The use of simulation-based education in cardio-respiratory physiotherapy

Gough, Suzanne (2016) The use of simulation-based education in cardio-respiratory physiotherapy. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

This thesis is situated in the context of simulation-based education (SBE) within cardio-respiratory physiotherapy in the UK. A pragmatic mixed methods study has provided a comprehensive examination of the use of SBE from two perspectives: 1) physiotherapy education and 2) pre-registration physiotherapy students’ experiences of managing a deteriorating patient in a simulation context. Two national surveys in Phase 1 provided the first insight into the spectrum of SBE utilised in pre-registration and postgraduate physiotherapy education in the UK between 2009 and 2010. National inconsistencies in simulation provision and accessibility were identified. Financial costs, time and access to simulation centres/laboratories reportedly influenced the use of SBE within cardio-respiratory physiotherapy education. Phase 2 combined SBE and video-reflexive ethnography (VRE) methods to elicit a unique and comprehensive exploration of performance, behaviours, errors and personal experiences of 21 final year (pre-registration) physiotherapy students from one higher education institution in the UK. This study has identified the multi-layered impact of personal experiences and behaviours on practices, clinical decisions, dynamics and the complexities and interconnectivity of participants to the simulation environment. The range of errors identified by this study also highlights the complexity of managing an acutely deteriorating patient in a simulation context. The combination of SBE and VRE allowed the participants to explore errors and defences erected within the scenario and their impact on patient safety. The findings of this thesis emphasise the importance of scenario design, considering the learner’s level of experience, prior knowledge and sequencing of abstract skills before requiring contextualisation within a complex scenario. Carefully planned and executed SBE and VRE methods can provide a safe learning environment to allow participants to explore routine, evolving and complex situations whilst allowing them to learn to be become comfortable with making and exploring errors. Thus, the findings provide valuable insights to inform future research regarding physiotherapy practice and integration of educational methods to augment patient safety awareness and enhance safe healthcare practice. The key message of this thesis is that SBE is a valuable learning modality to explore the complexities of healthcare education and practice.