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“Clinical simulation is a widely used teaching methodology in health science studies. It fosters a safe environment to carry out their practices in a similar way to how they would do it in real life.”
The physical examination allows healthcare professionals to obtain data related to the health condition of their patients. This exam begins with a global assessment and then a focused exploration to know the specific aspects of each person (Jensen, 2012). This article addresses the physical examination of adults (i.e., over 15 years old) when they pass from pediatric to adult consultation. At this stage, the physical exam gathers data through inspection, palpation, auscultation, and percussion (Gallego, 2015). To care for adults, nurses require a high level of knowledge and technical skills.
This preparation for delivering excellent care must be sustained by good attitudes, values, and communication that foster a relationship of trust between the caregiver and patient. This relationship must be safeguarded by safety precautions to minimize the risk of damage to both the attended patients and the nurses.
In the Nursing Degree program at the University of Girona in Spain, students acquire the professional competencies, attitudes, and skills necessary to practice healthcare, attending the illness of any person, regardless of age, gender, or social status.
Clinical simulation for learning
Clinical simulation is a teaching methodology widely used in health science studies. It offers students a safe environment to conduct their practices similar to real life. In nursing studies, the simulation clinic is usually integrated into clinical practice subjects, often in the second year when the student already has some theoretical knowledge of the discipline. When incorporating this tool into a class, one must consider the fidelity of the simulation, which is defined as “the credibility or degree to which a simulation approximates reality;” it includes physical, psychological, emotional, social, and cultural factors.
“Clinical simulation allows, in addition to learning physical examination techniques and their application to the anatomy of the person, learning communication and safety skills to interact with the patient, critical thinking and teamwork.”
Historically, the demand on the student body has been to arrive in the clinical environment as prepared as possible to perform the best. For students, the experience of applying and integrating knowledge must occur in a safe environment where they can make mistakes in the place of learning without causing harm to third parties or themselves (Fuentes-Pumarola, C. et al., 2016). To offer experiential learning to students in the Faculty of Nursing of the University of Girona, we integrated clinical simulation into the curriculum to learn to perform the physical examination of an adult person safely. To fortify their knowledge, the students conduct an activity called debriefing, or post-analysis, to identify errors or failures in their simulation practices to identify improvement opportunities and accelerate the learning curve. The scientific evidence gathered about the simulation indicates that it is an effective methodology to learn the students’ competencies. The simulations generate high satisfaction among the teaching team and students (Cant & Cooper, 2010,2017; Schubert, 2012).
Teaching experience integrating clinical simulation in class
In the nursing specialty of the University of Girona, we integrate clinical simulation within a first-year subject called Nursing Care for the Healthy Person throughout the Life Cycle. Students learn to perform physical examinations on adults through simulations. This experience is innovative in several respects:
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It includes simulation within a theoretical subject;
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It incorporates this methodology in the early stages of training (first year of degree), and
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It integrates high-fidelity simulation in a clinical nursing environment with a person who acts as a standardized patient.
We also use a supporting computer platform for the simulation that facilitates its application and evaluation. Groups of 20 students in pairs perform the physical examination of the body systems of a 70-year-old woman who interacts with them as an actual patient. The students learn physical examination techniques and how their findings apply to the patient’s anatomy through the simulation. They develop communication and safety skills to interact with the patient, work in teams, and develop critical thinking. The simulation activity is video recorded in the computer platform for review by the teachers and students later during the debriefing.
About the assessment of the simulation, the simulation platform allows its evaluation by the teaching staff. This actress intervenes as a standardized patient, the students (self-evaluation), and, finally, the co-evaluation among the students. In this way, various qualifications (grades and scores) are attained, but the students also analyze and reflect on the simulation at different times, thus achieving a foundation of learning. The teaching team and the students valued the experience as very satisfactory. It was possible to verify that the grades obtained during the simulations increased as an indicator of advancement in learning (Roqueta-Vall-llosera et al., 2021).
Reflection
To continue improving this learning experience, we must identify the errors in simulation practices and note the improvement of students’ practices after the debriefing. Likewise, it is necessary to look for simulation environments as faithful as possible to the usual care practice.
