New technology and methods for diagnosis and treatment require that health personnel keep abreast with new practices [1]. Traditionally, clinical and communication skills were taught at bedside[2]. However, in the clinical environment it is challenging to make adequate observations and to perform feedback and to have enough time for reflection and discussion [2]. Also, today there are fewer opportunities for training through direct patient contact, onereasonbeing thespecialization of disciplineswhich risks leading to fragmentation and making it difficult for students to hold a holistic view/perspectiveon the patient[3].Several other factors make clinical teaching challenging, such as shorter hospital stays[4],patients being too sick or unwilling to participate in teaching encounters, increasing demands on clinicians and teachers, and increasing efficiency demands leading to shorter time for patient consultations[2]. The World Health Organization (WHO) recognizes that patient safety knowledge applies to all areas of practice and to all health care professions [5, p. 22].To facilitate this the WHO has provided a Patient Safety Curriculum Guide which recommends learning about patient safety through hands-on experience and simulation [5, p. 84]. Simulation is an important pedagogical method widely used by healthcare professions and may involve a range of learning activities [6]. Motola et al. (2013) highlight that simulation is a pedagogical method which has the potential to improve skills and skill retention through training in a controlled environment. Results from systematic reviews show that simulation has positive effect on learning knowledge and skills [7-9], and can potentially improve patient related outcomes [7, 10-14].
Issenberg and Scalese[4]state that the aim ofsimulation is “to imitate real patients, anatomic regions, or clinical tasks, or to mirror the real-life situations in which medical services are rendered”.Different types of simulatorsare used for simulation:part-task trainers, simulated patients, simulated environments, virtual reality and haptic systems, computer-based systems, andintegrated simulators (instructor driven simulators or model driven simulators)[15].Simulation is frequently described as high fidelity or low fidelity[16].Simulators that offer complex and immersive scenarios by providing realistic feedback are described as high-fidelity simulators[17], while low fidelitysimulatorsare described as more simple, for example a static model or task trainer, thatfeel less real to the learner and offer no or low responsiveness[18]. To achieve optimal and efficient utilization of resources when designing simulation-based activities it is recommend to: perform a needs assessment;define learning outcomes; design a scenario to provide the context for the simulation including the levels of fidelity;ensure a facilitative approach; conduct pre-briefing and debriefing and feedback/evaluation;make available resources for preparing the participants;and,pilot test the simulation scenario before implementation[19].
Simulation is regarded as a highly suitable strategy for learning radiography [12, 20:43],and higher levels of simulation used in radiography education have been shown to enhancethe radiographers’ perceptions of self-efficacy and critical thinking skills in image evaluation and patient assessment comped to lower levels of simulation[20, p.93].The professional practice in radiography is characterized by the use of advanced technologies and equipment for diagnostic purposes or for treatment of medical conditions [21].Important skills for simulation-based learning are related to positioning, exposure, physics, patient care and quality assurance[20 p.52]. Students need opportunities to practice in a safe environment to ensure quality in the profession, and simulationoffers the possibility for training without putting the patient at risk[4].Simulation alsooffers the benefit of repeated learningof outcomes that promote increased cognitive recall and higher confidence with clinical tasks[22-24]. The term radiographer refers to “professional roles in the fields of diagnostic imaging, nuclear medicine, interventional radiology and radiation therapy” [25, p.20].
Simulationin radiography has previously been addressed in a literature review which focused on simulationofconventional diagnostic radiography[12].Most studies published after this review were studies with small sample sizes, evaluating different aspects of simulation [6, 22, 26-32]. Several of these studies used mixed methods[28]. Examples of topics covered were related to emotional preparedness when encountering open wounds [32] or when being exposed to clinical burns cases [30]; confidence levels before and after simulation [31]; and perceptions of learning in different high fidelity computed tomography simulation environments [28]. Others experimental studies compared use of virtual reality versus traditional placements [27]; virtual reality against existing simulation techniques [26] and virtual reality against clinical role-play [22]. Simulation was also compared against traditional therapeutic radiography placements in a randomized controlled trial [6].
According to Lee etal.[28], reviews addressing the use of simulation across the different radiography specialties are lacking.Further knowledge on simulation in radiography education is needed to inform curriculum design and future research. The aim of this proposed scoping review is to explore, map and summarize the extent, range and nature of published research on simulationin radiography education.To achieve the aim of this review we will:
- Explore the extent and range of simulation researchconducted in radiography education (e.g. publication dates, volumes, yearly distributions, proportions, geographical locations).
- Explore research methods and designsused in research on radiography education(g. purposes, contexts, study populations, sample sizes, designs, and methods for data collection).
- Exploresimulation interventionsreported in research onsimulation in radiography education.