Contextualising simulation: the use of patient-focused hybrid simulation for clinical skills education

Abstract

This thesis documents a research programme into the use of Patient-Focused Hybrid Simulation (PFHS) for clinical skills education. PFHS is an approach to simulating clinical skills that combines a simulated patient (SP) with a part-task trainer (PTT) embedding the simulation of procedural skills within a more holistic clinical context, potentially overcoming some of the shortcomings of single modality simulation. Although promising, there remains limited evidence supporting its use. Two studies were conducted using a mixed-method approach. The first study was based on the simulation of the management of a traumatic skin laceration and consisted of two parts: 1) investigating the use of PFHS as a means of introducing clinical challenge by modifying the clinical context in which a procedure is performed; 2) exploring clinician’s perception of the use of PFHS and PTT for assessing of clinical competence. These findings suggest that by changing the clinical context in which a procedure is performed, PFHS can potentially be used to objectively simulate challenge. It also demonstrated that PFHS when compared to PTT simulations was better able to induce authentic clinical behaviour within the simulation. Central to this is the presence of a human being (SP). The second study compared the use of PFHS to patients for the training and assessment of cardiovascular examination skills. Within the limitations of this study, no significant difference was observed between PFHS and real patient-trained students in terms of their post-training performance of cardiovascular examination on real patients. There also appeared to be degree of concurrent validity between assessment of competency with PFHS and with real patients when conducted as an Objective Structured Clinical Examination (OSCE). The work presented provides additional evidence to the existing literature to support the use of PFHS in clinical skills education. However, it also raises a multitude of questions particularly of how PFHS as well as simulation in general should be used and future directions for simulation research.