Simulation plays an important role as an alternative method for training of students, particularly in health education. As a result of coronavirus disease 2019 (COVID-19) restrictions of face-to-face interactions, traditional teaching methods have been disrupted, increasing the need for alternative methods to supplement modes of student clinical training in healthcare programmes.
The scoping review aimed to determine what has been documented about simulation as a mode of clinical training in healthcare professions (HCPs) in order to guide speech-language pathology and audiology (SLP&A) professions during the COVID-19 pandemic and beyond.
A scoping review was conducted. Electronic bibliographic databases including Science Direct, PubMed, Scopus MEDLINE, ProQuest, Google Scholar and WorldCat were searched to identify peer reviewed publications, published in English, between January 2011 and December 2021, and related to the use of simulation in HCPs clinical training programmes.
A total of 32 articles met the inclusion criteria for this scoping review. Three themes emerged when reviewing the studies: (1) face-to-face simulations as a mode of clinical training, (2) virtual reality simulation and telesimulation as modes of clinical training and (3) simulation as a complementary mode of clinical training. Evidence suggests that whilst simulations are cost-effective, accessible and efficacious as clinical training modes, they need to be combined with other modes of training such as the traditional clinical training to yield better learning outcomes.
Current findings highlight the role and value of simulation as a clinical training mode during COVID-19 and beyond. However, there are aspects that need to be considered to ensure that this mode of clinical training is effective, with endorsement and regulations by the SLP&A Professional Board of the Health Professions Council of South Africa (HPCSA). Simulations need to be complemented with traditional clinical training methods. In the context of SLP&A, particularly in low- and middle-income countries (LMICs), simulation can be used to better prepare students for their clinical placement where clinical training platforms are limited and where simulation combined with teletraining or telesupervision can be utilised to increase access to training.
Simulations may be defined as scenarios that are artificially created to study or experience something that is possible in real life (Al-Elq,
To meet the growing demand for speech-language pathologists and audiologists, international and national universities that offer speech-language pathology and audiology (SLP&A) programmes were obliged to increase the intake of students into these programmes. However, this increased intake of students may have resulted in overburdening training platforms and university staff members who accommodate and facilitate SLP&A programmes (McAllister & Lincoln,
In addition to the high student-to-staff ratio, there is a clinical training platform challenge where there is a shortage of clinical placement sites, which may result in fewer learning opportunities and an increase in number of HCP students competing for supervision and access to the same patients (Feingold, Calaluce, & Kallen,
Furthermore, the American Speech-Language-Hearing Association (ASHA
The coronavirus disease 2019 (COVID-19) pandemic has additionally undoubtedly added to the aforementioned challenges by disrupting the clinical training in HCPs, where clinical training activities had to either be cancelled, paused or postponed (Haridy, Abdalla, Kaisarly, & Gezawi,
All these challenges highlight the need for innovative modes of providing clinical training during public health emergencies, such as during the COVID-19 pandemic, as well as beyond. Technological advances embedded within telehealth have been documented to be valuable to overcome these challenges, even as part of hybrid approaches to clinical training (Khoza-Shangase, Moroe, & Neille,
Therefore, in light of the benefits of simulation training, the resource constraints that may affect HCP students’ learning and achievement of the core clinical competencies and the impact that COVID-19 has had on traditional clinical training of student HCPs, this scoping review was aimed at exploring published evidence on simulations as a mode of clinical training in HCPs, to plan for SLP&A training during the COVID-19 pandemic and beyond.
The researchers utilised the framework outlined by Arksey and O’Malley (
Additionally, the authors followed Levac, Colquhoun and O’Brien’s (
This scoping review sought to answer the following research question: ‘what has been documented about simulation as a mode of clinical training in HCPs?’ This research question was prompted by the need for alternative or supplemental modes of traditional clinical training to account for clinical training challenges encountered by SLP&A programmes during the COVID-19 pandemic. Findings from this scoping review will guide clinical training planning in SLP&A during the COVID-19 pandemic and beyond. These findings will also inform curriculum, policy formulation and future research.