We share this experience to demonstrate that clinical simulation is a teaching methodology that can be applied in different subjects in medicine for students who begin their studies, especially when faced with complex scenarios.
The authors intend to encourage other teachers to apply this methodology in their classes. We are open to sharing more details of this experience that is valued as very positive. It has improved the quality of nursing students’ learning and greatly satisfied all the actors involved.
About the authors
María del Carmen Malagón Aguilera (carme.malagon@udg.edu) Nurse. Social Gerontologist. Masters in Medical-S
urgical Care. Masters in Health Promotion. Ph.D. from the University of Girona. Member of the Health and Sanitary Care research group. Associate Professor in the Department of Nursing of the University of Girona.
Marta Roqueta Vall-llosera (marta.roqueta@udg.edu) Nurse Specialist in Obstetrics and Gynecology, Midwife. Masters in Health Promotion. Associate Professor in the Department of Nursing of the University of Girona.
Josep Olivet Pujol (josep.olivet@udg.edu) Nurse specialist in medical-surgical care. Postgraduate in pre-hospital care. Masters in Health Promotion. Ph.D. from the University of Girona. Professor in the Department of Nursing of the University of Girona.
Glòria Reig Garcia (gloria.reig@udg.edu) Nurse. Masters in Health Promotion. Ph.D. from the University of Girona. Research professor in the Department of Nursing at the University of Girona.
References
Cant, RP, and Cooper, SJ. (2010). Simulation‐based learning in nurse education: a systematic review. Journal of Advanced Nursing, 66 (1), 3-15, 10.1111/j.1365-2648.2009.05240.x
Cant, RP, and Cooper, SJ. (2017). Use of simulation-based learning in undergraduate nurse education: An umbrella systematic review. Nurse Education Today, 49, 63-71. 10.1016/j.nedt.2016.11.015
Fuentes-Pumarola, C., Ballester-Ferrando, D., Gelabert-Vilella, S., Bosch-Farré, C., Malagón-Aguilera, MC., Rascón-Hernán, C., Bonmatí-Tomàs, A., Fernandez-Peña, R. (2016). Nursing student and professor perceptions and assessments of the achievement of practicum competencies: A mixed-method approach. Nurse Education Today.45:199-205. doi: 10.1016/j.nedt.2016.08.013.
Facultad de Enfermería (2019). Memoria de los estudios de Grado en Enfermería de la Universidad de Girona de marzo de 2019. Modificación aprobada por el Consejo de Gobierno de la UdG. Universidad de Girona.
Miller, GE. (1990) The assessment of clinical skills/competence/performance. Academic Medicine.65 (9 Suppl):63-7. doi: 10.1097/00001888-199009000-00045.
Jeffries, PR., Clochesy,JM. (2013). Clinical simulations: An experiential, student-centered pedagogical approach. En DM, Billings and JA,Halstead (Eds). Teaching in nursing: A guide for faculty (4th ed.), Elsevier Health Sciences.
Jensen, S. (2012). Valoración de la salud en enfermería. Una guía para la práctica. Madrid: Wolters Kluwer/Lippincott Williams & Wilkins, D.L.
Schubert, C.(2012)Effect of Simulation on Nursing Knowledge and Critical Thinking in Failure to Rescue Events. Journal of Continuing Education in Nursing, 43 (10),467-471, 10.3928/00220124-20120904-27
Roqueta-Vall-llosera, M., Malagón-Aguilera, MC., Olivet-Pujol, J., Bonmatí-Tomàs, A., Gelabert-Vilella, S., Bosch-Farré, C. (2021). Flipped classroom i simulació clínica, de la teoría a la pràctica amb aprenentatges actius i basat en una plataforma digita. Revista del Congrés Internacional de Docència Universitària i Innovació (CIDUI). En premsa
Villoslada, R; Núñez, N; Madera, A; González, N; González, B; Casado, V. (2017). Importancia del control del adulto sano. Medicina de Familia, 43,3918
Edited by Rubí Román (rubi.roman@tec.mx) – Observatory of Educational Innovation.
Translation by Daniel Wetta.
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