Aug 2026· Medical Teacher· pp.
1-17
· 0 citations· 39 references
Medicine
TL;DR
Sequential simulation may help clerkship students connect principle-based ethics teaching with real-time reasoning and communication demands and increased learners' perceived readiness for challenging clinical encounters.
Abstract
INTRODUCTION
Clerkship students encounter ethically significant dilemmas but have limited opportunities to rehearse ethically grounded decision-making and difficult conversations in realistic clinical contexts. We evaluated an immersive, sequential simulation-based clinical ethics education program.
Methods
We conducted an explanatory sequential mixed-methods pre-post study with clerkship students at Kaohsiung Medical University from September 1, 2022, to May 31, 2023. Participants completed a core e-learning curriculum (digital modules/videos) before a two-day immersive simulation. The simulation comprised six longitudinal standardized patient cases, each with four sequential scenarios. Quantitative outcomes included ethical knowledge, ethical sensitivity, vignette-based ethical decision-making, and confidence in managing clinical ethical dilemmas; satisfaction was measured post-intervention. Pre-post comparisons were made using Wilcoxon signed-rank tests. Focus groups were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. Findings were integrated using a joint display.
Results
Thirty-eight clerkship students participated. Post-intervention ethical knowledge showed gains across all seven assessed domains. Ethical sensitivity increased across three issues, and ethical decision-making improved across all six vignettes. Confidence increased in nine of 11 items, including dilemma awareness, clarifying ethical problems, ethical reasoning, communication to reach consensus, and confidence in ethical decision-making. Satisfaction with simulation education was high. Qualitative integration identified three themes explaining these gains: confidence through enactment, structured ethical decision-making, and voice and consensus under pressure.
Discussion
The program was associated with short-term gains in ethics knowledge, ethical sensitivity, vignette-based decision-making, and confidence. Qualitative findings suggested that enactment, feedback, and reflection made ethics learning more practical and increased learners' perceived readiness for challenging clinical encounters. Sequential simulation may help clerkship students connect principle-based ethics teaching with real-time reasoning and communication demands. Controlled longitudinal studies are needed to examine durability, transfer, and workplace-based performance.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT05547893.
Objective Non-technical skills (NTS) are essential for safe emergency care but are inconsistently taught in undergraduate curricula. Video-assisted debriefing (VAD) may support reflection on team performance, but its feasibility within routine clerkships is underexplored. This study evaluated the feasibility of integrating VAD into a mandatory emergency medicine clerkship and descriptively explored learner perceptions and observed NTS performance. Methods A convergent mixed-methods feasibility study was conducted within an 8-week final-year emergency medicine clerkship in Qatar (N=66). Weekly simulation sessions included structured NTS teaching and VAD. Feasibility was predefined as: participation ≥80%, survey completion ≥70%, and ≥50% of recordings technically suitable for faculty assessment using the Simulation Performance Assessment Tool-Modified (SPAT-M). Learner perceptions were explored through a post-clerkship survey and free-text reflections. Results All 66 students completed the mandatory simulation curriculum; 46 (69.7%) completed the post-clerkship survey, narrowly below the predefined 70% threshold. Of 16 recordings screened, nine (56.3%) met technical criteria for SPAT-M analysis; seven (43.7%) were excluded for incomplete capture, audio failure, or poor image quality. Students reported high perceived NTS competence (median 4.0–4.5/5); faculty ratings of the nine usable recordings reflected competent-to-proficient performance (median 3.5–4.5). Situational awareness was the relatively lowest-rated domain and the most frequently reported area for development. Thematic analysis identified three themes: applying NTS in clinical practice, situational awareness as an area for development, and support for earlier longitudinal NTS integration. Conclusion Integrating VAD into a mandatory emergency medicine clerkship was feasible, although survey completion narrowly missed the predefined threshold and technical limitations restricted structured assessment to 56.3% of recordings. Learners perceived VAD as supporting reflection on NTS performance. Further multi-institutional studies are needed to evaluate educational effectiveness and transfer to clinical practice.
K. Bashir, Amani A. Al-Rajhi, Amr Elmoheen et al.· Advances in Medical Educatio...· 0 citations
Simulation-based learning is widely used to prepare nursing students for therapeutic communication, but transfer is often treated as if students acquire decontextualized skills in the laboratory and then apply them in clinical practice. This qualitative descriptive study explored how undergraduate nursing students experienced the transition from communicating with simulated patients to communicating with real patients during early clinical practice. Fifteen third-year Bachelor of Science in Nursing students in the United Arab Emirates who had completed the required Adult Health Nursing I simulation component and an initial medical-surgical clinical rotation participated in three face-to-face focus groups. Data were analyzed inductively using reflexive thematic analysis. The overarching interpretation was that students moved from prepared encounters in simulation to situated responsiveness in clinical practice. Three themes explained this shift: encountering unplanned patient agency, becoming accountable for one’s response, and communicating within institutional opacity. Simulation supported foundational communication practices but did not fully reproduce the emotional, relational, cultural, and organizational conditions of real patient communication. Findings suggest that simulation-to-practice transfer should be supported through progressively complex patient portrayals, explicit orientation to communication boundaries and workflows, and structured post-clinical reflection.
