There are many different ways that simulations can be used in physical therapy education, and not all of them involve technology. This study compared simulation and role-playing in the context of training clinicians to treat low back pain, but which was more effective?
Simulations are a useful educational tool to help students improve their clinical thinking and decision-making skills as they provide students with authentic learning experiences. This is because people play through the scenario that enables students to apply multiple skills together and not at the same time as well as with interpersonal elements.
This differs from a traditional approach where intellectual observation or description are the primary elements of the learning experience. The evidence related to simulations suggests that by participating in them, students improve their teamwork, communication and decision-making skills.
Perfect your clinical reasoning of the lumbar spine
Simulation comes in several forms, with virtual reality simulation becoming increasingly popular over the past year, but it is important that we do not neglect the value of less technical versions such as role-playing and actor-based simulation. But which of these two is more effective?
A new randomized controlled trial published in BMC Medical Education should find out by comparing the OSCE results of students with simulated patients and role-play forms of the simulation.
Methods
This RCT took place at two Colombian universities. One group at each university was randomized into a clinical simulation group and the other into a role play group. There were a total of 21 students in each group, whereby the exclusion criteria were students under the age of 18, those who had stepped over from another degree program and those with previous experience in simulation.
OSCE scores were the main outcome measure that was used to assess the effectiveness of the two educational styles. Baseline scores were obtained at the start of the study and another was repeated eight weeks later on the same case. The case used went through a content validity review process and external staff carried out the OSCE to reduce the assessment bias.
The OSCE is described in detail in the article and comprises seven levels and evaluates skills or abilities related to physiotherapy decision-making for a person with low back pain. The evaluation was carried out on a scale from 0.0 to 5.0 with different weightings for each level of the OSCE.
Both groups received the same core training sessions, which consisted of five 2-hour sessions that covered the basics of practical skills including manual therapy and exercise prescription for people with low back pain, as well as other basic skills. Two weeks before the randomization, the students were also provided with a learning guide.
Then, depending on the group, the students went through two different educational approaches.
The simulation group
The simulation group received a 120-minute class-based clinical simulation session with an actor playing the role of a patient with low back pain. There were three simulated patients trained with an emphasis on creating clinical decision making experiences for the students, assisted by guided questions from the professor while the students observed.
The students
also had the opportunity to interact with the simulated case and to carry out clinical reasoning themselves . At the end of each session, the students had time to reflect on the case, their learning opportunities and opportunities for improvement. This information was also used in the analysis.
The role play group
The role play group received a 120-minute training unit in which the students took on different roles. Some acted like people with low back pain and some acted like physical therapists. Training in role play as a person with back pain was not planned.
The cases used by the role play group differed from the simulation group, but were similarly complex. First the group was divided into two groups, patient and physical therapist, then the students were given three case studies. The students played the cases according to their role and were then guided through each case by a professor at the end of the session.
Case one was pregnancy, the second involved post-trauma pain, and the third was a case study on non-specific pain. The debriefing process was similar between the groups, with the conversations used in the analysis.
Results
Both groups had improved results after using simulations in their training, but surprisingly the role play group increased their results more than the simulation group (0.66 vs 0.59) . What we unfortunately do not have is a control group that does not use a simulation in its training for the treatment of low back pain.
Brief summary of the use of simulation in physiotherapy training for low back pain
The role play group had higher OSCE values compared to the simulation group
Simulation doesn't have to be virtual to be effective and this is important for students with limited access to technology and the internet
To improve the applicability of this study, a control group could have been used without simulation
Without this control group, it is difficult to agree with the authors 'assertions that this has the potential to improve students' decision-making potential in the future. Sure, it looks like it will improve student outcomes in treating low back pain, but without the control group, we can't be sure. The small sample sizes also limit the applicability.
It would be interesting in the future to see a comparison between virtual simulation and traditional simulation training such as the methods used in this study, as this is a rapidly evolving field of education with promising preliminary results.
