Effect of simulation based workshop on changing faculty perception for simulation-based education

Objective: To compare the perceptions of participants before and after a one-day workshop on Simulation-based Education. The other objective was to determine the feedback of participants about the one day workshop on Simulation-based Education. Methods: In March 2023, a one-day workshop on Simulation-Based-Education (SBE) was conducted by the Department of Medical Education of Fazaia Ruth Pfau Medical Education in collaboration with the foreign guest faculty through zoom. This workshop was conducted with the participants (faculty members) of the Certificate program. The study adopted quasi experimental (pretest posttest) research design. For data collection we used a validated questionnaire which compromises of three parts. Data was analyzed using SPSS 23. This is a semi-structured questionnaire which consists of four parts. The first part entails the demographic data of the participants. The second structured part collects the perception of participants through 26 statements on 5 points Likert scale (strongly disagree = 1, disagree = 2, agree to some extent = 3, agree = 4, strongly agree = 5). Results: The mean difference in participant perceptions was significant (P<0.05)on 13 statements: Improves communication skills (pretest 3.05±1.050, posttest 4.20±1.056; p=0.004), enhance teamwork (pretest 3.30±0.979, posttest 4.30±0.923; p=0.004), overcomes the challenge of uncooperative patients during real practice (pretest 3.80±0.696, posttest 4.30±0.470; p= 0.008), enact live patients (pretest 2.70±0.923, posttest 3.65±1.040; p=0.004), incopororation into medical education (pretest 3.20±0.894, posttest 4.40±0.503; p=0.000), provide safe, reliastic and conducive learning environment (pretest 2.85±0.875, postest4.00±0.795; p=0.000), provide easy learning (pretest 2.75±0.716, posttest 4.05±0.605 p=0.000), decrease ethical issues with more repeated practice (pretest 2.75±0.716, posttest 3.90±0.788; p=0.000), reduces the effort put in by a faculty in clinical teaching (pretest 2.80±0.696, posttest 3.45±0.999; p=0.039), supplement to clinical practice (pretest 2.75±0.444, posttest 4.55±0.510; p=0.000), evidence required for simulation activities (pretest 2.95±0.605, posttest 4.10±0.641; p=0.000), able to add simulation in clinical subject (pretest 3.15±1.089, posttest 3.80±0.834; p= 0.055), can instruct complex skills without simulation (pretest 2.55±0.887, posttest 3.40±0.883; p=0.018). Conclusions: The study signifiacnaty changed the faculty members’ perceptions of simulation-based education.These encouraging findings may influence their future practice in simulation-based education, allowing them to provide safe, high-quality health care in the workplace and, eventually, enhance patient outcomes.


