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Clinical Simulation in Nursing (2012) 8, e429-e435

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Simulation and Psychomotor Skill Acquisition:


A Review of the Literature
Jennifer Gunberg Ross, PhD, RN, CNE*
College of Nursing, Villanova University, Villanova, PA 19085, USA

KEYWORDS Abstract: Decreased opportunities for skill practice and mounting concerns that graduate nurses are
literature review; not competent in basic psychomotor skills requires nurse educators to reevaluate methods to teach
nursing; these skills. Simulation offers a fresh approach to psychomotor skills education allowing the student
psychomotor skills; to integrate knowledge from all three learning domains while practicing the skill. This article discusses
simulation; the current state of the science on the use of simulation for psychomotor skill acquisition. This liter-
skill ature review identifies that limited empirical evidence exists to support the efficacy of simulation to
teach psychomotor skills, most notably within the discipline of nursing. The existing data stem from
studies with limitations that affect the interpretation and generalizability of the results. These findings
suggest the need for further research in the area of simulation and psychomotor skill acquisition within
nursing education.
Cite this article:
Ross, J. G. (2012, November). Simulation and psychomotor skill acquisition: A review of the literature.
Clinical Simulation in Nursing, 8(9), e429-e435. doi:10.1016/j.ecns.2011.04.004.
2012 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier
Inc. All rights reserved.

Background skills needed for competent nursing care (Farley & Hendry,
1997; Gerrish, 2000; Hilton, 1996; Hilton & Pollard, 2004;
Nursing shortages, busy clinical environments, increased Knight, 1998; Knight & Mowforth, 1998; Salyers, 2007).
demand for student clinical placements, and a shift away Furthermore, inexperienced students increase risk of patient
from acute care continue to decrease the opportunities for harm when learning and practicing basic skills on patients
nursing students to learn psychomotor skills within patient (Castanelli, 2009). Such concerns necessitate consideration
care settings (Castanelli, 2009; Sears, Goldsworthy, & of the efficacy of teaching strategies for psychomotor skills
Goodman, 2010). Not only have these factors decreased in nursing education.
learning opportunities for students, they have also created Traditionally, psychomotor skill education in health care
inconsistencies among the clinical practicum experiences has been fragmented. Skills are divided into components
of student nurses. Because of the limited opportunities for including the psychomotor skill, cognitive knowledge, and
psychomotor skill development, concerns are mounting affective considerations, and each is taught separately. This
among nurses and nurse educators that newly graduated technique allows the student to progress from simple to
nurses are not proficient in many of the basic psychomotor complex, but it fails to fully incorporate the many
complexities involved in performing psychomotor skills
* Corresponding author: Jennifer.Ross@villanova.edu (J. G. Ross). on actual patients (Nestel, Kneebone, & Kidd, 2003).

1876-1399/$ - see front matter 2012 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
doi:10.1016/j.ecns.2011.04.004
Simulation and Psychomotor Skill Acquisition e430

