March 30, 2020By Dr. Kim Baily

Transfer of Learning: From Healthcare Simulation to Clinical Practice

How far we have come from the days when nursing education consisted of lectures with overhead projectors and acetate sheets with diagrams and anatomical drawings. For those of you who remember those days, you probably also remember that when the bulb went out, you often waited weeks for a replacement! The introduction of PowerPoint in the 90s seemed at the time, revolutionary and although many faculty resisted the change in technology, Powerpoint lectures became common by the turn of the century. Since that time, educational strategies and theories in healthcare education have developed considerably with the focus now being on the learner and not the “sage on the stage” — with healthcare simulation becoming closer and closer to “center stage”! But how does healthcare simulation transfer to clinical practice? Today, guest author Dr. Kim Baily PhD, MSN, RN, CNE, previous Simulation Coordinator for Los Angeles Harbor College and Director of Nursing for El Camino College, helps to address that crucial question

Immersive and experiential learning have become a major focus in medical education and clinical simulation is now widely utilized to improve learner outcomes. Current research looks at the effectiveness of medical simulation not only in terms of improved learner knowledge and clinical skills but also in terms of improved patient outcomes. This article reports on a recent focus-group study concerning Nursing students’ transfer of learning outcomes from simulation-based training (SBE) to clinical practice (Hustad, J., Johannesen, B., Fossum, M. et al. Nursing students’ transfer of learning outcomes from simulation-based training to clinical practice: a focus-group study. BMC Nurs 18, 53 (2019).

The study aimed to explore nursing students’ experiences during simulation in healthcare and to determine how the students perceived the transfer of learning to clinical practice. Thirty-two second and third year Nursing students participated in the study. The clinical simulation sessions were part of a one-week program conducted before the students entered their first hospital clinical practice. All students participated in two high-fidelity healthcare simulations designed to prepare them for hospital patient care. Both scenarios involved changing patient conditions with either heart disease or postoperative bleeding as the focus.


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Most of the students took an active role in the simulations. Gibbs’s reflective cycle was used for debriefing. Following a 2-4 month gap and completion of at least 8 weeks of clinical studies, students were then interviewed in 8 focus groups of 3-6 participants. The focus groups lasted between 42 and 87 minutes and were audio recorded and transcribed verbatim.

The groups were asked three main open ended questions:

  1. What were your experiences of simulation-based training?
  2. What were your learning outcomes from the debriefing?
  3. How has the simulation in healthcare impacted your practice in the clinical placement?

The interviews were then analyzed using thematic analysis inspired by Braun and Clarke’s six step-by-step guide for thematic analysis. Three major themes emerged from the focus group interviews:

Simulation-based training promoted self-confidence: Some students reported that nursing simulation based training prepared them mentally for their clinical. Others noted that although they experienced stress during the healthcare simulation, they became aware of how they responded to stress and how their peers assessed their behavior. Some noted that their self-confidence grew following the healthcare simulation and that this was in part due to the positive feedback they received from faculty. Feedback gave them confidence that they were completing clinical care correctly. Others indicated that simulation gave them experiences that matched those they had in the hospital. The students appreciated that their instructors were supportive and non-judgmental.


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Understanding from simulation-based training improved clinical skills and judgements in clinical practice: Students reported difficulty in transitioning from theory to application during the nursing simulation however, having completed the simulation, their transition to the hospital was easier. They noted that simulation highlighted the importance of examining clinical symptoms and vital signs. One student mentioned that they used decision-making tools for evaluating vital signs in the clinical setting that they had previously used in the simulation.

Healthcare Simulation seemed to lessen panic and provided students with an opportunity to notify licensed personnel about a change in a patient’s condition. One participant noted, “I was much more prepared, more self-confident, having learned the various kinds of modern equipment, how they work and how I should handle them”. Students noted that healthcare simulation gave them practice with coping with unexpected situations.

Simulation-based training emphasized the importance of communication and team collaboration. Students found that healthcare simulation made them realize that communication with both patients, families and healthcare team members was more important than they had realized particularly in regards to caring for a patient with a rapidly changing condition. Students appreciated the opportunity to practice ISBAR and closed loop communication. They also felt that their healthcare simulation experiences highlighted the role of other healthcare practitioners and the importance of leadership during emergency situations.

This study revealed that healthcare simulation offered by caring and supportive faculty lessens nursing student anxiety by providing real life experiences, opportunities to practice communication skills and to function in a realistic clinical setting.

Further Research Reading: “Nursing students’ transfer of learning outcomes from simulation-based training to clinical practice: a focus-group study” (Hustad, et al.): Simulation-based training is used to develop nursing students’ clinical performance in assessing and managing situations in clinical placements. The use of simulation-based training has increased and become an integrated part of nursing education. The aim of this study was to explore nursing students’ experiences of simulation-based training and how the students perceived the transfer of learning to clinical practice. Eight focus group interviews were conducted with a total of 32 s- and third-year nursing students who participated in a simulation-based training organized as preparation for clinical placement. The transcribed interviews were analysed with thematic analysis.

Three major themes emerged from the focus group interviews; first, the simulation-based training promoted self-confidence; second, understanding from simulation-based training improved clinical skills and judgements in clinical practice; and third, simulation-based training emphasised the importance of communication and team collaboration.

This study revealed students’ transfer of learning outcomes from simulation-based training to clinical practice. The students’ experiences of the simulation-based training remain as enduring and conscious learning outcomes throughout their completion of clinical practice. The organisation of simulation-based training and its implementation in the curriculum are crucial for the learning outcomes and for students’ experiences of the transfer of knowledge to clinical practice.

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