INTRODUCTION
Around the world, there have been considerable changes to medical education.Concern for the patient's safety is one of the causes for the adjustments. 1imulation-based healthcare education has grown significantly over the past few years.These changes signify a pivotal moment where simulation is no longer perceived as a novelty that requires defense by a small group of passionate advocates. 2Simulation is a method or technique that is used to create an experience without really going through the real event. 3This approach offers a chance to instruct, inform, educate, train, and coach healthcare workers using fictitious patients or aids. 4The discipline of simulation-based learning is expanding and provides medical professionals and students with a secure, regulated environment for learning.Since the invention of mannequins (also known as dummies) in the middle of the 17 th century, simulations have been a significant learning tool in medical and nursing education for almost 400 years.It was formerly only allowed for the practice of fundamental skills, but today it may be used to boost learner competency and patient safety, which can reduce medical errors and enhance team management abilities among trainers and students. 5dditionally, simulation has started to alter a lot of the ways that trainees and junior doctors are taught medicine and develop the necessary abilities.Using simulation technology, medical, nursing, and other healthcare personnel can refine their abilities repeatedly if necessary without endangering patients. 6aculty create simulations to get the intended educational objectives.They design simulations as an immersive teaching strategy that imitates or replicates real-world situations, issues, processes, or competencies.Students participate in the situation, put their skills to use, think critically, and extrapolate lessons from it.The principles of simulation as a teaching strategy connect well with constructivist teaching and learning theory, which may be modified for social and physical learning experiences to fulfil the requirements of all students. 7BE training needs to be incorporated into all health professions education levels. 8Understanding simulationbased education and applying it in an educational context requires faculty training.This is a new advancement in our country, and currently, our faculty is not adequately prepared to utilize it to its maximum potential.Faculty members need to be familiar with the benefits and drawbacks of simulation-based education and be equipped with various capacity-building activities to effectively integrate it into their teaching methods.Faculty members should have opportunities to learn and seek clarification for their questions. 9With adequate training of faculty, we will be able to effectively utilize simulation and yield excellent results.
For building capacity of our faculty members about simulation-based education, a one-day workshop on was aslo taken to utilize the data from the activities for our research study Data collection procedure: The workshop consist of following activities and data was collected along with these: Activity 1 -Pre-test: At the beginning of the workshop, the participants' opinions about the SBE were recorded through a questionnaire that had been validated by Laerdal Global Health Nepal. 10 This is a questionnaire which compromises of three parts.The participants' demographic information is included in the first section.The second part collects the perception of participants through 26 statements on five points Likert scale.The likert scale was defined as strongly disagree = 1, disagree = 2, agree to some extent = 3, agree = 4, strongly agree = 5.The first and second part of this questionnaire was used in this activity.The data collected was termed as pre test data.Activity 2 -Online synchronous session: After the pretest, an interactive online synchronous session was conducted by the team of the Simulation Department of The Hospital for Sick Children.The team of multiple experts in the simulation field briefed the participants about the practice of simulation in the health setting through group discussion.All the information regarding the process of simulation and how to implement it in the health education settings were discussed with the participants.The experts offered participants the chance to ask questions, which were promptly addressed in real-time.. Activity 3 -Jigsaw: After the online synchronous session, the participants were provided with the reading material related to the process, implication, benefits, and shortcomings of the SBE in health sciences in the form of articles.The participants were then involved in a Jigsaw activity to do the reading of a particular topic within the group related to simulation and then share the information with the larger group to complete the entire picture of SBE.Activity 4 -Role-play: Facilitators from the DME and four volunteers from the participants demonstrated the two clinical scenarios using a task trainer and full body manikin.High fidelity simulated environment was created through the help of using scenarios of an emergency setting (pediatric hypovolemic shock case and RTA case) along with role-play.Activity 5 -Debriefing: After the demonstration of medical simulation, a debriefing session was conducted under the supervision of the facilitators from DME. Participants of role-play were asked to reflect on their performance and overall activity of simulation.Debriefing is the main component of the clinical simulation which facilitates the participants to critically think about their perceptions and assumptions regarding the act of simulation. 11Activity 6 -Post-test: After all the activities, the participant's perception was again taken through the questionnaire used before in the pre-test.The data collected was termed as post test data.Part three of the questionnaire was used here to take the feedback regarding the SBE workshop.This part consist of 14 statements.Data Analysis Plan: The data were analyzed by using SPSS 22. Descriptive analysis was done for frequency and means ± SD.When comparing responses from the pretest and posttest, paired t-tests were employed to compare means.

Demographic and educational information of participants:
Out of 25 participants, only 20 participants gave permission to fill out the questionnaire.Among these, 100% belonged to full-time faculty members at different institutes.There were more female participants (55%) than males (45%) as shown in Table-I.Notes: Strongly disagree = 1; disagree = 2; agre to some extent = 3; agree = 4; strongly agree = 5. *P<0.05=Significant.

