Innovations in applied health: Evaluating a simulation-enhanced, interprofessional curriculum

Abstract

Background: In response to current trends in healthcare education, teachers at the Michener Institute for Applied Health Sciences implemented a New Curriculum Model (NCM) in 2006, building a curriculum to better transition students from didactic to clinical education. Through the implementation of interprofessional education and simulated clinical scenarios, educators created a setting to develop, contextualize and apply students' skills before entry to the clinical environment.

Aims: In this pilot study, researchers assessed the impact of the NCM intervention on student preparedness for clinical practicum.

Methods: A mixed-methods evaluation was conducted, collecting survey assessments and qualitative focus group feedback from clinical educators and students.

Results: Clinical educators identified Michener NCM students to be significantly better prepared for clinical practicum when compared to previous cohorts (p < 0.05%). Students also noted significant improvements as implementation issues were resolved from years one to two of the NCM.

Conclusions: The infusion of simulation and interprofessional education into Michener's applied health curricula resulted in a significant improvement in clinical preparedness. The Michener NCM bridged the gap previously separating didactic education and clinical practice, transitioning applied health students from trained technicians to more complete health care professionals.

Introduction

Preventable medical errors, adverse events, and near misses have been attributed to various origins in health care: most commonly, to the prevalence of complex system errors, communication barriers among professionals, and concerns over student preparedness for clinical practice (Ternov & Akelsson 2005; Salas et al. 2008). As a leading educator of applied health professionals, the Michener Institute for Applied Health Sciences has targeted student preparedness for clinical as a key area for development, through the implementation of a New Curriculum Model (NCM) to bridge the common gap between didactic education and clinical practicum. The Michener Institute was the first applied health post-secondary institution in Canada to integrate both a broad range of simulation teaching methods and the principles of interprofessional education (IPE) to facilitate multidimensional, integrative learning, and assessment (Bandali et al. 2008).

This model was adopted in response to growing apprehension over the scarcity of clinical placements and resources, the desire to transition away from profession-specific delivery methods for education, and ongoing feedback from clinical educators that students would benefit from additional preparation prior to entry into clinical practicum. Educators sought to improve the quality of education provided to students by responding to current trends in healthcare and education, improving the school's ability to impact the preparedness of future student cohorts. The infusion of simulation and IPE was designed to ease the path into clinical practice by bringing together students’ abilities in three key competency areas: The refinement of practical technical abilities, interprofessional collaboration (IPC) skills, and several non-cognitive “core skills”; defined as communication, professionalism, conflict resolution, and critical thinking (Figure 1). The Michener NCM provides an important pilot study highlighting the implementation of an interprofessional, simulation-enhanced curriculum in applied health education, with important lessons in how to transition students from traditional, didactic education to clinical practice.

Figure 1. Integration of clinical preparedness skills under the Michener NCM.

While the benefits of simulation have been extensively documented in medicine and nursing education (Ziv et al. 2003; Gaba 2004; CPSI 2005; Windsor 2009; Cant & Cooper 2010), support for simulation in applied health has begun to emerge more recently, with increasing validation across various disciplines that include respiratory therapy, radiological technology, and medical laboratory sciences (Bridge et al. 2007; Grant & Davis 2007; Tuttle et al. 2007; Gropper et al. 2010). In particular, interprofessional team training in simulation has been proven to address the worsening discontinuities between educational and practice settings (Buelow et al. 2008; Robertson & Bandali 2008; Salas et al. 2008). For example, Buelow et al. (2008) suggest that interprofessional training, when implemented effectively into applied health simulation, can lead to fewer hospitalizations, decreased health costs, lower mortality and morbidity rates, and improved function by patients.

Despite a growing number of educational institutions offering interprofessional scenarios in simulation, only 29% of Canadian simulation centers in 2005 had evaluated the impact of their simulation programming (CPSI 2005). This article will detail the implementation of the Michener NCM, with its focus on transitioning students from didactic education to clinical practicum, and will highlight a pilot study designed to compare NCM student preparedness to that of previous cohorts. Given the critical role that applied health professionals play in the full health care team, innovations to improve student preparedness for clinical must be shared, with unique insights applicable for all health professions.