Usually, psychomotor skills are taught on static manikins in quantitative studies related to the use of simulation in the
a college-based laboratory environment allowing for a safe, acquisition of psychomotor skills. For the purposes of this
controlled setting where students can learn skills at their own review, simulation encompassed the use of task-trainers,
pace without fear of patient harm. However, such education in static manikins, role playing, and patient care scenarios
the collegiate setting is completely separate and unique from only; computer-based simulation and virtual reality simu-
the clinical environment lation studies were excluded. Furthermore, this review
where the skill will focuses only on the acquisition of psychomotor skills;
Key Points eventually be performed studies exploring the transfer of skills learned in simulation
 There is limited em- (Kneebone et al., 2004). Stu- to actual patient care are outside the scope of this literature
pirical evidence in dents often cite difficulty review. Databases included in the literature search were the
the nursing literature transitioning from the college Cumulative Index of Nursing and Allied Health Literature
supporting the effi- learning laboratory setting to (CINAHL), PubMed, and Educational Resources Informa-
cacy of simulation to actual clinical environments tion Center (ERIC). Key terms used for the search included
teach psychomotor (Medley & Horne, 2005); the following: simulation, clinical competence, clinical
skills. however, all health care prac- performance, skill, nursing skills, and psychomotor skills.
 The existing data titioners must eventually care Various combinations of the above terms were created
stem from studies for patients in actual clinical using the Boolean search terms AND, OR, and NOT to
with limitations that environments independently. generate the most comprehensive list of empirical articles
affect the interpreta- Given the concerns about available. Additional limits of humans and English
tion and generaliz- students ability to transfer were placed on database searches. Database searching
ability of the findings. knowledge and skills from identified a total of 530 articles for initial review. However,
 More research is the learning laboratory in it is important to note that this total article number may
needed to support the the collegiate setting to actual include some articles that were listed in more than one
use of simulation to patient care areas, it is imper- search or in more than one database.
teach psychomotor ative that nurse educators In addition to thorough searches of the relevant literature
skills. consider innovative methods databases, an ancestral search of reference lists of all
to teach these skills and ease relevant articles was also performed. Reference lists were
the transition to clinical practice. screened for titles, which included the key terms of
Simulation offers many advantages to students learning simulation, simulator, skills, psychomotor, performance,
psychomotor skills. As mentioned previously, psychomotor acquisition, competency, training, learning, or teaching.
skills do not exist independently, but rather contain compo- Fifty-one articles were identified through this process.
nents from all three learning domains: psychomotor, cogni- However, as with the database searches, some articles
tive, and affective. Traditionally, each domain of learning has may have been referenced more than once.
been taught individually, but all are necessary when interact- The searches described above yielded a total of 581
ing with patients in the clinical environment (Kneebone et al., articles for initial review. Each articles abstract was first
2002). Kolbs (1984) experiential learning theory suggests that reviewed for relevance, and then the full article was
students learn most effectively when the learning environment obtained and screened for appropriateness. This compre-
combines relevant components of psychomotor, cognitive, hensive screening process yielded a total of four research
and affective knowledge because learning is a continuous pro- studies related specifically to psychomotor skill acquisition
cess based on experience. Patient care simulations, by nature, and simulation in nursing education. Because of the dearth
integrate all domains of learning (Goldenberg et al., 2005; of quantitative studies evaluating simulation training on
Nehring et al., 2001) allowing students to completely synthe- psychomotor skill competency in nursing, multiple health
size the related components of knowledge before working in care disciplines were included in this review, including
an actual clinical environment. Transfer of knowledge is eased various subspecialties of medicine and allied health,
by decreased anxiety and increased self-confidence, qualities leading to a total of 19 articles for inclusion.
that are evident in simulated learning experiences such as sim-
ulation (Goldenberg et al., 2005; Wilford & Doyle, 2006). Be-
cause simulation mimics real clinical environments, the goal is Results
for students to more easily apply what they learn in simulation
to actual patient care settings (Wilford & Doyle, 2006). Nursing

Alinier, Hunt, Gordon, and Harwood (2006) conducted


Methods a preeposttest study to determine the effectiveness of
scenario-based, intermediate fidelity, full-scale simulation
A comprehensive search of the literature was conducted training on the clinical skills and competence of second-
between January 2008 and January 2011 to obtain relevant year diploma nursing students. Alinier, Hunt, and Gordon

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Simulation and Psychomotor Skill Acquisition e431