The initial search was carried out in December 2021 by N.N. The following databases were searched: Science Direct, PubMed, Scopus, ProQuest, Google Scholar, WordCat and MEDLINE. An exhaustive search of these databases was conducted to obtain papers that pertain to simulation as a mode of clinical training in HCPs. The identified papers were included if they were published in English, because of the limited resources available for translation. The papers also needed to focus on simulation as a clinical training method in HCPs. The search terms were as follows: HCPs, simulation-based education, telesimulation, virtual simulation, clinical training, clinical education, continuous professional education, continuous professional development and COVID-19. The same search strategy was used to search Google Scholar and WorldCat to source grey literature such as research reports, dissertations and theses that discuss simulation as a method of clinical training in HCPs. However, no papers were generated through this search. Additionally, as a method of snowball sampling, the reference lists of the identified papers were screened to capture other papers that potentially met the inclusion criteria.
Zotero referencing software was used to save the citations retrieved from the databases. This software allowed for any duplicate citations to be removed. Further duplicate citations, if found, were removed during the title and abstract relevance screening and data characterisation of full articles.
A two-stage screening to assess the eligibility of the papers identified in the search was employed. Publications that contained the keywords and phrases and (if broadly described) simulation as a mode of clinical training in HCPs were included. To account for advancements in technology as well as to capture contemporary evidence, papers that were published between the years 2011–2021 were included in the review. Publications that described simulation without referring to clinical training and HCPs were excluded from the analysis.
For the first level of inspection, only the title citations were reviewed. Thereafter, the abstracts of those citations that were deemed to be eligible for inclusion at the title level were screened. Next, the full articles of those citations that passed the abstract screening were reviewed. If abstracts were not available, the citations were included for the review of the full article. This review was independently conducted by N.N. and B.S. N.N. created a title, abstract and full-text screening spreadsheet. The researchers discussed any discrepancies in the selected papers. Where consensus was not reached, K.K-S. performed the review to make a final decision. There was a high level of agreement between the researchers as the overall kappa was 0.81 (Dohoo, Martin, & Stryhn,
In total, the database search from all databases identified 330 publications. All identified database citations were exported to Zotero, a web-based referencing software. Through Zotero, duplicate studies were identified and removed. After the duplicates were removed, 275 records remained. The 275 records were screened, guided by the search question, and 153 were excluded as not being relevant to the study. One hundred twenty-two articles were then assessed for eligibility; of these, 32 were excluded because they did not meet the inclusion criteria. Consequently, a full-text screening of 90 articles resulted in 32 studies meeting the inclusion criteria and being included in this scoping review.
PRISMA flow diagram for the current scoping review which included searches of databases and other sources.
Relevant information from the publications that met the inclusion criteria was extracted and noted in the data chart. The data were extracted and charted by N.N., B.S. and M.M. The data charted included the author, year of publication, publication type, publication focus and aims, methodology (study design and sample and data sources, measurement of the outcomes post-simulation training), description of simulation training (preparation for the training, briefing, simulation activity and debriefing), context (country) and results (depicted in
Summary of studies included in the scoping review documenting the use of simulation as a clinical training tool.
