required. Add-on technology, such as voice-over technology, new applications and trainers could be used with the low-fidelity manikins, however, adding to the realism and the effectiveness of the simulation. For example, the voice-over technology in which a facilitator (that could be a student) is the voice of the patient speaking from a microphone in a control room could significantly enhance the interaction between the manikin and the student health care providers.
Clinical simulation practise (CSP) could take three different formats, from low to high fidelities, depending on the simulator features and © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 32–36 33
tct_12291.indd 33
1/14/2015 3:44:13 PM
competence, confidence and collaboration in performing professional practice in real settings. To do so, the CSP must provide the following three dimensions:
For CSP to be successful...the design and management of the simulation is crucial
1. a safe, positive, reflective and fun simulated learning environment; 2. challenging, but realistic, and integrated simulated scenarios; and 3. interactive, inclusive and interprofessional patient-centred simulated practise.
Clinical simulation practise (CSP) holds great potential to derive a positive transformation in students’ learning by creating interactive bridges between theory and practice. According to the literature, despite the growing advancement in teaching and learning strategies, students are still facing challenges in applying their theoretical knowledge in real practice, which could be because of the students’ perceived lack of competence and confidence in performing integrated holistic care and treatment.3 For CSP to be successful in filling the gap, as with any other teaching and learning strategy, the design and management of the simulation is crucial.2,4,5 Designing and implementing simulated case scenarios are becoming an integrated component of an educator’s role, and so educators are looking for best practice in using simulation in their education. At the same time, the evidence is still sparse in support of the effectiveness and transferability of simulation learning into real practice. Although the number of research studies evaluating the impact of simulation on students’ learning is increasing, the lack of theoretical and conceptual frameworks underpinning this body of research makes it difficult to compare the findings to draw reliable conclusions.
Hence, this article briefly introduces a new framework called ‘Clinical simulation practise framework: A knowledge to action strategy in health professional education’, developed through integrating the literature and the personal experience of working with post-secondary health professional students in simulation for many years.
CLINICAL SIMULATION PRACTISE FRAMEWORK This CSP framework (Figure 1) theorises that simulation is an experiential educational tool that could improve students’
Safe, Positive, Reflective, & Fun Simulated Learning Environment
A safe, positive, reflective and fun simulated learning environment Simulation is well-known to be a relatively safe environment (compared with clinical practice settings), in which students can make mistakes without facing consequences or putting a human patient in harms way. In my personal simulation experience I also found that providing students with a non-judgemental and non-threatening environment maximises the CSP learning effect. Such a non-judgemental and non-threatening environment allows students to ease their anxieties and stress during performance, and to openly share their thoughts and ideas during debriefing sessions.
Challenging, but Realistic, Integrated Simulated Scenarios
IP ClientCentered Inclusive Simulated Practice
Competent, Confident, Collaborative Professional Student in Real Practice Setting Figure 1. Clinical simulation practise framework: a knowledge-to-action strategy in health professional education (© Khalili, 2013)10
34 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 32–36
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1/14/2015 3:44:13 PM
Debriefing, with the engagement of students’ self-reflection and discovery skills,7 can provide students with an opportunity to ‘think critically, discuss rationales for behaviour, discover what was done well and what could have been done differently, and integrate lessons learned into their practice’.8 Hence encouraging critical reflection throughout the simulation, in particular during debriefing, is at the heart of CSP. Providing reflection opportunities before, in, and on actions along with maintaining a positive environment by focusing on ‘learning’ assists and encourages students to actively engage in simulation, discovering their strengths and areas in need of further development. The discovery of strengths will assist students to gain confidence and to address their learning needs.9 The role of the educator as facilitator in debriefing is essential. There is a concern that uncorrected or unacknowledged student errors during simulation will ‘become the reality’ that students will ‘perceive as correct and later transfer to the live clinical situation’.2 In fact, it is crucial that educators safeguard against errors of conditions, processes or procedures in simulation, to prevent them from becoming real errors in patient care, by revealing, acknowledging and correcting those errors with students.2 Challenging, but realistic, and integrated simulated scenarios Clinical simulation practise (CSP) is not about skills review and practise, rather it is about placing students in a situation deemed realistic, and assisting students in consolidating their learning to provide holistic care and treatment to the simulated patient. Replicating the reality of the workplace in a simulated environment will foster students’ growth on their road to becoming a professional, and will enable them to prepare for what they
