In 2021 the Department of Health and Social Care (DHSC) announced funding of up to £15 million for English universities to rapidly expand simulated learning for nursing and other healthcare students (DHSC, 2021), this was initially driven by the need to provide flexibility during the pandemic and lockdown restrictions, and was supported by the Nursing and Midwifery Council (NMC), who supported up to 300 hours of pre-registration practice education to be delivered via simulation.
In January this year, Devereux (2023) reported that the Nursing and Midwifery Council (NMC) has approved changes to the pre-registration education standards. The changes included a doubling of the number of hours that nursing students can receive in their programme for simulated practice learning. Education institutions will now be able to run simulation learning for 600 of the 2300 practice learning hours that students need to complete. This is double the amount that was previously permitted.
While on an interview panel for an education role recently, I asked the candidates their view on the use of simulation. The NMC (2019) defines simulation as:
‘An artificial representation of a real-world practice scenario that supports student development and assessment through experiential learning with the opportunity for repetition, feedback, evaluation and reflection.’
.I was surprised to hear some of the views of different candidates, some colleagues sharing their views on the opportunities that simulation affords, and others strongly against the use of simulation stating that ‘students always prefer the “real hands-on practice”’.
In my experience, simulation has been a popular option allowing students to practise their clinical skills in a safe and controlled environment, often with the aid of high-fidelity mannikins or computerised simulations, providing an opportunity for learners to gain real-life experience without putting patients at risk.
On looking at the evidence base, I found that there has been a great deal published on this topic, and although there are some gaps in the evidence base, and a call for wider research, all that I have read was largely very positive regarding simulation training, for example:
- Hegland et al (2017) undertook a systematic review with the aim of evaluating effect of simulation-based training on nurses' skills and knowledge, they found that simulation-based training is an effective strategy to improve nurses' skills. They also concluded that simulation can be an element in a tailored strategy to improve healthcare quality and reduce errors
- Sterner et al (2022) used a pre-measurement and a post-measurement scale to test the outcomes of simulation-based training. They explored the influence of simulation-based education on a group of 102 new graduate nurses, specifically the perceived ability to provide care in acute situations. Their study showed that simulation-based education resulted in a statistically significant change in the nurses' perceptions of their ability to care in acute situations
- Koukourikos et al (2021) undertook a literature review to present modern data related to simulation. Their findings were that the implementation of simulation enables students to practise their clinical and decision-making skills for some significant issues they may face in their daily work. In addition, the protected environment, and the sense of security experienced, enhances students' self-esteem and confidence, thus promoting learning. In this way, they concluded that the gap between theory and practice is substantially reduced.
‘Simulation allows students to practise their skills in a safe and controlled environment’
I think that overall, the potential for the increased use of simulation is a welcome one. However, it is quite a significant change for many institutions and readiness is an issue from both a cost and infrastructure perspective as well as the availability of skilled simulation teaching staff. The evidence base does appear to clearly state that there are significant benefits to both learners and patients using simulation and I see this as an opportunity for healthcare providers to work in stronger partnerships with higher education institutions to deliver high-quality simulation training as a step towards professional registration.