provided preliminary results on the same study in 2004. and basic life support (BLS) after simulation training.
The clinical skills evaluated in this study included psycho- Power analysis revealed a necessary sample size of 62;
motor skills such as electrocardiogram electrode place- however, only 50 first- and third-year nursing students com-
ment, airway management, pulse oximetry measurement, pleted the study. Pre- and posttest multiple choice tests were
ventilator tubing installation, and blood pressure measure- administered to assess cognitive knowledge while posttest-
ment. In addition, several cognitive and other practical only vignettes and OSCEs were used to assess skill perfor-
skills were assessed. Furthermore, each participant was mance. All students received simulation training that
given a questionnaire before the posttest that asked about included scenarios and debriefing. Mean scores on the
their confidence, previous experience in health care, and BLS multiple choice test increased significantly
stress related to technology. Based on power analysis, (p < 0.01) while mean scores on the manual handling mul-
a sample size of 125 (d 0.5, a 0.05, power 0.8) tiple choice test increased, but not significantly (p 0.07).
was required; however, after accounting for dropouts, a con- Mean scores for the posttest vignette and OSCE were
venience sample of 99 was used in the study. The authors 68.5% and 77.8%, respectively, with no pretest for compar-
acknowledge that the sample used was sufficient to detect ison. Students responded positively to the benefits of simu-
the effect size in the sample. All subjects were given a pre- lation for skill acquisition. The authors suggested that the
test in the form of an Objective Structured Clinical Exam- results show simulation helps students gain knowledge
ination (OSCE). Subjects were randomly assigned to and skills; however, without pretest vignettes and OSCE
control (n 50) and experimental (n 49) groups after or a control group, it is hard to interpret these data because
the pretest. The experimental group received simulation there are no data for comparison of results.
training after the pretest, and the control group received Ackermann (2009) conducted a two-group quasi-exper-
no additional training. Six months after the pretest, all sub- imental study exploring the effect of a high-fidelity simula-
jects took part in a posttest OSCE. Task-specific checklists tion intervention on baccalaureate nursing students
were used for each skill tested. Data were analyzed using acquisition and retention of cardiopulmonary resuscitation
t tests. The experimental group improved their performance (CPR) knowledge and skills. Power analysis indicated
on the OSCE between the pre- and posttests 7% more than a necessary sample size of 68 subjects; 65 junior baccalau-
the control group; this difference is statistically significant reate nursing students completed the pretest and first post-
(p < 0.001). The authors concluded that simulation training test (acquisition), while only 49 subjects completed the
has a positive impact on student performance. second posttest (retention). Subjects were randomly as-
Radhakrishnan, Roche, and Cunningham (2007) con- signed to either a control or experimental group. After stan-
ducted a quasi-experimental pilot study to evaluate the use dard training, all subjects were evaluated at pretest using
of a high-fidelity simulator (Laerdal SimMan) on multiple choice tests to assess knowledge. The experimen-
second-degree baccalaureate nursing students performance tal group participated in a mock code simulation using
of several patient care skills, including basic assessment Laerdals SimMan, and the control group received no ad-
skills, safety, and communication. A convenience sample ditional intervention. All subjects were then posttested for
of 12 second-degree BSN nursing students were randomly knowledge and skill performance. Multiple choice tests
assigned to either the control group or the experimental were used to assess knowledge, while simulated mock co-
group. The experimental group received simulation practice des, using Laerdals Resusci-Anne manikin, were used
in managing a two-patient assignment, while the control to assess skill performance. All subjects were subsequently
group did not receive any additional practice outside of clin- posttested a second time 3 months later using the same
ical. At the end of the semester, all subjects were evaluated evaluation strategies. At the first posttesting, the experi-
in a simulated patient care scenario. Data were analyzed mental group had significantly higher knowledge scores
with the chi-square test. The experimental group scored sig- (p 0.015) and skill performance (p < 0.001) than the con-
nificantly higher than the control group in safety (p 0.001) trol group. The author concluded that high-fidelity simula-
and basic assessment skills (p 0.009). More specifically, tion had a positive effect on CPR knowledge and skill
the experimental group assessed vital signs significantly bet- acquisition and retention. Because the control group did
ter than the control group (p 0.009). The small sample not have an alternative activity during the experimental
size markedly limits the power and generalizability of find- groups simulation training, it is hard to determine whether
ings. There was no pretest to compare posttest results, mak- the significant results were actually related to the simula-
ing it difficult to analyze the results. In addition, the control tion training or simply a result of the extra practice time ex-
group did not have an alternative activity during the exper- perienced by the experimental group.
imental groups simulation training, indicating that the sig- The dearth of reports of nursing research studying
nificant results could be related to a factor other than psychomotor skill acquisition and simulation clearly dem-
simulation training, such as increased time of practice. onstrates the need for further research in this area. The
In 2008, Moule, Wilford, Sales, and Lockyer published available nursing literature suggests that simulation is
a single group mixed methods study exploring nursing stu- effective at increasing knowledge and skill performance
dents knowledge and skill performance of manual handling in nursing students; however, these results must be