Author(s) (date) | Publication title | Type of publication | Publication focus and aims | Methodology (including outcome measures of simulation training) | Description of simulation training | Context |
Results |
---|---|---|---|---|---|---|---|
Country | |||||||
McGaghie, Issenberg, Cohen, Barsuk and Wayne ( |
Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence | Review | Comparing the effectiveness of traditional clinical education toward skill acquisition goals versus simulation-based medical education (SBME) with deliberate practice (DP). | - | - | - | SBME with DP is superior to traditional clinical medical education in achieving specific clinical skill acquisition goals. |
Wright et al. ( |
The influence of a full-time immersive simulation-based clinical placement on physiotherapy student confidence during transition to clinical practice | Research article | Evaluating changes to students’ confidence across a simulation-based placement and clinical competence at the end of their first core clinical placement. | 60 physiotherapy students, non-standardised confidence measure and Assessment of Physiotherapy Practice (APP). | Immersive simulation placement; high-fidelity simulated scenarios (incl. simulated patients). | Australia | Improvement confidence: students who completed the simulation-based placement achieved significantly higher APP scores. |
Shrestha, Badyal, Shrestha and Shrestha ( |
Research article | Introducing |
Prospective quasi-experimental study with mixed research design; 25 medical interns; knowledge-based questionnaire and skill score sheet. | Simulations performed using a primitive manikin or a volunteer and a cardiac rhythm generator. | Nepal | Post-simulation knowledge score was higher; positive correlation between the number of simulations and the skill scores; simulation-safe learning environment for learning; debriefing sessions provided motivation for self-guided learning and allowed for errors to be identified. | |
Eide, Johansson and Eide ( |
First-year nursing students’ experiences of simulation involving care of older patients: A descriptive and exploratory study | Research article | Evaluating learning experiences that first-year nursing students had following geriatric patient simulation activity. | Descriptive study; 216 nursing students; survey regarding experiences. | High-fidelity simulated scenarios practised twice; debriefing. | Norway | Applied and integrated theoretical knowledge and practised geriatric nursing in a safe environment and in a practical way under real-world conditions. Better understanding of collaboration. Practising twice allowed for knowledge consolidation. |
Johnson, Cannon Mantilla and Cook ( |
Cricoid pressure training using simulation: A systematic review and meta-analysis | Review | Does cricoid pressure (CP) application improve with simulation training versus with no training, and how is learning retained after CP simulation training? | - | - | - | Simulation had a favourable impact on skills. The CP skill retention only lasted for one week after the simulation. |
Silberman, Panzarella and Melzer ( |
Using human simulation to prepare physical therapy students for acute care clinical practice | Research article | Do specific learning objectives pertaining to the preparation of Doctor of Physical Therapy (DPT) students for acute clinical care describe students’ preparation using this training method? | 22 physical therapy students; survey to determine perception of clinical preparedness and benefit of the experience. | Acute care scenario involving a patient following total knee replacement and ready for discharge; high- and low-fidelity manikin, course instructor acted as patient; debriefing. | Brazil | Opportunity to integrate students’ knowledge; better understanding of the expectations of the clinical setting; confidence in communication and management of clinical situations increased. |
Korayem and Alboghdadly ( |
Integrating simulation into advanced pharmacy practice experience curriculum: An innovative approach to training | Research article | Evaluating the impact of integrating simulation-based education into advanced pharmacy practice experience curriculum on students’ learning outcomes, training costs and satisfaction. | 57 pharmacy students; clinical competence assessed during rotations. | Simulation-integrated rotations (simulation- and hospital-based rotation) which ran simultaneously; simulations used were of human patient simulators, task trainers and high-fidelity manikins; debriefing. | Saudi Arabia | Higher grades in the simulation-based blocks versus hospital-based blocks; cognitive skills and affect learning outcomes higher in simulation-based block. According to Faculty members, students’ confidence, communication, leadership, and teamwork improved, but students’ patient case presentation delivery still needed improvement. Concurrent running of the rotations resulted in more clinical seats for students and reduced costs. |
Zarifsanaiey, Amini and Saadat ( |
