IntroductionIn medicaleducation, simulation teaching is commonly used to teach clinical skills and toassess competencies. Unlike standardized patients, simulators are easilyavailable, may repeat in several clinical settings and provide realistic experienceto learners.1 The practice with high-standards simulators hadsuggested promising role in the development of problem solving and clinicalreasoning skills.2 Previous studiesshowed that effective use of medium fidelity simulator helped students in themanagement of medical emergencies3 and learning outcomes increased interms of application of knowledge, mastering skills in a safe environment,communication skills, handling medical emergencies confidently and willingnessto participate in emergency situation.5 Study with novice faculty members and students found that the experienceallowed them to choose effective way of teaching and learning clinical skills.
4As the new teaching modality, recent studies attempted in Saudi Arabia todemonstrate that through simulation teaching student cognitive and psychomotorskills could be assured.6-8 The primary aim of this study was to assess the medicalstudent experience of simulation for regarding their clinical skills. Inaddition, to explore further the challenges and implicationof simulation method in clinical practice in order to help the medical educators to improve the simulationteaching for curriculum development and experiential learning. Methods This was amixed method design in which the quantitative investigation was collected with astructured questionnaire on five point Likert scale and a qualitativeevaluation using an interpretivist framework collected through semi structuredfocus group interviews with internees. We used mixed method to get a better understandingof the problems than using either method alone (Crosswell & Plano Clarke,2007). The combination of quantitative and qualitative methods provides anaccurate nature of the subject matter and reflects on the diversity of the neededknowledge (Flemming, 2007).
With triangulation theresults may be used to produce a comprehensive representation of the problembeing studied (Sands & Roer-Strier, 2006). Theoretical frameworkThe underpinning theoreticalframework of this study framed on Kolb’s experiential learning. Simulation usein teaching stimulates student’s experience of critical thinking, decisionmaking, clinical skills and professional behaviour. Experiential learning iscapable of stimulating students to reflect on the potential benefit of theirlearning experience. This type of experiential learning also provideopportunities to acquire decision making, motivation to engage in problemsituation by using critical thinking (Facione et al 2000). An interpretivistframework was used in which data collected through semi structured interviews. Subject of the studyFor inclusion of the participants, non-probabilityconvenience sampling technique was utilized.
All pre-clinical and clinical years students(n=900) exposed to simulation based learningwere invited to participate in the present study. Focus group interviewsThe investigatorsrecruited volunteer internees n=6 from National GuardHealth Affairs hospital. A semi structured focus group interview was conductedby the first author using open ended questions. Since the use ofsimulation is new method of experiential learning, these results are importantto improve the curriculum and learning strategies.ToolA self-administered structured questionnaireconsisting of 20 items on a Likert scale was used to get the responses of thestudents.
Items were scored as 5 – for strongly agree, 4 – for agree, 3 – for don’tknow, 2 – for disagree and 1 – for strongly disagree. The mainvariables included in the questionnaire were quality of tutor’s feedback, deliberate practice, simulation fidelity, skillsacquisition, problem solving and availability of facilities. The reliability of thescale was checked the overall Cronbach’s alpha was 0.
76. Sample Size EstimationSample size was calculated by using the Raosoft software.Keeping confidence level of 95 percent and margin of error at 10%, withthe population size with 50% response distribution the calculated sample sizewas 270 students.Ethical considerationThis study sought ethical approvalfrom King Abdullah International Medical Research Center (KAIMRC) of theUniversity to protect the rights of the participants. Information regardingstudy objective was given to participants.
They were assured about the privacy and confidentiality of the information. ProcedureSubsequently, a written consent from thestudents was obtained. A pre-structured questionnaire with demographic information was distributedafter simulated sessions.
The whole procedure took not more than 10to 20 minutes. The information on all the domains of the questionnaire waschecked for any missing information in student’s presence. Student wasrequested to provide missing information. Following, focus groupinterview was recorded and transcribed verbatim in addition to interviewer’s notes.
No incentive forparticipation was offered. Data wasfiled and organized in computer folders. Data analysisFor quantitativestudy, the data was encoded into SPSS Version 20 sheet. Mean and StandardDeviation was calculated for continuous variables like age whilepercentage/proportion was reported for categorical variables like yearcurrently studying. ANOVA was used to assess the differences across domains anddemographics. Qualitatively,interviews were transcribed and open coded for emergentthemes and subthemes and analyzed by using the Glaser (1965)9 constantcomparison method.
Theme codes were categorized as main and sub themes. Thiswas done by two researchers to include areas of agreement and to avoid disputedthemes.