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reviewed critically, because most studies had small or birthing simulator (Noelle) on proper techniques for a vagi-
underpowered samples, or less rigorous empirical designs, nal delivery with shoulder dystocia. Within 2 weeks of
such as a lack of pretest for comparison, lack of control training, all subjects performed a simulated shoulder dysto-
group for comparison, or unequal practice times for the cia delivery using the same birthing simulator. Residents
experimental and control groups, which makes it difficult to were evaluated using a task-specific checklist for skill
assess practical significance. Poorly designed studies do not performance and a Likert scale for preparation and
allow for causal interpretation of the results because the performance. Data were statistically analyzed using the
study findings could result from factors other than the ManneWhitney U test. The experimental group achieved
intervention. a significantly higher overall score (p 0.012) than the
control group on the posttest-simulated delivery. The au-
Medicine thors concluded that training with a birthing simulator im-
proves resident performance of a shoulder dystocia
In 2004, Curran, Aziz, OYoung, and Bessell conducted delivery. Because no pretest was administered, there is no
a preeposttest study to determine the effectiveness of way to determine that the control and experimental groups
a high-fidelity computerized simulation (ANAKIN neonatal were comparable at the start of the study, and there is no
simulator) on knowledge and skill retention of neonatal point of comparison for the posttest results.
resuscitation. A convenience sample of 60 third-year med- A study by Wayne et al. (2005) explored the effect of
ical students was randomly assigned to either the control high-fidelity simulation training on medical residents Ad-
group or experimental group. All subjects received a stan- vanced Cardiac Life Support (ACLS) skill performance.
dard neonatal resuscitation program (NRP) and were given Thirty-eight second-year medical residents were randomly
both knowledge and skills tests immediately after standard assigned to a control group or experimental group. All sub-
training. These served as pretests for the study. The control jects were pretested for baseline ACLS skill performance.
group then watched a video, while the experimental group After pretest, the experimental group engaged in
worked with the simulator 4 months after the initial NRP scenario-based simulation training using a high-fidelity pa-
training. At this point, all subjects were evaluated in knowl- tient manikin while the control group received no addi-
edge and confidence. Finally, 8 months after initial NRP tional training. After subsequent testing, the experimental
training, all subjects were posttested for skill ability using group and control group crossed over so all subjects ulti-
the high-fidelity simulator. Skill performance was evaluated mately received the simulation training. Resident perfor-
using the NRP task-specific checklist. Within-group com- mance of ACLS skills was measured using a task-specific
parisons of skill performance were evaluated using t tests. checklist. The experimental group scored 38% higher
Both the experimental group (p 0.007) and control group than the control group (p < 0.0001) on ACLS skill perfor-
(p < 0.001) showed a statistically significant decline in mance after simulation training. Consequently, the authors
skills performance from NRP training to 8 months post- determined that repetitive practice with a high-fidelity sim-
training. While the experimental group received higher ulator significantly improved medical residents perfor-
scores than the control group on the knowledge mance of ACLS skills. A limitation of this study is the
(p 0.927) and skill performance (p 0.841) posttests, lack of a comparable experience for the control group dur-
these results were not statistically significant. Calculated ing the experimental groups simulation training. It is pos-
power level was not reported; therefore it is unclear sible the significant results represent simply the extra time
whether there was enough power to detect a difference. A spent by the experimental group practicing rather than a re-
satisfaction survey administered to all subjects revealed flection of simulation training.
that students felt positive about the simulation identifying Deering, Brown, Hodor, and Satin (2006) performed
that simulation improved their understanding. On the other a one-group, preeposttest study to determine if simulation
hand, students felt anxious because they were being ob- training improves obstetric residents performance in
served. The authors concluded that skill performance dete- breech delivery. Twenty obstetric residents were pretested
riorates over time and simulation is not an effective method on simulated vaginal breech delivery performance to assess
to assist with skill retention. No recommendations were initial knowledge base. No differences were found among
made, although the authors acknowledged the inability to the subjects before the intervention. All subjects then par-
generalize findings as a limitation of the study. ticipated in scenario-based simulation training with
Deering, Poggi, Macedonia, Gherman, and Satin (2004) a high-fidelity birthing simulator (Noelle). Within 2 weeks
conducted a posttest-only study to determine if simulator of the simulation training, all residents were posttested on
training improves obstetric residents performance in a sim- a simulated vaginal breech delivery using the same simula-
ulated shoulder dystocia vaginal delivery. A convenience tion system. Pre- and posttests were scored using a task-
sample of 33 obstetric residents were randomly assigned specific checklist for skill performance and a Likert scale
to a control group (n 17) and an experimental group for safety performance. Data were analyzed using Wil-
(n 16). The experimental group received simulation coxon signed rank test, McNemar chi-square, regression
training using patient care scenarios with a high-fidelity analysis, and paired t tests as appropriate. Statistical

