Aug 2026· Journal of Educational Evaluation for Health Professions· Vol 23, pp.
24
· 0 citations
Medicine
TL;DR
Most studies found no significant differences between observer and active participant roles at Kirkpatrick Levels 1 and 2, but generalizability across all health professions and settings is limited.
Abstract
Purpose
This review examined the impact of learner role-active participant versus observer-on learning outcomes in healthcare simulation-based education using Kirkpatrick's evaluation model.
Methods
Five databases-PubMed, Scopus, Web of Science, ScienceDirect, and EBSCOhost-were searched for studies published from January 2018 to November 2024. Eligibility criteria, defined using the PICOS framework, targeted studies comparing learning outcomes between active participant and observer roles among health professions students and practitioners. Methodological quality was appraised using the Medical Education Research Study Quality Instrument, and findings were synthesized narratively. This review was registered in PROSPERO under registration number CRD42024611988.
Results
Of 648 records, 15 studies involving 1,799 participants met the inclusion criteria; role allocation was specifically reported for 644 active participants and 709 observers. Most studies were conducted in high-income countries (13/15) and nursing programs (11/15). At Kirkpatrick Level 1, most studies reported no statistically significant between-role differences, although an active participant advantage emerged for emotional arousal. At Level 2, knowledge, skills, and most attitudinal outcomes did not differ significantly between roles; active participant advantages were observed for technical skills at delayed follow-up, affective competencies in palliative care, and perceived learning transfer. No study assessed Levels 3 or 4.
Conclusion
Most studies found no significant differences between observer and active participant roles at Kirkpatrick Levels 1 and 2. Generalizability across all health professions and settings is limited. Pedagogically appropriate use of the observer role supports learning outcomes and may expand access to simulation-based education.
This systematic review aimed to identify the technology-supported learning approaches used in stoma care education for nursing students, evaluate their effects on learning outcomes, and examine their implementation characteristics, advantages, and limitations. Methods: The review was conducted in accordance with the PRISMA guidelines and registered in PROSPERO (CRD420261395533). A systematic search of PubMed, Scopus, Web of Science, ScienceDirect, Google Scholar, and DergiPark databases was conducted to identify studies published between 2016 and 2026. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools, while risk of bias was evaluated using Cochrane RoB 2 and ROBINS-I tools. Results: A total of 11 studies met the inclusion criteria. Identified interventions included simulation-based education, virtual reality (VR), serious game-based web applications, web-supported education, online/video-based learning, and digital presentation methods. Most studies reported positive effects on learning outcomes, particularly knowledge acquisition and skill development. Simulation-based interventions were found to improve self-efficacy, self-confidence, and communication skills. High-fidelity simulation and standardized patient applications appeared to be more effective than low-fidelity approaches. Serious game-based and web-supported approaches were associated with improved knowledge retention and greater student engagement. Follow-up assessments in a limited number of studies suggested that technology-supported interventions may contribute to long-term knowledge retention. Conclusion: Technology-supported learning approaches appear effective in improving nursing students’ stoma care knowledge and skills. However, larger multicenter studies with longer follow-up periods are needed to strengthen the evidence.
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