Table

Practice points

Medical teachers must continue to research innovative teaching tools in order to successfully bridge the common gap between didactic education and clinical practice. Curriculum evaluation must be implemented in parallel with curriculum reform and improvements adopted as best practices are revealed by students, educators, and curriculum planners. In order to effectively implement IPE and simulation-based curricula, educators must be provided the appropriate professional development to equip them with the necessary teaching tools for success. Simulation cannot replace didactic or clinical education, but can provide significant benefits to enhance student learning in these areas.

Methods

Setting

The implementation of the Michener NCM framework began in 2006, with students experiencing several key differences when compared to previous cohorts (Figure 2a and b). Prior to its implementation, students were educated under a traditional curriculum program which comprised of discipline-specific didactic courses in years one and two, with a 4-month gap prior to clinical placement in year three (Figure 2a). Courses were designed in silos, with no integration across disciplines. With a significant gap between didactic and clinical semesters, students experienced no transition course(s) and very few simulated clinical interactions to ease the progression into practice (what simulation scenarios were used ranged only from low to medium fidelity, primarily task-specific training).

Figure 2. (a) Traditional “Silo” curriculum model (with Didactic-Clinical gap) and (b) Michener NCM Design.

By contrast, NCM students participate in didactic lectures, as well as newly designed IPE courses during years one and two of the program. A simulated clinical preparation semester was added during the summer of year two, comprising of interprofessional, simulation-based interventions designed to contextualize learning for students in a mock clinical setting, to integrate students’ critical preparedness skills, and to assess readiness prior to students’ entry to clinical practicum (Figure 2b). The structure of the clinical practicum rotation in year three remained relatively unchanged, with clinical educators providing practical teaching and assessment in the high-stakes clinical environment.

The simulation semester's placement was intentional, bridging the gap chronologically and intellectually between the didactic and clinical components of the curriculum, providing the opportunity to integrate technical knowledge and clinical skills before exposure to real patient interactions. Simulation techniques range from low to high fidelity, including the use of task-specific trainers, mannequins, anthropomorphic phantoms, discipline-specific case scenarios, computer exercises, and the use of standardized patients and actors.

By implementing high-fidelity simulation techniques, predominantly the use of human patient simulators, Michener NCM students have been provided a setting to make mistakes without repercussions to real patients, along with exposure to repeated procedures and experiences both rare and common, and a venue to practice teamwork, professionalism, and other core skills with their peers. Michener's commitment to providing state-of-the-art simulation training also included the construction of a world-class simulation facility, complete with objective structured clinical examination suites and simulation studios in order to create optimal environments for students to experience high-fidelity interactions.

The Michener NCM also integrated the first-time assessment of students’ preparedness for clinical practicum, with required refinement and integration of three critical skills before entry to clinical: Technical skills, IPC skills, and “core” skills common across applied health programs: communication, professionalism, teamwork, conflict resolution, and critical thinking ability (Figure 1).

Procedure for curricular change

The Michener NCM was developed by an interprofessional steering committee, consisting of school administrators, curriculum planners, and faculty. First- and second-year IPE courses were designed by educators of all Michener applied health disciplines. Simulation courses were designed to enhance both discipline-specific practical skills and interprofessional ability.

Curriculum planners faced numerous costs of implementation, including the cost of professional development and training for faculty to properly teach and assess students using the interprofessional and simulation scenarios implemented. Overhead costs also included the purchase of new equipment, software, and the renovation of two floors at the Michener Institute to create a modern simulation center. The cost to promote complex cultural change was also significant, given the time and commitment required from multiple internal and external stakeholders.

