A Comparative Analysis of How Skills-based and Scenario-based Simulations Support Learning with EFAST as an Exemplar Skill




Battista, Alexis

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This study presents an investigation into how learning was supported in skills- and scenario-based simulations, and examines the influence of simulation context on the activities, guided participation, self-efficacy, and learning outcomes of student healthcare professionals. Using a mixed-methods comparative case study design, eight student healthcare professionals, naïve to ultrasound, were recruited to learn the Extended Focused Assessment using Sonography for Trauma (EFAST) exam. Following completion of a pretest evaluation of EFAST performance, students were randomly assigned to partake in either two skills-based or scenario-based simulation practice sessions. Qualitative data included video recordings of simulations, and student’s written reflections. Quantitative data included the EFAST self-efficacy scale and the Radiology Direct Observation of Procedural Skills (RAD-DOPS), which assessed students’ performance of the EFAST. Activity theory and guided participation informed analysis of students’ engagement during participation in skills-based and scenario-based simulations. Descriptive statistics were used to examine students’ performance on RAD-DOPS assessments and self-efficacy beliefs. Findings suggest that learning was supported in both simulation contexts when students, together with peers and faculty, engaged in clinically relevant activities, using culturally relevant tools and artifacts. The findings also suggest that students’ activities, guided participation, learning reports, and SE differed. All students reported learning the EFAST; however, scenario-based students reported learning about their role as member of the healthcare team, and how to integrate the EFAST into patient care. Students in skills-based simulations rated their self-efficacy for EAST numerically higher than did scenario-based students. Skills-based students were rated more highly on the posttest. Recommendations for practice are discussed.



Education, Activity theory, Simulation-based learning, Simulation, Guided participation, Medical simulation, Self-efficacy