Joanne M. Baird, Ketki D. Raina, Joan C. Rogers, John O’Donnell, Margo B. Holm; Wheelchair Transfer Simulations to Enhance Procedural Skills and Clinical Reasoning. Am J Occup Ther 2015;69(Supplement_2):6912185020. https://doi.org/10.5014/ajot.2015.018697
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© 2020 American Occupational Therapy Association
OBJECTIVE. We describe an educational intervention that involved simulation scenarios of medically complex patients to teach transfer training and promote clinical reasoning.
METHOD. Scenarios were developed with practitioner input that described (1) a patient who was acutely ill, (2) a critical medical management event that occurred during a bed-to-wheelchair transfer of the patient, and (3) an occupational need. Transfer training, using the scenarios, occurred in a high-technology laboratory with SimMan® and a mock hospital suite. Evaluation was based on student performance and perceptions of simulation effectiveness.
RESULTS. On average, students completed 66%–88% of the transfer items correctly. Student performance suggested that the simulation scenarios were more difficult than practitioners rated them. Students rated the simulation scenarios as effective teaching tools.
CONCLUSION. Scenario use in simulations for transfer training makes a positive curricular contribution to teaching procedural skills and clinical reasoning simultaneously.
Some things just cannot be taught in the classroom. It takes repeated exposure in a clinical setting to begin to develop confidence. . . . The [WISER Center] was a great introduction so that I didn’t feel like I was going in[to my clinical fieldwork] blind.
When I went to the [WISER Center], I hated it. It was stressful, and I thought the clinic wouldn’t be anything like that. Looking back, I almost think the scenarios should be more complicated—like real patients are. It really helped me [during my fieldwork] because I knew how important it was to watch vital signs carefully before you begin any type of treatment.
Human patient simulation challenges students to develop clinical reasoning and procedural skill components of practice simultaneously. The use of full-body simulators was effective in teaching students dependent bed-to-wheelchair transfers. The use of scenarios with critical events prepared students for unexpected contingencies.
Although the scenarios had learning benefits, they also had teaching benefits. Using the same performance criteria for the transfers as in the classroom provided a consistent format for assessment and guided instruction. For example, if multiple students evidenced difficulty with a specific skill set, such as one aspect of equipment management, those skills could be retaught, either in the classroom or by digital video review.
Simulation can be effectively included in existing course designs and need not be burdensome. Addressing multiple skills (hands-on procedural skills and clinical reasoning skills) simultaneously and including different settings (classroom, simulated acute care environment) provides intensive practice that may translate to other areas of proficiency and can thus save curricular resources.
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