Israa A. M. Abuijlan, F. M. Ibrahim, Eman Abdelaziz Rashad Dabou et al.· Global Qualitative Nursing R...· 0 citations
Background: Competency-based medical education (CBME) highlights the importance of communication, ethics, and professionalism in clinical practice. Obtaining informed consent is a key skill that reflects these competencies. However, assessment of informed consent during Objective Structured Clinical Examinations (OSCEs) often relies on checklist-based methods, which may not adequately capture the quality of communication or ethical reasoning. This study aimed to develop and evaluate a rubric-based OSCE approach to assess informed consent competency among undergraduate medical students.Materials and Methods: A quasi-experimental educational intervention was conducted among 120 Phase III MBBS students. A structured analytic rubric aligned with CBME competencies was developed and refined using a two-round Delphi process involving experienced faculty members. Faculty were oriented through calibration sessions prior to implementation. The same cohort of students was assessed in both pre-and post-intervention phases under comparable conditions. Student performance was analyzed using paired t-tests, inter-rater reliability using Intraclass Correlation Coefficient (ICC, two-way random effects), and stakeholder perceptions using Likert-scale surveys and thematic analysis.Results: Mean student scores improved from 58 ± 8.4 before implementation to 80 ± 6.9 after introduction of the rubric (p < 0.001). Inter-rater reliability demonstrated good agreement (ICC = 0.82). Most participants (78%) reported positive perceptions, highlighting improved clarity, fairness, and feedback quality.Conclusion: Rubric-based OSCE assessment provides a structuredand reliable method for evaluating informed consent competency. It supports more transparent assessment and facilitates meaningful feedback, thereby strengthening competency-based evaluation of communication and ethical skills. Further studies with comprehensive psychometric evaluation are recommended.
Gupta Richa, Khan Amir Maroof, Gupta Prashant et al.· Asian Journal of Medical Res...· 0 citations
Assessment of knowledge, attitudes, and perceptions of clinical medical students toward simulation-based learning at Ahmadu Bello University, Zaria, North-Western Nigeria indicates that most respondents possessed good knowledge of simulation-based learning and expressed positive attitudes and perceptions toward its use.
Jamilu Garba, Bilkisu Muazu Adam, A. Bello et al.· Nigerian Medical Journal· 0 citations
BACKGROUND
Immersive virtual reality (IVR) simulation is increasingly used in nursing education to support experiential learning and the development of non-technical skills. Debriefing is integral to simulation-based education; however, shortages of qualified facilitators and variability in delivery can constrain scalability and quality. Generative artificial intelligence (GenAI) may offer a standardised and scalable approach to post-simulation debriefing, yet comparative evidence in nursing education remains limited.
AIM
To compare the effectiveness of GenAI-assisted versus facilitator-led debriefing on nursing students' knowledge acquisition and self-reported non-technical skills following an IVR nursing simulation.
DESIGN
Quasi-experimental, two-group pretest-posttest study.
SETTING
A higher education institution in Hong Kong.
PARTICIPANTS
Undergraduate nursing students with less than four weeks of clinical internship experience.
METHODS
Participants were allocated by subject enrolment to either GenAI-assisted debriefing plus a 10-minute facilitator summary (experimental group) or facilitator-led debriefing (control group) after an IVR hospital simulation. Knowledge was measured using a multiple-choice questionnaire at baseline (T0) and post-intervention (T1), while self-reported non-technical skills were assessed at T1.
RESULTS
A total of 178 students participated (experimental n = 102; control n = 76). Baseline knowledge scores were comparable (experimental: M = 10.98, SD = 2.27; control: M = 11.03, SD = 2.56; p = .899). Knowledge increased significantly from T0 to T1 in both groups (experimental: M = 12.71, SD = 2.71, d = 0.79; control: M = 12.68, SD = 2.44, d = 0.72; both p < .001). After adjustment for baseline knowledge, there was no significant between-group difference in post-intervention knowledge (F = 0.03, p = .871). Non-technical skill domain scores did not differ significantly between groups (all p = .272-0.876).
CONCLUSIONS
GenAI-assisted debriefing produced outcomes comparable to facilitator-led debriefing for knowledge and self-reported non-technical skills. These findings warrant further investigation of GenAI-assisted debriefing as a complement to existing approaches.
P. Kor, Kitty Chan, Alex Pak Lik Tsang et al.· Nurse Education Today· 0 citations
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