DISCUSSION
Globally, medical education has undergone rapid transformation in response to all current issues, countless factors have contributed to these shifts, such as changing societal demands and countless scientific and technological advancements brought on by the development of evidence-based medical knowledge. 12ur findings indicate that participants initially believes that simulation could not improve communication skills and team work.However, after the workshop, their perceptions changed, and they acknowledged that SBE could indeed enhance students's communication and teamwork skills.The primary reason could be that the workshop encompassed various aspects related to communication and teamwork skills.This comprehensive approach likely facilitated better understanding among the participants.Sezgin & Bektas in their study stated that SBE proven to be an effective instructional method in enhancing communication and teamwork among health professional students. 13imulation provides a safe and controlled environment where learners can practice without the risk of harming real patients.This reduces anxiety and allows learners to focus on building their skills, even if the patient is uncooperative.It enacts live patients, allowing learners to practice until they feel confident in managing live patients.The result also showed significant difference in perception regarding the use of simulation to overcome challenges faced by uncooperative patient during real life practice.Also, simulation facilitates in enacting live patients.Elshama SS et al. have identified that SBE has overcome the issues of patient safety and patient care during the training of students.He stated that during live patient interaction, problems arise in dealing with uncooperative patients and patient safety also compromises, which has been easily overcome by the use of simulated patients in SBE. 14 The results of this study encourage the integration of SBE in curricula of medical education as SBE offers a very secure and practical learning environment and also makes learning easy for students.Ayaz O & Ismail FW also indicated that Health simulation should be part of Medical curricula as it provides a variety of clinical cases close to reality in a secure learning environment for the students.Students learn the required clinical competencies in an easy and accessible way. 15imulation can indeed help decrease ethical issues related to repeated practice by providing a controlled and ethical learning environment.Simulation allows learners to practice without putting real patients at risk.This eliminates the ethical dilemma of potentially harming patients through repeated practice or inexperienced interventions.This was well perceived by the participants as shown by the results.A study by Alshehri et al. stated that faculy members considered that simulation is a useful method for decreasing ethical issues.The faculty also emphasized that use of simulation can minimize errors through rigorous training in safe environment. 16,17imulation based education can facilitate students but direct dealing with actual patients will always be essential to make health professionals aware of the full complexity of clinical practice.Thus, SBE is not an attempt to replace actual patient training experiences but rather a complementing instructional modality.This finding is supported by evidence found in literature. 18,19he findings also revealed some interesting insights.Participants lacked confidence in developing checklists or evaluation forms to assess their students.Additionally, they were not supportive of the idea that simulation facilitates the assessment of students' performance.This highlights an area for further development in their training.Since simulation plays a significant role in assessment, faculty members must receive training to develop relevant assessment tools.

Top of Form
The feedback results showed that participants were encouraged to use simulation activities in their teaching and learning.They were satisfied with the performance of facilitators and the resources available.They enjoyed the sessions as they found them to be interesting.However, the workshop's allotted time was not long enough for the participants to construct useful scenarios and evaluation tools, let alone put their newfound knowledge into practice.This need to be taken under consideration while planning future activities for simulation based education.

Limitations:
The study has small sample size.Also most participants were from one single institution.

CONCLUSION
The study showed that the workshop significantly changes the faculty members' perceptions of simulation-based education.The session piqued their curiosity.The training improved their awareness of how SBE increases communication skills, teamwork, and provides a replicable learning environment.
These encouraging findings may influence their future practise in simulation-based education, allowing them to provide safe, high-quality health care in the workplace and, eventually, enhance patient outcomes.
Grant Support & Financial Disclosures: None.

Table -
II displays the average scores of participants' responses to statements about their perceptions of Simulation-Based Education (SBE) on a Likert scale during both the pretest and posttest are displayed in Table-II.Using paired t-tests with 95% confidence intervals and 16 degrees of freedom, the table presents the differences in mean scores before and after the workshop.A significance level of P < 0.05 was used, and it was found that 13 out of 26 statements

Table - I
: Demographic profile of the participants

Table -
III: Feedback for the SBE workshop from participants (n=20).