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findings revealed that both overall median performance Other studies have been conducted on high-fidelity
scores (p 0.001) and safety performance (p 0.001) cardiac patient simulators (Harvey and HeartSim II)
were significantly higher after simulation training. The re- among medical residents, critical care nurses, and graduate
searchers concluded that resident performance of a simu- nursing students. These findings consistently demonstrate
lated vaginal breech birth improves with simulation improved cardiology skills (Issenberg et al., 2002;
training. Because there was no control group for compari- Woolliscroft, Calhoun, Tenhaken, & Judge, 1987), and im-
son, it is difficult to determine if these results were actually proved ability to recognize heart sounds after simulator
related to the simulation intervention. training (Butter et al., 2010; Champagne, Harrell, &
Hutton, Kenealy, and Wong (2008) conducted a one- Friedman, 1989; Harrell, Champagne, Jarr, & Miyaya,
group preeposttest study to assess the effectiveness of 1990a; Harrell, Champagne, Jarr, & Miyaya, 1990b).
a simulation model (SuperAnnie) to teach chest tube inser- The medical literature demonstrates that simulation is an
tion to junior physicians. Forty-nine physicians completed effective method to enhance skill knowledge and perfor-
all requirements of the study. All subjects were pretested mance. In addition to the above findings, a systematic
on chest tube insertion on the simulation model. After pre- review of high-fidelity simulation in medical education
testing, all subjects underwent chest tube insertion training showed that simulation can improve learning in clinical and
that involved observing and practicing chest tube insertion procedural skills and patient management, although in this
on the simulation model for 2 hours in small groups. One review simulation was not compared with other educational
month after the training, all subjects were posttested on modalities (Issenberg et al., 2005). Skill retention after sim-
chest tube insertion using the same simulation model. Chest ulation training shows mixed results. However, these results
tube insertion skill was measured using a task-specific must be interpreted with caution because many of the study
checklist. Chest tube insertion scores significantly im- designs could have been more rigorous. Omission of either
proved from pretest to posttest (p < 0.001). The authors a pretest or a control group makes it difficult to determine if
concluded that the simulation model training program ef- positive results were actually related to the intervention or
fectively improved chest tube insertion skill. One limitation to extraneous variables.
of this study was the lack of control group, which makes it
difficult to determine if the significant results were actually Allied Health
related to the simulation training.
In 2009, Barsuk, Ahya, Cohen, McGaghie, and Wayne Seybert & Barton (2007) conducted a one-group prospec-
published an article describing a preeposttest study explor- tive study to assess the use of simulation-based learning
ing the effect of simulation training on temporary hemodi- on doctor of pharmacy students accurate performance of
alysis catheter insertion skills. Eighteen nephrology fellows blood pressure (BP) measurement. A convenience sample
participated in the study; 12 participated in simulator train- of 102 students was enrolled in this study. All subjects re-
ing while six did not. All subjects were posttested on tem- ceived didactic classroom content on BP measurement im-
porary hemodialysis catheter insertion using a task-specific mediately followed by simulation training on BP
checklist on the simulator CentralLineMan. Data were an- measurement with a high-fidelity simulator (Laerdal Sim-
alyzed using the ManneWhitney U test. The simulator- Man). A second simulation training on BP was provided
trained group had significantly higher posttest scores than 2 weeks later. A task-specific checklist was used to
the control group (p 0.001). The authors acknowledged measure BP assessment performance on the same high-
the small sample size as a limitation of this study. In addi- fidelity simulator for all subjects after each simulation
tion, the control group was not pretested to ensure homoge- session. Subjects completed a Likert-style survey instru-
neity of the sample before the intervention. ment before and after simulation to assess their attitudes
Lee et al. (2009) conducted a preeposttest study to deter- towards simulation. Analysis of variance (ANOVA) was
mine the effect of simulation training on medical students used to statistically analyze performance of BP assessment.
technical skill in vascular surgery. Forty-one medical stu- Student performance of BP assessment showed significant
dents were pretested on a renal stent insertion on an endo- improvement after each simulation training session
vascular simulator (The Simbionix Angiomentor) after (p 0.029). Survey results indicated that students felt
receiving traditional education. Then, over the next 8 weeks, that simulation would improve their ability to measure
students received weekly simulation practice on various vas- BP. Based on these results, the authors concluded that
cular procedures on the same endovascular simulator. At the pharmacy students showed a significant improvement in
end of the course, students completed a second renal stent the performance of BP measurement after simulation train-
insertion as a posttest. Renal stent insertion competency ing. Because of the prospective design of this study, no as-
was measured using a global rating scale. Students showed sumption of cause and effect was made, but there were
significant technical skill improvement from pre- to posttest significant differences.
(p < 0.01). The lack of a control group for comparison Tuttle et al. (2007) conducted a quasi-experimental,
makes it difficult to ascertain whether the significant results repeated measures study to determine the effect of simulation
were actually related to the simulation training. training on mini bronchoalveolar lavage (BAL) performance

