Learning in simulated environments: Impact on learning transfer and clinical skill acquisition in nurse practitioner students

This research study investigated the issue of transfer or learning of knowledge and skills by observing nurse practitioner students in a standardized patient simulation and then in clinical practice. The study also sought to learn if clinical self-efficacy changed among students who participated in a standardized patient simulation.;The design of the study was descriptive research. The sample consisted of 14 acute care nurse practitioner students who were entering their first semester of clinical rotations. Observations were done with each student in the simulation laboratory with a standardized patient and then in the clinical setting with an actual patient. In both settings students obtained a history and completed a physical examination. Students evaluated their self-efficacy at three points during the study---prior to evaluating the standardized patient, after evaluating the standardized patient, and after seeing an actual patient in the clinical setting. Last, students answered six open-ended questions about whether and how the simulation experience benefitted their learning. Five research questions were analyzed using appropriate statistical tests for the quantitative questions and traditional thematic analysis for the one qualitative question.;The results of the research showed significant growth in overall clinical competency from the simulation laboratory to the clinical bedside. There was a statistically significant correlation between the overall competency scores of students in the simulation lab (Time 1) and the overall competency scores of the same students in the clinical setting (Time 2). The overall relationship was positive, indicating that the more competent students were in the simulation lab, the more competent they were in the clinical setting. Three themes emerged from student's responses as to how the simulation experience affected their clinical competency: (1) it increased student confidence in obtaining a history and completing a physical examination on an actual patient, (2) it made students feel prepared for the real patient encounter, and (3) the feedback from the standardized patient was valuable and constructive. Finally, results indicated linear growth in self-efficacy over time among the students who participated in a standardized patient simulation with statistically significant differences in the mean health history self-efficacy scores.