Comparing self-guided learning and educator-guided learning formats for simulation-based clinical training

Authors

  • Ryan Brydges,

    1. Ryan Brydges PhD Post Doctoral Fellow The Wilson Centre, University of Toronto, Ontario, Canada, and Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
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  • Heather Carnahan,

    1. Heather Carnahan PhD Professor The Wilson Centre, University of Toronto, Ontario, Canada, and Department of Occupational Science and Occupational Therapy, University of Toronto, Ontario, Canada
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  • Don Rose,

    1. Don Rose PhD Associate Professor Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
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  • Adam Dubrowski

    1. Adam Dubrowski PhD Assistant Professor The Wilson Centre, University of Toronto, Ontario, Canada, and Learning Institute, Hospital for Sick Children, University of Toronto, Ontario, Canada
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R. Brydges: e-mail: r.brydges@gmail.com

Abstract

brydges r., carnahan h., rose d. & dubrowski a. (2010) Comparing self-guided learning and educator-guided learning formats for simulation-based clinical training. Journal of Advanced Nursing66(8), 1832–1844.

Abstract

Title. Comparing self-guided learning and educator-guided learning formats for simulation-based clinical training.

Aim.  In this paper, we tested the over-arching hypothesis that progressive self-guided learning offers equivalent learning benefit vs. proficiency-based training while limiting the need to set proficiency standards.

Background.  We have shown that self-guided learning is enhanced when students learn on simulators that progressively increase in fidelity during practice. Proficiency-based training, a current gold-standard training approach, requires achievement of a criterion score before students advance to the next learning level.

Methods.  Baccalaureate nursing students (n = 15/group) practised intravenous catheterization using simulators that differed in fidelity (i.e. students’ perceived realism). Data were collected in 2008. Proficiency-based students advanced from low- to mid- to high-fidelity after achieving a proficiency criterion at each level. Progressive students self-guided their progression from low- to mid- to high-fidelity. Yoked control students followed an experimenter-defined progressive practice schedule. Open-ended students moved freely between the simulators. One week after practice, blinded experts evaluated students’ skill transfer on a standardized patient simulation. Group differences were examined using analyses of variance.

Results.  Proficiency-based students scored highest on the high-fidelity post-test (effect size = 1·22). An interaction effect showed that the Progressive and Open-ended groups maintained their performance from post-test to transfer test, whereas the Proficiency-based and Yoked control groups experienced a significant decrease (P < 0·05). Surprisingly, most Open-ended students (73%) chose the progressive practice schedule.

Conclusion.  Progressive training and proficiency-based training resulted in equivalent transfer test performance, suggesting that progressive students effectively self-guided when to transition between simulators. Students’ preference for the progressive practice schedule indicates that educators should consider this sequence for simulation-based training.

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