A comparison of educational strategies for the acquisition of nursing students’ performance and critical thinking: Simulation-based training vs. integrated training (simulation and critical thinking strategies) | Research article | To compare the effects of integrated training (simulation and critical thinking strategies) and simulation-based training on the performance level and the critical thinking ability of nursing students. | A pre- and post-test research design; 40 nursing students; California Critical Thinking Skills Test Form B (CCTST-B) to determine critical thinking skills level; Objective Structured Clinical Examination (OSCE) to measure clinical performance. | Experimental group (critical thinking skills strategies and a simulation activity taught by basic instruction, through role-playing and practice on manikins. Control group only engaged in the simulation activity. | Iran | Critical thinking skills and performance level were significantly higher in the experimental group as compared to control group. |
Teles, Mendes-Castillo, De Souza Oliveira-Kumakura and Silva ( |
Clinical simulation in teaching pediatric nursing: Students’ perception | Research article | Undergraduate nursing students’ perceptions about learning to care for the child and family through clinical simulation. | 10 nursing care students interviewed. | Engaged with five high-fidelity simulation scenarios relating to paediatric nursing; debriefing. | Brazil | High chance that the scenarios could happen in practice. They felt more secure and confident to make decisions and deal with the situations in practice. Students able to practise before going to the hospital. The scenarios promoted learning of integral care. |
Zhang, Cheng, Xu, Luo and Yang ( |
Clinical simulation training improves the clinical performance of Chinese medical students | Research article | Examining the effectiveness of clinical practice training programs that use simulation. | 109 medical interns; OSCE to measure clinical performance. | Simulative clinical training, preclinical skills training complemented with real-life clinical skills prior to internship. | China | Graduate interns who trained with simulations showed learning ability significantly higher than those of interns who only received traditional training. In terms of the clinical skills competition, the results were higher in those who received simulative training than those who did not. |
Yang, Li, Liu and Liu ( |
Effect of vascular simulation training on practice performance in resident: A retrospective cohort study | Research article | Assessing the effect of simulation-based training on improving technical performance and clinical procedures of vascular surgery residents. | 95 vascular resident trainees; underwent theoretical and practical assessment. | Experimental group received lectures, engaged in simulation activity at times with direct instruction; practised on part-task trainers. Control group only received lectures. | China | Experimental group had higher scores on the theoretical assessment than control group. Experimental group performed procedures quicker; simulation training could reduce radiation damage of patients and residents. |
Cant and Cooper ( |
The value of simulation-based learning in prelicensure nurse education: A state-of-the-art review and meta-analysis | Review | Current evidence for the effectiveness of simulation as an educational strategy in prelicensure nursing education. | - | - | - | Simulation improves patient safety and students’ clinical competence and awareness. Self-efficacy, cognitive (incl. clinical knowledge), and self-confidence enhanced. |
Gunn, Rowntree, Starkey and Nissen ( |
The use of virtual reality computed tomography simulation within a medical imaging and a radiation therapy undergraduate programme | Research article | Investigating the impact of a computer-based virtual reality (VR) computed tomography (software) simulation on undergraduate medical imaging (MI) and radiation therapy (RT) students’ confidence. | 28 MI students; 38 RT students. | Not specified; RT students had an introduction to the virtual reality software. | Australia | MI and RT students’ clinical confidence above average in performing a CT scan. |
Shorey and Ng ( |
The use of virtual reality simulation amongst nursing students and registered nurses: A systematic review | Review | The use of two variations of virtual worlds desktop virtual reality simulations (dVR) and immersive virtual reality simulations (iVR) as teaching tools for nursing students. | - | - | - | Virtual worlds more effective to teach theoretical knowledge compared to teaching clinical skills and enhancing affective outcomes), but produced worse results compared to the traditional teaching methods for clinical skills, theoretical knowledge and affective outcomes. |
Kapoor, Kapoor and Badyal ( |
Simulated patients for competency-based undergraduate medical education post COVID-19: A new normal in India | Review | Need and use of simulated patients (SPs). | - | - | India | SPs used to teach technical, cognitive communication skills and interpersonal skills: |
Offiah et al. ( |
Evaluation of medical student retention of clinical skills following simulation training | Review | Investigating clinical skills performance following simulation-based medical training in an undergraduate medical curriculum. | - | - | - | Simulation-based mastery learning can improve medical students’ retention of core skills and deliberate practise of clinical skills. |
Miles, Friary, Jackson, Sekula and Braakhuis ( |
Simulation-based dysphagia training: Teaching interprofessional clinical reasoning in a hospital environment | Research article | Evaluating the effectiveness of simulation-based dysphagia training on students’ perceived confidence, knowledge and preparedness. | 31 students: 11 dietetics students and 20 speech-language pathology students; post simulation completed clinical vignettes; feedback on perception of the training quality, relevance and clinical applicability; survey on perceived confidence, knowledge and readiness for work, and pre- and post- training. | Three simulated scenarios; high-fidelity manikins, confederates and/or standardised patients. |
