Date Presented 4/19/2015
The literature indicates a void in the use of simulation during occupational therapy education. This study reveals that the addition of simulated learning in a high-acuity medical setting enhances student self-efficacy and preparedness for Level I fieldwork (FW) in medical contexts. Further study is required.
SIGNIFICANCE: Acute care fieldworks (FWs) are often anxiety provoking for students, and preparing for FW is an identified area of growth by our program’s clinical FW supervisors. To better enhance student readiness, a blended approach, involving use of simulation (sim), was taken. Students’ self-efficacy was enhanced as was the Level I FW supervisor feedback on student preparedness.
INNOVATION: This project involves the use of sim and standardized patients (SPs) to augment student learning in preparation for Level I FW as compared to traditional lecture and classroom-based lab experiences alone.
Simulated client encounters have been used in medicine since the 1990s. Moreover, the use of SPs in medicine has been proven to assist with the integration of classroom learning. A review of occupational therapy literature revealed a void on occupational therapy acute care sim yet did reveal the successful use of sim in cardiopulmonary physical therapy.
METHOD: A pre–post, within-/between-subjects, quasi-experimental design was used to study the effect of sim on students’ self-efficacy. A descriptive design was used to learn from students and clinical supervisors about perceived readiness for Level I FW. The setting took place on two campuses of a Midwest university. Forty-six female and 2 male entry-level occupational therapy students were recruited via convenience sampling: 26 from one campus (CC1) and 22 from another campus (CC2).
A pretest survey on self-efficacy was given to all. All participated in (1) online readings on acute care context/occupational therapy process, (2) classroom-based lectures on context and functional meaning of lab values/vital signs, (3) classroom-based labs on transfers/mobility, and (4) demonstration of occupational therapist (OT)–client encounter sim. In groups of two, CC1 students participated in 15-min encounters in a sim lab with SPs under video surveillance by two OTs with acute care experience. CC2 students participated in 15-min small group encounters during classroom-based sim but with instructors as clients and direct surveillance by experienced instructors. CC1 students received individualized written feedback, and both groups engaged in 30-min debriefings after sim. Afterward, a posttest survey was given. Following a medical-based Level I FW experience, feedback was sought from FW educators and students. Descriptives for pre- and posttest results were analyzed as were the within-/between-subjects differences (Wilcoxon signed-rank test).
RESULTS: Surveys used a 7-point ordinal scale to measure confidence in (1) gathering needed information; (2) interviewing; (3) determining physiological readiness; (4) helping a client with multiple lines; (5) adjusting occupational therapy session; (6) planning level of care; and understanding (7) occupational therapy process, (8) occupational therapy roles, and (9) the functional meaning of lab values/vital signs. All within-subjects results significantly improved (z > 3.0, p < .0001). Two significant between-groups differences, in favor of CC1 students, were found: determining physiological readiness (p = .005) and helping clients with multiple lines (p = .05). Feedback by Level I FW supervisors reflected this confidence.
CONCLUSION: Sim enhances student confidence and medical Level I FW performance. The use of SPs/individualized feedback enhances self-efficacy in assessing the physiological readiness and managing multiple lines. Limitations of this study include the following: groups were not randomized to an experience, and the effect of related work experience was not considered. The effects of traditional education and sim are combined and thus cannot be compared.
