In last few decades, simulation has become a useful alternative tool in training undergraduate medical students and in maintaining patient’s safety. Nowadays due to strict patient privacy, safety policies and current COVID 19 pandemic with its restrictions, learning clinical skills in clinics or wards has become very challenging (22). The key challenge is to explore, provide and adopt a favorable mode of providing knowledge, interactive learning, clinical encounters and their assessment by using available recourses to keep moving the clinical training onwards without compromising student’s safety (23). Many medical colleges are employing simulation as a key tool to help their students to master important clinical skills in stress-free environment. It helps them to learn in a realistic and immersive way, allowing them to experience almost real-world scenarios (24) (25).
The present study has explored student’s perception about learning clinical skill by simulation. Most of the students in our study have endorsed that SBL is a safe, reproducible and cordial learning environment (26). The study has also explored and described the favorable impact of SBL on undergraduate medical students in learning communication skill, procedural skills and integration of basic and clinical knowledge in a comfortable environment. The simulation helped to minimize the anxiety, improved comfort, knowledge retention and confidence among the students to work confidently in clinics (27). With the evolution of technology, various kinds of simulators are available to teach and train the psychomotor skills in undergraduate medical students. Various studies have mentioned the importance and utility of different simulators in enhancing the psychomotor skills and cognitive learning. The simulators provide an opportunity to the students to learn manual skills and monitor their own performance (28) (8). However, the students still supported the need and role of the tutor in these sessions. They preferred the tutor’s feedback and debriefing sessions. They found the debriefing sessions by the tutor after each encounter helpful to augment and improve their skill learning experience (29).
Finding rarest cases is another advantage of SBL. It is a deliberate practice of clinical skills under controlled environment. It supports to provide or create a rarest or important case scenarios for the students to practice and react accordingly (30). Simulated high stake procedures and encounters can also be used to enhance student’s competence in a particular field to compensate the exposure with rarest case presentations or diseases (31).
Medicine is perceived as one of the most stressful programs as compare to any other academic disciplines or programs. Clinical training stresses in medical students are mainly related to the fear of making errors, communication with patient, language barriers, fear of failing to perform in front of patient and peers, fear of not having enough knowledge and skill to deal with patients, and many more (32). Stress is a known factor affecting cognitive and psychomotor skill performance of the students and ultimately affecting patient care (33). Simulation based learning provides an opportunity to the students to work and practice in a controlled and stress-free environment (34) (35). The study participants also found SBL as controlled stress-free learning environment as compare to wards. They also found it useful to overcome the problems of uncooperative patients in wards, during exams and helps them to learn to handle the difficult patients. Minimizing standing hours, less overcrowding and reduced learner’s fatigue are the other explored added advantages of SBL in our study.
Patient safety is one of the core attitudes of clinical training of health professionals. Ensuring patient safety in clinical settings needs structured and controlled clinical skill practice and training before patient encounter. Simulation based learning can be a useful resource to train and teach patient safety protocol to the undergraduate medical students (36). Meticulous training of the students in such controlled setups can help to create a climate of responsibility and accountability about patient care and safety among our students. Conscientious training sessions through SBL can also help to minimize the medical errors by students and can successfully be used to improve the quality of health workers and patient’s interaction when each patient is unique (37).
Although majority of the participant in our study believed SBL is a pragmatic approach to learn clinical skill, they still affirm that simulation cannot replace the importance of real patient in real environment. They also strongly exhibited their trust on the role of teacher in learning of clinical skills. They strongly believed that students try to adopt the attitude, attire, professional dealing and behavior of their teachers in clinical settings (38) (39). Personality and teaching skills of the tutor are positive attributes of role model which they feel lack in SBL.
Limitation of the study
The main limitation felt was the inability to take the perception of students about use of different types of simulators individually for learning clinical skills e.g. high-fidelity mannequin, task trainer, standardized patients etc.