Encouraging critical reflection throughout the simulation is at the heart of CSP
will be expected to do in their professional role. The representation of ‘reality’ in the controlled and structured environment of simulation has been challenged, however.1,2 In a recent publication, Dunnington argued that the representation of reality in simulation, with regards to the complexity and uncertainty of human behaviour, may not be captured in a structured preprogrammed simulation, leading to some limitation in the transferability of simulation learning.2 Using a facilitator as the voice of the patient along with scenarios including some degree of fluidity and flexibility, based on the student’s performance and intervention, allows the student to face the consequences of their decisions and actions, which would add to the realism of the simulation.1 Interactive, inclusive, interprofessional patientcentred simulated practise Other aspects of simulation that are important in CSP include patient-centeredness, the interactivity of patient–student encounters, and the inclusion of family and other health care providers. CSP is about contextual and situated learning, and aims to move beyond hands-on skills training to real-life patient-centred care learning, with an emphasis on therapeutic communication,
holistic care, collaborative practice, critical inquiry, critical thinking, clinical judgement, prioritisation, problem solving, decision making, time management and organisational skills.1,2,8 These complex contexts are ‘less producible in the linear, sequential texture’ represented in preprogrammed or scripted simulated scenarios,2 and require interactive, inclusive interprofessional collaborative practise, in which students perceive that they are situated in a true-to-life clinical setting.
CONCLUSION With the growing ethical, legal and safety concerns of practising clinical skills on real patients in clinical settings,3 along with high competition for proper clinical practise sites, simulation is rapidly gaining traction in health professional education as an alternative for clinical placement. The main concern that remains vibrant, however, is the effectiveness and transferability of simulation learning into real practice. This article presents a conceptual CSP framework that could assist educators and curriculum developers in optimising the effectiveness of their simulation, leading to simulation learning sticking in the learners’ minds while transitioning into real
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 32–36 35
tct_12291.indd 35
1/14/2015 3:44:14 PM
The simulated practise should also represent the reality of the workplace by focusing on patient-centred collaborative care
Table 1. Clinical simulation practise framework: key strategies Strategies
Impact
Providing a non-judgemental and nonthreatening learning environment
• Ease students’ anxieties and stress
Applying experiential learning along with critical reflection
• Improve students’ engagement in simulation
• Encourage sharing and reflection on thought and ideas
• Assist students in discovering strengths and weaknesses • Assist students in gaining self-confidence
Employing scenarios with some degree of fluidity and flexibility
• Assist students to overcome the limitations of the controlled and structured simulation environment • Add to the realism of the simulation
Replicating the reality of the workplace: a true-to-life simulated clinical setting
• Foster students’ professional growth and professional role learning (competence)
Using interactive, inclusive, interprofessional patient-centred simulated practise
• Improve students’ therapeutic communication, holistic care, collaborative practice, critical thinking and clinical judgement
practice. The main application of this framework for clinical teachers could include the preplanning of clinical simulation by giving adequate consideration to the three dimensions of simulation: the learning environment, the scenario and the simulated practise. The learning environment needs to be safe for students to be able to enjoy and reflect on their performance, the scenario must be realistic and challenging for the students, calling for the application of critical thinking and clinical judgement and the simulated practise should also represent the reality of the workplace by focusing on patient-centred collaborative care, which assists students in bridging the gap between theory and practice. Table 1 provides a summary of the key CSP strategies presented in this article.
REFERENCES 1.
2.
