SIMBA was superior to SGT for knowledge gain, as shown by significantly higher MCQ scores in the post-SIMBA group compared to post-SGT only. SIMBA also had higher student satisfaction compared to SGT. Attending both SIMBA and SGT did not lead to greater knowledge gain than SIMBA-only, suggesting that SIMBA may be sufficient as a stand-alone teaching modality.
To foster productive learning, teaching models and learning environments must be suited to the target audience; younger generations prefer technology-assisted learning (22, 23). SIMBA utilised available technology familiar to the younger generation and provided teaching in an environment more conducive to learning by efficiently combining e-learning and SBL.
The six-step conceptual framework helped to define and address the needs, goals, and objectives to deliver end-user feedback-driven simulation-based learning (20). Although combining the simulation game and Kolb’s experiential learning theories helped deliver an engaging session (14, 15), open-ended feedback highlighted the need to ensure students attended the lectures before participation to maximise learning. We have therefore revised our model to include lectures as part of the concrete experience in future sessions. Stimulating interest to participate was difficult as students were occupied with pre-existing academic commitments. We will address this by involving the programme directors to incorporate the model into routine academic requirements. We also could not measure the active experimentation stage of our learning model. A follow-up interview of participants to explore how they use the knowledge gained from SIMBA for Students during their interactions with patients at clinical placements can address this.
Interest is crucial in motivating learning, and the ability to stimulate interest in students is a powerful tool and one which is essential to academic success (24). Results showed SIMBA stimulated greater interest than SGT, which may have contributed to the significant increase in MCQ scores post-SIMBA sessions.
It is more valuable to the student when the information they are taking holds context and can be applied to the goal they are working towards (25). The SBL model of SIMBA provides learners to develop applied learning. Similar work elsewhere showed that virtual simulation tends to be well-received, with several studies indicating that students feel an improvement in clinical confidence. Nursing students participating in a virtual simulation teaching activity felt less pressured and inhibited by faculty and peers during the session (26). Unlike a real scenario, SBL provided a safe space to learn from mistakes, a critical aspect of the learning process. This sentiment was echoed by a study involving medical radiation sciences students, highlighting the importance of “safe practice in a low-pressure environment” (27). Preliminary results from the obstetric and neonatal simulation workshop suggest it may be valuable to integrate interprofessional education into teaching curriculums post-pandemic (28).
SIMBA is an accessible model that can be used by students and teachers from any location, at anytime, anywhere. This saves time, money, and valuable resources in an already strained academic and healthcare system. SIMBA’s adaptability also means that the model can be used for students in different countries with different healthcare systems, with previous SIMBA sessions shown to be effective in educating healthcare professionals worldwide (17, 18). This pilot study focussed on endocrinology, but our model can easily be expanded to cover any subject in the medical school curriculum (29). SIMBA has other advantages compared to SGT by avoiding issues such as individual students dominating the discussion, shy or disinterested students failing to contribute, and attention being directed toward the facilitator, who is expected to provide answers (6). SIMBA is standardised and delivers equal experiences to all students taking part, thus avoiding the issue of differential knowledge gain depending on which facilitator is allocated when multiple parallel sessions are run. Therefore, SIMBA could become the mainstay teaching modality after lectures.
Moreover, recently the SIMBA model has successfully been used for patient education. Whilst this study focuses on students, this can be vital in improving shared decision-making and patient outcomes (30). This paves the way for future sessions where students can work with patients to improve their shared decision-making skills.
This study may be subject to sample selection bias. As the session is voluntary and not part of the curriculum, those attending may be more diligent or higher-scoring students, resulting in better MCQ scores in SIMBA than SGT. Moreover, some students may have joined the session due to an interest in endocrinology or the unique style of teaching, thus leading to bias regarding whether the session stimulated interest in endocrinology or whether the session was engaging and interactive. Suggestions for improvement for SIMBA mainly revolved around insufficient time allocated for each case and lack of personalised interaction. The time allocation for each case is based on the average time a student takes to complete all the questions. Undoubtedly, some students would take longer than others to answer and hence may not be able to complete some case scenarios. We, therefore, shared the remainder of the simulation that was not completed during the session to address this. Currently, it is difficult to incorporate personalised responses as not all moderators have the same clinical background. However, students have ample opportunity to have any questions regarding the cases to be addressed in the expert-led discussion session.