Australia | Significant increase in student overall scores in clinical vignettes, mostly clinical reasoning. Reported increase in confidence, preparedness and knowledge. |
Kononowicz et al. ( |
Virtual patient simulations in health professions education: Systematic review and meta-analysis by the digital health education collaboration | Review | Evaluating the effectiveness of virtual patients versus traditional education, blended with traditional education, compared with other types of digital education and design variants of virtual patients in health professions education. | - | - | Singapore | Virtual patients to traditional education showed similar results for knowledge and favoured virtual patients for skills. |
Hu et al. (2019) | To investigate the effect of simulation-based triage education on third-year nursing students’ self-reported clinical reasoning ability during simulated triage scenarios | Research article | Investigating the effect of simulation-based triage education on third-year nursing students’ self-reported clinical reasoning ability during simulated triage scenarios. | A pretest-posttest research design, 172 nursing students; Nurses Clinical Reasoning Scale (NCRS) utilised to measure pretest and posttest clinical reasoning. | Experimental groups received briefing to triage and simulation (standardised patient and high- and low-fidelity manikins) and self-studied triage content. Control group prepared for triage education; received a lecture. Debriefing on clinical reasoning. | China | After the triage education, significant increase in scores of clinical reasoning ability in all the three groups, average clinical reasoning ability scores in the experimental groups were significantly higher compared to control group. |
Choong and Tan ( |
The role of simulation in burns education | Review | The role of simulation as an important and effective tool for burns education worldwide. | - | - | - | Incorporation of simulations in burns education have improved trauma care and survival of victims. Use of manikins enhances technical, procedural skills, confidence levels; non-technical skill; moulage contributed to positive training experience, encourages to treat standardised patients as real burns victims. |
De Ponti et al. ( |
Pregraduation medical training including virtual reality during COVID-19 pandemic: A report on students’ perceptions | Research article | Assess medical students’ perception on fully online training, including simulated clinical scenarios during COVID-19 pandemic. | 115 medical students; questionnaire to rate training quality. | Briefing followed by simulated clinical scenarios conducted online; debriefing. | Italy | 77% considered virtual reality training realistic for the initial clinical assessment, 94% for the diagnostic activity and 81% for the treatment options; 84% considered the future use of this virtual reality training useful in addition to traditional clinical training; no one recommended the standalone use of this virtual reality; 28% participants found the online access difficult due to technical issues. |
Grabowski et al. ( |
A pilot study to evaluate the effect of classroom-based high-fidelity simulation on midwifery students’ self-efficacy in clinical lactation and perceived translation of skills to the care of the breastfeeding mother-infant dyad | Research article | Evaluate the impact of a classroom-based breast-feeding simulation on nurse-midwifery students’ self-efficacy in lactation skills. | A pilot study using a prospective cohort study design. Study sample: 9 nurse-midwifery students. Self-efficacy surveys used to measure self-efficacy. | Two high-fidelity simulation-based workshops that focused on competencies for midwives and lactation professionals. | United States of America | Increase in perceived self-efficacy skills in basic and advanced clinical lactation skills after completing both workshops. |
Vermeulen et al. ( |
The experiences of last-year student midwives with high-fidelity perinatal simulation training: A qualitative descriptive study | Research Article | Experiences of last-year student midwives with high-fidelity perinatal simulation training. | Descriptive research design; 13 midwives; focus groups. | High-fidelity perinatal simulation sessions. | Australia | High-fidelity perinatal simulation training to be a positive learning method that increased students’ competence and confidence. |
Büyük et al. ( |
Use of simulation to teach in the operating room: Don’t let the COVID-19 pandemic to interrupt education: An observational clinical trial | Research article | Evaluating the difference between the pre- and post-simulation knowledge test scores to evaluate the effectiveness of simulation training. Examining if it creates any anxiety on participants. | Study sample, anaesthesiology and intensive care residents; true/false questions and State-Trait Anxiety Inventory used to assess knowledge and anxiety before and after activity, respectively. | Turkey | Junior residents received significantly higher scores in post-training theoretical tests compared to their pretraining scores. There was no difference between pretest and posttest scores of seniors. Pre- and post-anxiety inventory scores were nearly the same and both were in the moderate group. | |