Lasater K. High-fidelity simulation and the development of clinical judgment: students’ experiences. J Nurs Educ 2007;46:269–276. Dunnington RM. The nature of reality represented in high fidelity patient simulation: philosophical perspectives and implications for nursing education. Nurs Philos 2014;14:14–22.
3.
Harper M, Eales-Reynolds L, Markham C. Transforming simulation in clinical education: is preplacement hybrid learning valuable to healthcare students? J Contemp Med Educ 2013;1:15–24.
4.
Jeffries PR ed. Simulation in nursing education, from conceptualization to evaluation. New York: National League of Nursing; 2007.
5.
Nuzhat A, Salem RO, Al Shehri FN, Al Hamdan N. Role and challenges of simulation in undergraduate curriculum. Med Teach 2014;36:69–73.
6.
Seropian MA, Brown K, Gavilanes JS, Driggers B. Simulation: not
just a manikin. J Nurs Educ 2004;43:164–169. 7.
Kardong-Edgren SE, Starkweather AR, Ward LD. The integration of simulation into a clinical foundations of nursing course: student and faculty perspectives. Int J Nurs Educ Scholarsh 2008;5:1–16.
8.
Hammer M, Fox S, Hampton MD. Use of a Therapeutic Communication Simulation Model in Pre-Licensure Psychiatric Mental Health Nursing: Enhancing Strengths and Transforming Challenges. Nurs Health 2014;2:1–8.
9.
Limoges J. An exploration of ruling relations and how they organize and regulate nursing education in the high-fidelity patient simulation laboratory. Nurs Inq 2010;17:57–63
10. Khalili H. High fidelity clinical simulation practice; an innovative approach to improve interprofessional collaboration. All Together Better Health VI (ATBH-VI) Conference, October, 2013, Kobe, Japan.
Corresponding author’s contact details: Hossein Khalili, Coordinator, BIEN and International Partnership & Projects, School of Nursing, Fanshawe College, 1001 Fanshawe College Boulevard, PO Box 7005, London, ON, N5Y 5R6, Canada. E-mail: [email protected]
Funding: None. Conflict of interest: None. Acknowledgements: None. Ethical approval: Not required. doi: 10.1111/tct.12291
36 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 32–36
tct_12291.indd 36
1/14/2015 3:44:14 PM
Copyright of Clinical Teacher is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Clinical simulation practise framework Hossein Khalili BIEN and International Partnership & Projects, School of Nursing, Fanshawe College, London, Ontario, Canada
CSP holds great potential to derive a positive transformation in students’ transition into the workplace
SUMMARY Background: Historically, simulation has mainly been used to teach students hands-on skills in a relatively safe environment. With changes in the patient population, professional regulations and clinical environments, clinical simulation practise (CSP) must assist students to integrate and apply their theoretical knowledge and skills with their critical thinking, clinical judgement, prioritisation, problem solving, decision making, and teamwork skills to provide holistic care and treatment to their patients.
Context: CSP holds great potential to derive a positive transformation in students’ transition into the workplace, by associating and consolidating learning from classrooms to clinical settings, and creating bridges between theory and practice. For CSP to be successful in filling the gap, the design and management of the simulation is crucial. Innovation: In this article a new framework called ‘Clinical simulation practise framework: A knowledge to action strategy in health professional education’ is being introduced that aims to assist educators and curriculum
developers in designing and managing their simulations. This CSP framework theorises that simulation as an experiential educational tool could improve students’ competence, confidence and collaboration in performing professional practice in real settings if the CSP provides the following three dimensions: (1) a safe, positive, reflective and fun simulated learning environment; (2) challenging, but realistic, and integrated simulated scenarios; and (3) interactive, inclusive, interprofessional patient-centred simulated practise.