Participants

Findings were collected from 118 NCM students and 77 clinical educators across five Michener programs. Four of five programs studied were early NCM adopters, with feedback collected from 2009 graduating class stakeholders. These included Medical Laboratory Science (MLS) and Respiratory Therapy (RT) undergraduates and educators, as well as feedback from second-entry programs Diagnostic Cytology and Genetics Technology. NCM students in Medical Radiation Sciences first graduated in 2010 and their feedback was included where available. Ethics approval was received by the local Review Board prior to evaluation.

Rationale for study methodology

Preparedness for clinical has been used by numerous health care institutions when measuring the effectiveness of new teaching models, whether self-reported by health professional students (Blumenthal et al. 2001; Woolf et al. 2007), qualitatively described in conversation with clinical instructors (Hicks-Moore & Pastirik 2006), or rated on a Likert scale by educators (Murphey et al. 2004). Few schools have combined these three sources in order to evaluate their programs from multiple perspectives. For that reason, researchers designed a holistic evaluation of the Michener NCM intervention as a means of understanding its impact from multiple perceptions. A mixed-methods evaluation was implemented, collecting qualitative focus group feedback and subjective assessments of preparedness through quantitative online surveys. Although objective assessments such as student grades and competency exam scores were originally collected by researchers, they were excluded from this pilot study given that these assessment tools simply could not be compared to previous curriculum tools, which were only designed to assess technical abilities. To gain a true understanding of the NCM's impact, subjective, holistic assessments comparing new and previous cohorts were instead collected.

Tools

NCM student cohorts were compared to previous cohorts using preparedness for clinical practicum as the critical metric, with feedback coming from three contributing sources:

1. Quantitative assessments of differences in cohort preparedness by clinical practicum educators (using a five-point Likert scale, Appendix 1).

2. Quantitative assessments of preparedness by NCM students (four-point Likert scale, Appendix 2).

3. Qualitative focus groups and interviews with clinical educators, students, and faculty (Appendix 3).

Clinical educators provided a unique and practical assessment of cohort proficiency, comparing new cohort graduates to previous cohorts, and tasked with evaluating differences in technical, IPC, and core skills. Educators compared the cohorts using a five-point Likert scale, ranging from “Much worse than previous cohorts” to “Much better”, with “No Difference” as an alternative (Appendix 1 for full survey). Educators were made aware of the NCM implementation and of which students belonged to each cohort, but were not directly involved in its design.

Students were responsible for assessing the impact of simulation on their own preparedness, responding from “Strongly Disagree” to “Strongly Agree” to the statement: “The simulated clinical semester prepared me well for my clinical rotation” (Appendix 2). Student data collection occurred at two intervals: prior to entry to the clinical practicum semester (simulated preparation semester, year two) and at five-rotation points during the clinical placement semester (year three). The timing of these surveys sought to compare students’ assessments of simulation before and after the “shock” of experiencing the high-stakes clinical setting.

Qualitative assessments were also collected from clinical educators during third-year clinical practicum focus groups and from faculty and students during the simulation semester (Appendix 3). All qualitative feedback was analyzed and coded thematically by the Michener Research team.

Statistical analysis

Statistical analysis was conducted using SPSS Statistics version 18.0.0 (SPSS Inc. 2009). A one-way ANOVA tested for differences in clinical educator responses across the five academic programs studied, with multiple paired t-tests used to compare differences in clinical ratings across technical, core, and IPC skills. When comparing student course evaluation responses, paired and independent sample t-tests were used to detect significant changes from simulation to mid-clinical and in differences across years one and two of the NCM. All statistics were tested for normality of distribution and homogeneity of variances, with a significance level of p < 0.05%.

Response rates

Response rates from the clinical educator survey ranged from 37% in MLS to 48% of eligible clinical educators in RT, resulting in an average response of 41% across all five programs surveyed (n = 77/187). On-site focus groups were conducted with 66% of clinical educators (n = 123/187).

