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In medical education, simulation teaching is commonly used to teach clinical skills and to assess competencies. Unlike standardized patients, simulators are easily available, may repeat in several clinical settings and provide realistic experience to learners.1 The practice with high-standards simulators had suggested promising role in the development of problem solving and clinical reasoning skills.2 Previous studies showed that effective use of medium fidelity simulator helped students in the management of medical emergencies3 and learning outcomes increased in terms of application of knowledge, mastering skills in a safe environment, communication skills, handling medical emergencies confidently and willingness to participate in emergency situation.5 Study with novice faculty members and students found that the experience allowed them to choose effective way of teaching and learning clinical skills.4 As the new teaching modality, recent studies attempted in Saudi Arabia to demonstrate that through simulation teaching student cognitive and psychomotor skills could be assured.6-8 The primary aim of this study was to assess the medical student experience of simulation for regarding their clinical skills. In addition, to explore further the challenges and implication of simulation method in clinical practice in order to help the medical educators to improve the simulation teaching for curriculum development and experiential learning.
This was a mixed method design in which the quantitative investigation was collected with a structured questionnaire on five point Likert scale and a qualitative evaluation using an interpretivist framework collected through semi structured focus group interviews with internees. We used mixed method to get a better understanding of the problems than using either method alone (Crosswell & Plano Clarke, 2007). The combination of quantitative and qualitative methods provides an accurate nature of the subject matter and reflects on the diversity of the needed knowledge (Flemming, 2007). With triangulation the results may be used to produce a comprehensive representation of the problem being studied (Sands & Roer-Strier, 2006).
The underpinning theoretical framework of this study framed on Kolb’s experiential learning. Simulation use in teaching stimulates student’s experience of critical thinking, decision making, clinical skills and professional behaviour. Experiential learning is capable of stimulating students to reflect on the potential benefit of their learning experience. This type of experiential learning also provide opportunities to acquire decision making, motivation to engage in problem situation by using critical thinking (Facione et al 2000). An interpretivist framework was used in which data collected through semi structured interviews.
Subject of the study
For inclusion of the participants, non-probability convenience sampling technique was utilized. All pre-clinical and clinical years students (n=900) exposed to simulation based learning were invited to participate in the present study.
Focus group interviews
The investigators recruited volunteer internees [n=6] from National Guard Health Affairs hospital. A semi structured focus group interview was conducted by the first author using open ended questions. Since the use of simulation is new method of experiential learning, these results are important to improve the curriculum and learning strategies. Tool A self-administered structured questionnaire consisting of 20 items on a Likert scale was used to get the responses of the students. Items were scored as 5 – for strongly agree, 4 – for agree, 3 – for don’t know, 2 – for disagree and 1 – for strongly disagree. The main variables included in the questionnaire were quality of tutor’s feedback, deliberate practice, simulation fidelity, skills acquisition, problem solving and availability of facilities. The reliability of the scale was checked the overall Cronbach’s alpha was 0.76. Sample Size Estimation Sample size was calculated by using the Raosoft software. Keeping confidence level of 95 percent and margin of error at 10%, with the population size with 50% response distribution the calculated sample size was 270 students. Ethical consideration This study sought ethical approval from King Abdullah International Medical Research Center (KAIMRC) of the University to protect the rights of the participants. Information regarding study objective was given to participants. They were assured about the privacy and confidentiality of the information.
Subsequently, a written consent from the students was obtained. A pre-structured questionnaire with demographic information was distributed after simulated sessions. The whole procedure took not more than 10 to 20 minutes. The information on all the domains of the questionnaire was checked for any missing information in student’s presence. Student was requested to provide missing information. Following, focus group interview was recorded and transcribed verbatim in addition to interviewer’s notes. No incentive for participation was offered. Data was filed and organized in computer folders.
For quantitative study, the data was encoded into SPSS Version 20 sheet. Mean and Standard Deviation was calculated for continuous variables like age while percentage/proportion was reported for categorical variables like year currently studying. ANOVA was used to assess the differences across domains and demographics. Qualitatively, interviews were transcribed and open coded for emergent themes and subthemes and analyzed by using the Glaser (1965)9 constant comparison method. Theme codes were categorized as main and sub themes. This was done by two researchers to include areas of agreement and to avoid disputed themes.
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