32 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 32–36
tct_12291.indd 32
1/14/2015 3:44:12 PM
INTRODUCTION The use of simulation has a longstanding history in health professional education.1 Historically, simulation has mainly been used to teach students hands-on (psychomotor) skills in a relatively safe environment.1,2 Learned during laboratory practise, these skills were seen to be key for skill acquisition among students before entering the clinical setting. With current changes in student and patient populations, professional regulations and clinical environments, however, many educational and professional experts believe that skill laboratories are no longer sufficient (although necessary) in preparing students for the transition to a demanding ever-changing workplace.1–5 Students in the health professions, like professionals in the field, are required to take on increasingly complex care management in real workplaces that ‘require a much higher level of critical thinking and clinical judgement skills than in the past’.1 With the advancement of both simulation technology and educational pedagogy, educators and curriculum developers have been provided with an opportunity to extend students’ clinical practice experiences by creating simulated ‘real-life’ clinical settings during their educational tenure.1–3 Clinical simulation practise (CSP), like real clinical practice, requires students to integrate and apply their critical thinking, clinical judgement, prioritisation, problem solving, decision making and teamwork abilities, along with their theoretical knowledge and hands-on skills, to provide holistic care and treatment to their patients.1–4
Students in the health professions, are required to take on increasingly complex care management
complexity. Computerised human patient simulators (HPSs), with an increased level of sophistication and realism, provide highfidelity simulation with realistic lifelike manikins. HPS manikins have the ability to produce physical findings, like heart sounds and pulses, throughout the body, and different physiological actions, including responding to student interventions, breathing, blinking, crying and urinating, similar to patients in a clinical setting.1,6 The use of HPSs in some professional programmes has been seen to be too expensive to adopt because
of the computer programming, technologists, and training for staff and educators required. Add-on technology, such as voice-over technology, new applications and trainers could be used with the low-fidelity manikins, however, adding to the realism and the effectiveness of the simulation. For example, the voice-over technology in which a facilitator (that could be a student) is the voice of the patient speaking from a microphone in a control room could significantly enhance the interaction between the manikin and the student health care providers.
Clinical simulation practise (CSP) could take three different formats, from low to high fidelities, depending on the simulator features and © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 32–36 33
tct_12291.indd 33
1/14/2015 3:44:13 PM
competence, confidence and collaboration in performing professional practice in real settings. To do so, the CSP must provide the following three dimensions:
For CSP to be successful...the design and management of the simulation is crucial
1. a safe, positive, reflective and fun simulated learning environment; 2. challenging, but realistic, and integrated simulated scenarios; and 3. interactive, inclusive and interprofessional patient-centred simulated practise.
Clinical simulation practise (CSP) holds great potential to derive a positive transformation in students’ learning by creating interactive bridges between theory and practice. According to the literature, despite the growing advancement in teaching and learning strategies, students are still facing challenges in applying their theoretical knowledge in real practice, which could be because of the students’ perceived lack of competence and confidence in performing integrated holistic care and treatment.3 For CSP to be successful in filling the gap, as with any other teaching and learning strategy, the design and management of the simulation is crucial.2,4,5 Designing and implementing simulated case scenarios are becoming an integrated component of an educator’s role, and so educators are looking for best practice in using simulation in their education. At the same time, the evidence is still sparse in support of the effectiveness and transferability of simulation learning into real practice. Although the number of research studies evaluating the impact of simulation on students’ learning is increasing, the lack of theoretical and conceptual frameworks underpinning this body of research makes it difficult to compare the findings to draw reliable conclusions.
Hence, this article briefly introduces a new framework called ‘Clinical simulation practise framework: A knowledge to action strategy in health professional education’, developed through integrating the literature and the personal experience of working with post-secondary health professional students in simulation for many years.
CLINICAL SIMULATION PRACTISE FRAMEWORK This CSP framework (Figure 1) theorises that simulation is an experiential educational tool that could improve students’
Safe, Positive, Reflective, & Fun Simulated Learning Environment
A safe, positive, reflective and fun simulated learning environment Simulation is well-known to be a relatively safe environment (compared with clinical practice settings), in which students can make mistakes without facing consequences or putting a human patient in harms way. In my personal simulation experience I also found that providing students with a non-judgemental and non-threatening environment maximises the CSP learning effect. Such a non-judgemental and non-threatening environment allows students to ease their anxieties and stress during performance, and to openly share their thoughts and ideas during debriefing sessions.
