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Discussion

 

The prominence and benefits associated with the simulation
use in clinical setting had encouraged medical colleges to initiate the
simulation use in medical curricula. Present study assessed the SBL impact on
learning. In this study the percentage scores on most of the items were
all in favor of SBL. The results were comparable with the study by Joseph et al
that reported overall positive perception of medical students.18The
result indicated that teaching on simulation had improved students’ learning in
term of knowledge, critical thinking, reasoning and self-confidence. Literature
also confirmed the effective use of
simulation in teaching and learning medicine19 and nursing.20
In addition, students showed general agreement on type, number and quality of
the equipment provided by the college.

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It is known fact that debriefing is
crucial aspect of SBL which increased performance and improved reflective
practice.21 However,
tutors’ debriefing and feedback skills were highly criticized and considered inadequate
by many participants. This issue of feedback and its role in the skill
development is an area that needs consideration. This is vital to strengthen
the deep learning process and to support development. As a reliable means to assess competencies, the
contribution of tutor’s constructive feedback in learning should be further
investigated.22Moreover,
result emphasized on the importance of training sessions and curriculum reform
by developing experiential learning approach in teaching. Form the
results it is evident that within the framework of experiential learning increasing
use of simulator in teaching and more exercises may contribute to better
learning outcomes.

In addition, this
study observed a significant increase in the scores based on the level of the
students in college. The students’ experience and practice on simulated
patients at different level of study might be a reason of this significant
difference. Interestingly, a significant increase among genders on the domains
of process, equipment and feedback suggested the overall satisfaction of female
students as compared to male students with this modality.

Even though, few students who gave unfavorable
feedback, the qualitative analysis in this study, acknowledged the benefits of
simulation teaching in practice. The shared benefits summarized as; confidence
building, improved communication and acquisition of reasoning skills. The group of participants raised attention to two features
issues facts; first, simulation center and tutors had a critical role in the
advancement of teaching clinical skills. Secondly, initiative and involvement
of leadership in the necessity of prioritization with regard to standards
and demands of simulation resources in the clinical setting. The findings were consistent with a study
done on nursing students argued on the critical role of stakeholders in
enhancing the clinical learning experience to students.20 Reflecting on our results, a
lack of explicit directions to support faculty and students were found.

Study
limitations

Some
limitations that prevented the generalization were small number of participants
from one institution but it suggest the need to include sample from other
colleges of the region. Secondly, there was no control group for comparison to
see the contribution of other modalities on students learning. The findings
despite certain limitation will guide the stakeholders on how students’
learning needs should be addressed. This recognition is important in planning, implementation
and evaluation of SBL in medical education.

Conclusion and
recommendations

SBL in this
study generally recognized as useful and effective way of learning skills. The current integration between
clinical teaching methods and simulation is still at its start, and there is
vast potential for further association. It would be important for educational leaders in the institution to
understand that all the stakeholders have a significant role in teaching the
clinical knowledge and skills to medical students. There is a need to
communicate benefits of simulation with faculty members and students and to
review the current strategic goals of the
use of simulation to include this approach in medical curricula. Enactment of
the process is an important step to make it clear and evident to all students. Further
studies to explore the current and future implications of simulation in
clinical learning are required.  

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