Mileder, Bereiter and Wegscheider ( |
Telesimulation as a modality for neonatal resuscitation training | Research article | Investigating the feasibility and effectiveness of telesimulation for neonatal resuscitation training. | Prospective observational pilot study; 9 medical students and nine neonatal nurses; questionnaire regarding their knowledge of neonatal resuscitation training. | Simulated session conducted remotely broadcasted from a clinical skills training centre. |
Austria | Telesimulation enjoyable, gained knowledge, educational methodology suitable for neonatal resuscitation training, still preferred traditional face-to-face instruction due to potential technical issues, training logistics and the quality of supervision. |
Hernández-Padilla, Granero-Molina, Márquez-Hernández, Cortés-Rodríguez and Fernández-Sola ( |
Effects of a simulation-based workshop on nursing students’ competence in arterial puncture | Research article | Evaluating if a short simulation-based workshop in radial artery puncture improves nursing students’ competence to the extent that patients’ safety is not compromised. | Pretest-posttest design; 86 undergraduate nursing students; core clinical competencies arterial blood gas (ABG) analysis in simulation activity. | Briefing activity; watched a video on and provided with examples of ABG analysis; conducted ABG analysis independently. | Spain | Posttest scores for knowledge, skills, and self-efficacy were higher than the pretest scores; 61.1% of the participants showed the level of competence required to safely practise radial artery puncture on a live patient. |
Roberts et al. ( |
Simulation to replace clinical hours in nursing: A metanarrative review | Review | Review of published literature on the replacement of part of the clinical placement hours with simulation in undergraduate nursing education and its feasibility. | - | - | Australia | No significant differences between clinical experience and simulation when simulation replaces up to 50% of clinical hours. Comparable student engagement, educational outcomes and student proficiency with simulation and traditional clinical practice. |
Boudiche et al. ( |
Simulation training for continuing professional development of nurses in cardiology and cardiovascular surgery | Research article | Clarifying the interest of simulation learning in terms of continuing professional development involving nurses in the management of cardiac arrest. | Comparative prospective observational study; 32 nurses; skill evolution sheet to assess basic life support and manual defibrillation. | Provided with theory on basic and advanced life supports; provided basic life support on a low-fidelity manikin and manual defibrillation on a high-fidelity manikin. | Tunisia | Significant improvement was noted after the simulation session in terms of diagnosing cardiac arrest and providing basic life support and manual defibrillation. |
Warren, Luctkar-Flude, Godfrey and Lukewich ( |
A systematic review of the effectiveness of simulation-based education on satisfaction and learning outcomes in nurse practitioner programs | Review | Included studies that explored any learner outcome related to high-fidelity simulation (HFS) in nurse practitioner (NP) programmes | - | - | - | Nursing students perceived enhancement of their critical thinking skills, evidence-based practice and knowledge and ability to function in the clinical setting when using HFS. Significant increase in knowledge and technical skills post-engagement with HFS and compared to those who received traditional education. Higher clinical compared to web-based education. High-fidelity simulation has positive effects on NP student confidence and self-efficacy. |
Sun, Pan, Li and Gan ( |
Airway management education: simulation-based training versus non-simulation-based training: A systematic review and meta-analyses | Review | To evaluate all published evidence comparing the effectiveness of simulation-based training (SBT) for airway management versus non-simulation-based training (NSBT). | - | - | - | SBT-improvement in performance behaviours but did not transfer into increased success rate in clinical setting. No significant difference in success rate of procedure completion on patients in both groups; no patients treated by students in both groups suffered any significant adverse effects. Skills decay significantly in both groups. Confidence scores were higher in SBT group versus NSBT group. |
Datta, Upadhyay and Jaideep ( |
Simulation and its role in medical education | Review | No specified. | - | - | - | Simulation can complement traditional clinically based training. |
HFS, high-fidelity simulation; SBME, simulation-based medical education; DP, deliberate practice; APP, Assessment of Physiotherapy Practice; CP, cricoid pressure; DPT, Doctor of Physical Therapy; CCTST-B, California Critical Thinking Skills Test Form B; OSCE, Objective Structured Clinical Examination; VR, virtual reality; MI, medical imaging; RT, radiation therapy; dVR, desktop virtual reality; iVR, immersive virtual reality; SPs, simulated patients; NCRS, Nurses Clinical Reasoning Scale; HFS, high-fidelity simulation; NP, nurse practitioner; SBT, simulation-based training.
The data were compiled in a single spreadsheet and imported into Microsoft Excel 2010 (Microsoft Corporation, Redmond, WA) for descriptive analysis, where thematic analysis was conducted by N.N., K.K-S. and N.M. to analyse the data extracted.