Challenging, but Realistic, Integrated Simulated Scenarios
IP ClientCentered Inclusive Simulated Practice
Competent, Confident, Collaborative Professional Student in Real Practice Setting Figure 1. Clinical simulation practise framework: a knowledge-to-action strategy in health professional education (© Khalili, 2013)10
34 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 32–36
tct_12291.indd 34
1/14/2015 3:44:13 PM
Debriefing, with the engagement of students’ self-reflection and discovery skills,7 can provide students with an opportunity to ‘think critically, discuss rationales for behaviour, discover what was done well and what could have been done differently, and integrate lessons learned into their practice’.8 Hence encouraging critical reflection throughout the simulation, in particular during debriefing, is at the heart of CSP. Providing reflection opportunities before, in, and on actions along with maintaining a positive environment by focusing on ‘learning’ assists and encourages students to actively engage in simulation, discovering their strengths and areas in need of further development. The discovery of strengths will assist students to gain confidence and to address their learning needs.9 The role of the educator as facilitator in debriefing is essential. There is a concern that uncorrected or unacknowledged student errors during simulation will ‘become the reality’ that students will ‘perceive as correct and later transfer to the live clinical situation’.2 In fact, it is crucial that educators safeguard against errors of conditions, processes or procedures in simulation, to prevent them from becoming real errors in patient care, by revealing, acknowledging and correcting those errors with students.2 Challenging, but realistic, and integrated simulated scenarios Clinical simulation practise (CSP) is not about skills review and practise, rather it is about placing students in a situation deemed realistic, and assisting students in consolidating their learning to provide holistic care and treatment to the simulated patient. Replicating the reality of the workplace in a simulated environment will foster students’ growth on their road to becoming a professional, and will enable them to prepare for what they
Encouraging critical reflection throughout the simulation is at the heart of CSP
will be expected to do in their professional role. The representation of ‘reality’ in the controlled and structured environment of simulation has been challenged, however.1,2 In a recent publication, Dunnington argued that the representation of reality in simulation, with regards to the complexity and uncertainty of human behaviour, may not be captured in a structured preprogrammed simulation, leading to some limitation in the transferability of simulation learning.2 Using a facilitator as the voice of the patient along with scenarios including some degree of fluidity and flexibility, based on the student’s performance and intervention, allows the student to face the consequences of their decisions and actions, which would add to the realism of the simulation.1 Interactive, inclusive, interprofessional patientcentred simulated practise Other aspects of simulation that are important in CSP include patient-centeredness, the interactivity of patient–student encounters, and the inclusion of family and other health care providers. CSP is about contextual and situated learning, and aims to move beyond hands-on skills training to real-life patient-centred care learning, with an emphasis on therapeutic communication,
holistic care, collaborative practice, critical inquiry, critical thinking, clinical judgement, prioritisation, problem solving, decision making, time management and organisational skills.1,2,8 These complex contexts are ‘less producible in the linear, sequential texture’ represented in preprogrammed or scripted simulated scenarios,2 and require interactive, inclusive interprofessional collaborative practise, in which students perceive that they are situated in a true-to-life clinical setting.