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Simulation and Psychomotor Skill Acquisition e434

among respiratory therapists. A convenience sample of 107 high-quality studies on the use of simulation and psycho-
respiratory therapists was studied. Twenty-four respiratory motor skill acquisition.
therapists had their current performance of mini BAL as- This literature review focused on health care education
sessed with a scenario-based, high-fidelity simulation assess- literature related to simulation training in the acquisition of
ment. These therapists had been trained with standard psychomotor skills. Overall, this literature review reveals
training at some point before the evaluation. Subsequently, the following:
83 respiratory therapists received Web-based instruction on
mini BAL followed by simulation training with a high-  Most of the available literature is found in the medical
fidelity mannequin (Laerdal SimMan). Performance was profession; there are limited empirical studies available
evaluated at three points in time: after Web-based training, exploring the use of simulation for psychomotor skills
after simulation training, and 90 days after simulation train- training in nursing education.
ing. Performance was assessed using a task-specific checklist  Most of the available empirical evidence demonstrating
during a scenario-based simulation using the same simula- the efficacy of simulation for psychomotor skill acqui-
tion manikin. Respiratory therapists performed better after sition focuses on high-fidelity simulation.
simulation training than after either standard training or  Simulation appears to enhance psychomotor skill per-
Web-based training (p < 0.01). In addition, 90-day skill re- formance; however, much of the evidence supporting
tention after simulation training was better than immediate the use of simulation in psychomotor skills acquisition
assessment after initial training or Web-based training stems from studies with limitations, such as small sam-
(p value not reported). Based on these results, the authors ple sizes and lack of control group for comparison;
concluded that mini BAL training can be enhanced with sim- therefore the results must be interpreted with caution.
ulation. In addition, the researchers determined that simula-  Simulation is well received by students.
tion training helps with skill retention.
Rigorous empirical data exploring the use of simulation This literature review demonstrates the need for further
for psychomotor education in allied health fields is very research regarding the use of simulation in the education of
limited. The studies that are available further support the psychomotor skills in nursing education, specifically:
use of simulation for psychomotor skill education. Use of
more rigorous research designs using two groups with  Quantitative evaluation of the efficacy of simulation to
a pretest for comparison and power analysis would teach psychomotor skills within the nursing discipline.
strengthen these findings.  Quantitative evaluation of low-fidelity simulation to
teach psychomotor skills.
 Inclusion of more varied psychomotor skills.
Discussion  Use of rigorous, true experimental designs with power-
driven sample sizes and control groups to test psycho-
With the upsurge of simulation use, the literature related to motor skill performance after simulation training.
simulation in health care education is rapidly expanding.
Much of the available simulation literature is descriptive in
nature, with a surprisingly limited numbers of empirical Conclusion
studies. The majority of empirical literature on simulation
is found within the medical profession; however, there is Psychomotor skills are a necessary component for all health
a growing body of evidence available on the use of care practice. Simulation offers a novel method for teaching
simulation in nursing and allied health care. Despite the psychomotor skills. However, robust quantitative research
widespread adoption of simulation in nursing education, about the efficacy of this teaching strategy is sorely lacking,
there is a dearth of research available exploring the efficacy especially in the nursing literature. Given the importance of
of simulation on competency development (Harlow & competent psychomotor skill performance, it is essential
Sportsman, 2007). Much of the empirical data that is avail- that teaching strategies are explored for their efficacy.
able is of questionable rigor. Furthermore, there is a general Simulation is rapidly gaining popularity as a gold-standard
lack of quantitative studies exploring the effectiveness of teaching technique for psychomotor skills. However, the
simulation in cognitive and psychomotor skill attainment. current nursing literature is devoid of adequate empirical
Although the health care literature exploring simulation evidence to support the use of this strategy in such a context.
is vast, the available literature related to simulation and Continued research efforts are needed to empirically
psychomotor skills has a limited focus on specific psycho- support this current education trend.
motor skills (most notably cardiac assessment). Most
available studies explore various uses for high-fidelity References
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commonly studied. In addition, there is a lack of rigorous, quisition and retention of CPR knowledge and skills learned with the

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