During the simulated clinical semester, student course evaluations were conducted in-class, resulting in an average response rate of 89% (n = 118/132) in 2009. Response rates ranged from 82% in Cytology and Genetics to 93% in MLS. Evaluations during the clinical practicum semester were administered online and resulted in a response rate of 66% for 2009 graduates (n = 87/132) and 64% for 2010 (n = 86/134).

Results

Michener NCM students were consistently rated by clinical educators as better prepared for clinical practicum when compared to previous graduating years. A total of 61% rated NCM students as “better prepared,” representing a significant majority (Figure 3, n = 77). No significant difference was observed in educators’ ratings across the five academic programs surveyed (Figure 4), despite differences in program size, length, or status as undergraduate or second-entry. A total of 72% of clinical educators rated technical skills as most improved under the NCM (Figure 5), with only technical and core skill ratings differing significantly. All three “clinical preparedness” skill areas were positively rated, with 96% of educators noting technical, IPC, and core skills were improved or unchanged from previous years (Figure 5, n = 77).

Figure 3. Clinical educator assessments of cohort differences (all Michener programs). Ratings of student cohorts were collected using a five-point Likert scale. Note: *Percentage represents a significant majority of clinical educator responses.

Figure 4. Clinical educator assessments of cohort differences, by program. Ratings of student cohorts were collected using a five-point Likert scale. Note: *Percentage represents a significant majority of clinical educator responses.

Figure 5. Clinical educator assessments of cohort differences by clinical preparedness skills. Notes: Technical skills were rated as improved by a significant majority of educators when compared to previous cohorts. Ratings of student cohorts were collected using a five-point Likert scale. Average scores: core skills: 3.59; technical skills: 3.85; and IPC skills: 3.56. *Percentage represents a significant majority of clinical educator responses.

Student assessments provided another perspective of preparedness for clinical proficiency. In MLS, Cytology and Genetics, a significant majority of graduates (p < 0.05%) admitted that simulation had prepared them well for clinical practice. By contrast, while over 95% of RT students felt better prepared for clinical at the culmination of the simulation semester (Figure 6), only 58% admitted the same after several months in clinical (Figure 6). This marked a significant decrease (p < 0.05%) in 2009 graduate perceptions from simulation to mid-clinical, with average scores falling from 3.4 to 2.6 on the four-point Likert scale. The following year, responses from 2010 RT graduates improved considerably – as 77% (Figure 6) acknowledged that the re-tooled simulation semester had prepared them well when surveyed during clinical practicum – a significant increase from 2009 to 2010 (p < 0.05%).

Figure 6. RT: Student assessments of clinical readiness. Percentage of students who agreed or strongly agreed (3,4) on a four-point Likert scale with the statement: “The simulated clinical semester prepared me well for my clinical rotation.” Due to implementation issues resolved in year two of the program, ratings from 2009 to 2010 RT graduates significantly improved.

Focus groups with faculty and students highlighted several key benefits that the simulation semester was able to provide when paired with traditional didactic courses:

• Simulation scenarios fostered the development of communication, interprofessional and intraprofessional collaboration skills; areas that were not sufficiently targeted by traditional didactic settings.

• Simulation allowed students to grow accustomed to the pace and workflow of a real clinical environment.

• Allowed students to identify their strengths and weaknesses and to reflect on their skills before progressing to clinical.

• Students learned how to look at patients holistically and globally.

• Enhanced students’ sense of responsibility, accountability, and professionalism.

• Standardized patients were praised by faculty and students for their ability to transition students toward realistic clinical interactions.

Discussion

Michener's interprofessional, simulation-enhanced NCM was implemented to address growing concerns about the availability of clinical placement positions, the persistent training of students in an antiquated profession-specific model, and concerns regarding student preparedness for the clinical environment in both technical and interpersonal skills. Curriculum planners sought to increase the quality of education provided to Michener students, responding to growing trends in healthcare and education by implementing IPE and simulation. According to clinical educators, NCM student preparedness upon entry to clinical practicum was much improved over previous cohorts. Stakeholders identified numerous benefits that the Michener NCM was able to provide when used to complement traditional didactic and clinical practicum courses.