CONCLUSION With the growing ethical, legal and safety concerns of practising clinical skills on real patients in clinical settings,3 along with high competition for proper clinical practise sites, simulation is rapidly gaining traction in health professional education as an alternative for clinical placement. The main concern that remains vibrant, however, is the effectiveness and transferability of simulation learning into real practice. This article presents a conceptual CSP framework that could assist educators and curriculum developers in optimising the effectiveness of their simulation, leading to simulation learning sticking in the learners’ minds while transitioning into real
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 32–36 35
tct_12291.indd 35
1/14/2015 3:44:14 PM
The simulated practise should also represent the reality of the workplace by focusing on patient-centred collaborative care
Table 1. Clinical simulation practise framework: key strategies Strategies
Impact
Providing a non-judgemental and nonthreatening learning environment
• Ease students’ anxieties and stress
Applying experiential learning along with critical reflection
• Improve students’ engagement in simulation
• Encourage sharing and reflection on thought and ideas
• Assist students in discovering strengths and weaknesses • Assist students in gaining self-confidence
Employing scenarios with some degree of fluidity and flexibility
• Assist students to overcome the limitations of the controlled and structured simulation environment • Add to the realism of the simulation
Replicating the reality of the workplace: a true-to-life simulated clinical setting
• Foster students’ professional growth and professional role learning (competence)
Using interactive, inclusive, interprofessional patient-centred simulated practise
• Improve students’ therapeutic communication, holistic care, collaborative practice, critical thinking and clinical judgement
practice. The main application of this framework for clinical teachers could include the preplanning of clinical simulation by giving adequate consideration to the three dimensions of simulation: the learning environment, the scenario and the simulated practise. The learning environment needs to be safe for students to be able to enjoy and reflect on their performance, the scenario must be realistic and challenging for the students, calling for the application of critical thinking and clinical judgement and the simulated practise should also represent the reality of the workplace by focusing on patient-centred collaborative care, which assists students in bridging the gap between theory and practice. Table 1 provides a summary of the key CSP strategies presented in this article.
REFERENCES 1.
2.
Lasater K. High-fidelity simulation and the development of clinical judgment: students’ experiences. J Nurs Educ 2007;46:269–276. Dunnington RM. The nature of reality represented in high fidelity patient simulation: philosophical perspectives and implications for nursing education. Nurs Philos 2014;14:14–22.
3.
Harper M, Eales-Reynolds L, Markham C. Transforming simulation in clinical education: is preplacement hybrid learning valuable to healthcare students? J Contemp Med Educ 2013;1:15–24.
4.
Jeffries PR ed. Simulation in nursing education, from conceptualization to evaluation. New York: National League of Nursing; 2007.
5.
Nuzhat A, Salem RO, Al Shehri FN, Al Hamdan N. Role and challenges of simulation in undergraduate curriculum. Med Teach 2014;36:69–73.
6.
Seropian MA, Brown K, Gavilanes JS, Driggers B. Simulation: not
just a manikin. J Nurs Educ 2004;43:164–169. 7.
Kardong-Edgren SE, Starkweather AR, Ward LD. The integration of simulation into a clinical foundations of nursing course: student and faculty perspectives. Int J Nurs Educ Scholarsh 2008;5:1–16.
8.
Hammer M, Fox S, Hampton MD. Use of a Therapeutic Communication Simulation Model in Pre-Licensure Psychiatric Mental Health Nursing: Enhancing Strengths and Transforming Challenges. Nurs Health 2014;2:1–8.
9.
Limoges J. An exploration of ruling relations and how they organize and regulate nursing education in the high-fidelity patient simulation laboratory. Nurs Inq 2010;17:57–63
10. Khalili H. High fidelity clinical simulation practice; an innovative approach to improve interprofessional collaboration. All Together Better Health VI (ATBH-VI) Conference, October, 2013, Kobe, Japan.
Corresponding author’s contact details: Hossein Khalili, Coordinator, BIEN and International Partnership & Projects, School of Nursing, Fanshawe College, 1001 Fanshawe College Boulevard, PO Box 7005, London, ON, N5Y 5R6, Canada. E-mail: [email protected]
Funding: None. Conflict of interest: None. Acknowledgements: None. Ethical approval: Not required. doi: 10.1111/tct.12291
36 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 32–36
tct_12291.indd 36
1/14/2015 3:44:14 PM
Copyright of Clinical Teacher is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
