This study explored final year Baccalaureate nursing students’ perceptions of their ability to transfer learning from simulated experience to clinical practicum. There is an expectation that learning automatically transfers to real world settings.1 A well-practiced skill can relatively easily be reproduced in a new situation if it is to be reproduced in very similar environment to that of initial learning.2 The complex nature of current healthcare environments - which is where nursing students undertake clinical practicum- is often unlike the structured simulation setting.3 A perceived disconnect from simulated to clinical setting may contribute to difficulty in the application of skills and knowledge in real world practice.4 Questions about the transferability of knowledge and skills are very important, yet, the questions of ‘how’ and ‘what’ transfers from simulated learning remains relatively unexplored.
For students to connect learning, and therefore be able to transfer learning to a different, real world context, a deliberate cognitive process must be engaged. Through a process of meaningful reflection, the extraction of a mental concept of the central attribute of the problem may function as a cognitive ‘bridge’.2 This ‘bridge’ can provide a link from the learning context of simulation to a new situation in real clinical practice, therefore enhancing learning transfer.
In this study, the post simulation debriefing became a platform to implement an intervention debriefing. A debriefing was devised which used specific reflective questions based on seminal work by educational psychologists, Salomon and Perkins ‘near and far’ transfer theory.5
Methods:
This study was conducted at a large metropolitan university in Australia. A convenience sample of undergraduate Baccalaureate nursing students (n= 256) who were enrolled in a final year, final semester course, undertook simulation as a scheduled learning experience.
A convergent parallel, mixed methods design used pre-test, post-test survey and focus group interviews were used learning outcomes. The control group received a standard post simulation debriefing whereas the intervention group received a debriefing based on transfer of learning principles. Both groups completed the Nurses Clinical Reasoning Survey6 immediately after the simulation and debriefing. Focus group interviews were conducted two weeks after simulation while the students were on clinical practicum.
Results: Overall, trends of improvements in clinical reasoning scores were evident in both groups. Three items within the survey showed no improvement in either group - ‘I know how to collect an admitted patient's health information quickly; I can set nursing goals properly for the identified patient problems and I can identify and communicate vital information clearly to the doctors based on a patient’s current condition’. These results were paradoxical to focus group interview findings. It was these three particular areas that participants verbalized they had been able to transfer to clinical practice.
Conclusion:
Results of this study have provided beginning findings of how to best use simulation as an instructional method so that simulation becomes less of learning about one specific clinical case, but rather more about using underlying concepts supporting learning transfer