Making it Real: Can Simulation Improve Physical and Occupational Therapy Student Confidence and Skills for in-patient environments?


Student preparation for in-patient environments is complicated by the current perceived crisis in clinical education. The problems underlying this investigation include: 1) limited student exposure to in-patient care skills in the didactic curriculum, and 2) increasing competition for in-patient clinical sites. The purpose of this study was to evaluate how simulation using peer role playing vs. low-fidelity mannequins impacts student confidence and skills for when managing patients in in-patient environments.


Volunteer students from the PT and OT programs were randomly assigned to the experimental (E) group (using simulation mannequins to learn in-patient care skills) or the control (C) group (using standard lab practice with other students role-playing patients). All participants received the same online instruction including a “how-to” lecture and skills video. Next the groups participated in a face-to-face lab where the E group received 2 hours of training with the mannequins, while the C group received 2 hours of traditional peer-to-peer training.

Data was collected as follows:

1. Self-Confidence: Participants rated their confidence in performing acute care skills at 3 points in time: Before training, after online training, and after hands-on training with each other or mannequins. The scale consisted of 13 items related to in-patient care, and students rated confidence from 0-100%.

2. Skill acquisition: After the conclusion of training, all participants were assessed using a practical exam with a standardized patient. A blinded grader scored performance using a 15-item nominal (yes/no) scale.

3. Qualitative impact of the simulation experience:
Three subjects in the E group participated in a focus group to determine their perceptions of simulation as a learning experience.


Students in both groups improved significantly over time in confidence scores. Although both groups showed significant improvement over time, there was no significant difference in confidence scores between those who used simulation and those who did not. Furthermore, there was no significant interaction between group and time. Additionally, there was no significant difference found between groups in performance in each of the 15 practical exam items, nor the cumulative practical exam score. Qualitative analysis of the focus group identified common themes related to mannequin training.

Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education

Simulation has been extensively investigated in both nursing and medicine. Research in PT education indicates that high-fidelity simulation improves self-confidence for acute care clinical practice. This study further supports the use of simulation, including low-fidelity mannequins and peer role-playing to improve student confidence and skills.

This presentation addresses the sub theme entitled “instructional strategies for the classroom and clinic.” Evaluating the effectiveness of simulation is also relevant to the pursuit of excellence in physical therapy education.


Geyer M, Biearman B. Use of Human Patient Simulation in Acute Care Physical Therapy Education. Abstract presented at: American Physical Therapy Association Combined Section Meeting 2008.

Guinane S, Molloy L. Training on Demand: A solution to Clinical Education Through Simulation The Journal of Physician Assistant Education 2013;24(4):32-26.

Hayden JK, Smiley RA, Alexander M, Kardong-Edgren S, Jeffries PR. The NCSBN National Simulation Study: A Longitudinal, Randomized, Controlled Study Replacing Clinical Hours with Simulation in Prelicensure Nursing Education. Journal of Nursing Regulation July 2014 Supplement 5(2):S2-S64.

McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ. A critical review of simulation-based medical education research: 2003-2009. Medical Education 2010;44:50-63.

Ohtake PJ, Lazarus M, Schillo R, Rosen M. Simulation Experience Enhances Physical Therapist Student Confidence in Managing a Patient in the Critical Care Environment Physical Therapy. 2013;93(2):216-228.

Rosen MA, Salas E, Wilson KA, et al. Measuring Team Performance in Simulation-Based Training: Adopting Best Practices for Healthcare. Simulation in Healthcare: Journal of The Society for Simulation in Healthcare. 2008;3(1):33-40.

Shoemaker MJ, Riemersma L, Perkins R. Use of High Fidelity Human Simulation to Teach Physical Therapist Decision-Making Skill for the Intensive Care Setting. Cardiopulmonary Physical Therapy Journal. 2009;20(1):13-18.

Sabus C, Macauley K. Simulation in Physical Therpay Education and PRactice: Opportunities and Evidence-Based Instruction to Achieve Meaningful Learning Outcomes. Journal of Physical Therapy Education 2016;30(1):3-13.

Silberman NJ, Litwin B, Panzarella KJ, Fernandez-Fernandez A. High Fidelity Human Simulation Improves Physical Therapist Student Self-Efficacy for Acute Care Clinical Practice Journal of Physical Therapy Education. 2016;30(1):14-24.

BACK to Abstract Results

  • Control #: 2526765
  • Type: Platforms
  • Event/Year: ELC2016
  • Authors: Dr. Timothy Miller, Dr. Mary Blackinton, Dennis McCarthy , Dixie Pennington
  • Keywords:

BACK to Abstract Results