The effectiveness of using human patient simulation manikins in the teaching of clinical reasoning skills to undergraduate nursing students: a systematic review.

BACKGROUND: Human patient simulation manikins are being used extensively both nationally (in Australia) and internationally in the education of health professionals. There is evidence suggesting that these types of technologies are effective in teaching psychomotor skills. Furthermore student satisfaction with simulation approaches is generally high. However, the extent to which human patient simulation manikins are effective in the teaching of clinical reasoning skills to undergraduate nursing students is less clear.

OBJECTIVE: The aim of this systematic review was to identify the best available evidence for the effectiveness of using whole-body high-fidelity human patient simulation manikins to teach clinical reasoning skills to undergraduate nursing students.

INCLUSION CRITERIA: The review included all randomised controlled trials that assessed the effectiveness of high fidelity human patient manikins in educating undergraduate nursing students. Studies that included health professionals were excluded unless data for nursing students were analysed separately. The primary outcome measure was clinical reasoning. Other outcome measures included critical thinking, student satisfaction, knowledge acquisition, confidence levels, and skill performance as assessed by methods such as objective structured clinical examinations, and questionnaires.

SEARCH STRATEGY: Using a systematic search strategy designed for each database, the following electronic sources were searched for the period 1999 -2009: AMED, CINAHL, Cochrane Database, Dissertation and Theses, EMBASE, ERIC, Journals@Ovid, MEDLINE, Proquest Nursing Journals, PsycINFO. Hand searching of the reference lists of included studies and conference proceedings was undertaken to identify further studies.

METHODOLOGICAL VALIDITY: Two independent reviewers assessed the methodological quality of each study selected for retrieval prior to inclusion using a critical appraisal tool from the Joanna Briggs Institute.

DATA COLLECTION AND SYNTHESIS: Data were extracted from studies using the standardised data extraction tool from the Joanna Briggs Institute. Statistical pooling was not possible and the findings are therefore presented in narrative form.

RESULTS: Eight studies were selected for inclusion in this review. The results indicate that the use of human patient simulation manikins improved knowledge acquisition and critical thinking; and enhanced students' satisfaction with learning. There is lack of unequivocal evidence on the effectiveness of using high-fidelity human patient simulation manikins in the teaching of clinical reasoning skills to undergraduate nursing students.

CONCLUSION: Further research is required to ascertain the effectiveness of the use of human patient simulation manikins as an educational strategy to improve clinical reasoning skills of undergraduate nursing students. The importance of this research is underscored by the potential for patient outcomes to be improved by enhancing the clinical reasoning skills of undergraduate graduate nursing students and graduates.

IMPLICATIONS FOR EDUCATION: This review presents evidence to suggest that using HPSMs significantly improve learning outcomes related to clinical reasoning namely: critical thinking; clinical skill performance and knowledge acquisition. In addition, results indicate high student satisfaction with HPSMs simulation experience.

IMPLICATIONS FOR RESEARCH: Future priorities for research include undertaking larger more robust pre-test and post-test multisite experimental studies with reliable and valid instruments that measure clinical reasoning in undergraduate nursing students.