As depicted in
Nuanced analysis of the studies, as reflected in
Of the studies reviewed, the use of simulation as a mode of clinical training has been explored mostly for undergraduate and postgraduate HCPs students. Very few studies have described its use as a method of continuous professional education in qualified HCPs (e.g. Boudiche et al.,
Thematic analysis of the papers reviewed revealed three themes. These themes that emerged from the data were as follows: (1) face-to-face simulations as a mode of clinical training, (2) virtual reality simulation (VRS) and telesimulation as modes of clinical training and (3) simulation as a complementary mode of clinical training. The rest of the scoping review findings will be presented under these three themes.
Most of the studies included in this scoping review discussed face-to-face simulations, which comprised at least a simulation scenario and debriefing sessions (e.g. De Ponti et al.,
In LMICs, it seems that when simulation is used as a mode of clinical training, face-to-face simulations that incorporate low-fidelity simulators and students simulating patients are used (Boudiche et al.,
The findings from the review revealed that incorporating simulated patients into medical education may allow medical students to achieve the core clinical competencies. Face-to-face simulations improved nurse-midwifery, nursing and physiotherapy students’ self-efficacy and confidence (e.g. Silberman et al.,
Although face-to-face simulations have been shown to improve students’ clinical competency, there are concerns that skill retention after solely face-to-face simulation training is short (Johnson et al.,
Face-to-face simulation training was not always possible because of the social distancing regulations implemented during the COVID-19 pandemic. Therefore, medical programmes used telesimulation or VRS to train medical students (De Ponti et al.,
This lack of authentic realism may explain why HCP students’ clinical tasks skills still need to be enhanced in traditional clinical training. This point may be reinforced by the findings of Gunn et al. (
A review conducted by Roberts et al. (
The current scoping review provides evidence that simulation is an effective method of clinical training in basic and specialised medical education, nursing, radiography, pharmacy and physiotherapy as it enhances the clinical competence of HCP students in these programmes. Therefore, it may equip students with knowledge, skills and attitudes required to interact with patients that they encounter in their clinical placements and independent practice. Simulation, particularly VRS and telesimulation, can be used as a mode of clinical training to allow for the continuation of clinical training of HCP students and practitioners despite the COVID-19 restrictions. However, simulation cannot replace traditional clinical training but may be combined with traditional clinical training in a hybrid mode – which may further enhance HCPs students’ clinical competence.
As alluded to earlier, because of resource constraints, the large number of students enrolled in SLP&A programmes cannot be sufficiently accommodated for particularly in terms of clinical placements. Therefore, the current authors recommend deliberations around utilising simulations prior to traditional clinical placements, as a way of hastening acquisition of core clinical competencies, thus allowing students more opportunities to practise (both depth and breadth of the scope of the professions). The improved preparedness may also lessen the workload of clinical educators, whilst enhancing skills for independent safe practice (Cant & Cooper,
The studies included in this scoping review have mostly provided insight into the use of simulations for clinical training in HCPs other than SLP&A. However, the studies may still support the consideration for using simulations in SLP&A clinical training, as clinical training in all HCPs is based on the same core clinical competencies (Medical and Dental Professions Board,
Therefore, research on the utility of simulation and how it can be incorporated in SLP&A is required. Specifically for LMICs, whilst simulation has proven to be cost-effective and a responsive mode of training HCPs during public health emergencies as evidenced during COVID-19 and beyond, there are contextual realities that cannot be ignored. These include resources that are not readily available because of finances and poor infrastructure (Khoza-Shangase,
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
N.N. was the lead researcher. She conducted the search, title, abstract and full-text screening and extracted the data from the relevant full-text papers. She also analysed the data and wrote the first draft of the paper. B.S. conducted the title, abstract and full-text screening and extracted the data from the relevant full-text papers. M.M. extracted the data from the full-text papers. K.K.-S. and N.M. conceptualised and supervised the project as well as analysed the data. All the other researchers reviewed the drafts of manuscript written and corrected by N.N.
This article followed all ethical standards for research without direct contact with human or animal subjects.
The authors thank the National Research Foundation for providing financial assistance for the publication of the manuscript.
Data sharing is not applicable to this article as no new data were created or analysed in this study.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.