Technical skills were the most significant improvement (Figure 5), which can most easily be attributed to the implementation of simulation scenarios to improve technical skill acquisition and discipline-specific training (Issenberg et al. 1999; Sinz 2007).

Although still very highly rated by clinical partners, students and faculty noted potential improvements to IPC and core skill training under the NCM: For example, standardized patients were frequently identified by students for their positive impact on learning, with one respondent acknowledging that they allowed students to “look at the patient first instead of only being focused on the equipment.” An increased use of human patient simulators was a key takeaway for curriculum planners. However, some actors presented exaggerated emotions, reducing the believability of patient care scenarios. Other actors possessed insufficient knowledge of their specific medical condition, due to the interprofessional setting in which patient actors were integrated. Improved implementation of human patient simulators, including improved actor training, was also suggested by stakeholders as a necessary step to maintaining effective interprofessional scenarios in the eyes of applied health students. Students also acknowledged that additional opportunities to interact with other health disciplines in realistic scenarios would benefit their development, enhancing their ability to collaborate with unique healthcare teams. The implementation of interprofessional and simulation-enhanced teaching methods during the first years of Michener's NCM implementation were designed to better transition students from didactic to clinical practicum. Students and educators clearly noted the benefits of these interventions, suggesting that greater frequency and improved scenario design would benefit future cohorts’ development.

Student course evaluations revealed that simulation had positively impacted student preparedness in nearly all Michener programs. In the RT program, however, opinions degraded after students were exposed to the high-stakes clinical environment, particularly during specialized rotation placements (Figure 6). To highlight, only 32.7% of 2009 graduates believed that simulation had prepared them well for clinical when responding to evaluations during Neonatal and Pediatric ICU rotations. This compared to 65% of students responding as “well prepared” during adult ICU rotations, where necessary practice skills are considerably less specialized. Subsequent iterations of the simulated clinical semester in RT have begun to address these specialized areas more prominently with the implementation of more diverse high-fidelity simulation scenarios. These iterative changes helped to significantly improve student perceptions for the 2010 cohort.

Given the size and scope of the Michener curriculum reform, evaluating the impact of the NCM on student preparedness was a critical step to ensuring the program's success moving forward. With the significant preparedness improvements noted by RT students across years one and two of the NCM implementation, the design of interprofessional- and simulation-based learning techniques must remain an iterative process, with changes adopted as best practices are revealed by students, educators, and curriculum planners. Stakeholder feedback must continue to be collected and utilized by academic programs to make necessary curriculum changes and to ensure continued quality improvement.

Faculty members also identified several key benefits of simulation, including the ability to provide constant feedback and a diverse range of scenarios to practice and assess teamwork, professionalism, and collaboration prior to entering the high-stakes clinical environment. This contrasted the experience of previous graduates, who did not experience a transition semester and in faculty's words, were often forced to learn patient care and communication “on the fly” with actual patients in the clinical setting.

In addition to tracking assessments of clinical preparedness, student post-graduation milestones were also closely monitored. As graduation rates, certification scores and employment rates were reviewed, NCM student scores remained consistently high and generally equal to those of previous cohort graduates. It became evident to educators and curriculum planners that such metrics were challenged to measure significant changes in the interpersonal/humanistic abilities taught under the NCM due to a potential lack of alignment between the NCM tenants and professional examinations geared to test cognitive knowledge for prospective health care professionals. Furthermore, a number of confounding variables related to certification examinations makes it difficult to directly link the advancements of the NCM with such external measures. Similarly, employment rates were too closely linked to external confounding factors and industry demand.

The results presented represent an initial pilot study, preceding a longitudinal evaluation to follow with future cohorts. This pilot study can provide educators with key lessons regarding the general design and implementation of a simulation - and interprofessionally enhanced curriculum and its ability to better transition students from didactic to clinical practice. Further research will be needed to validate the effectiveness of the Michener NCM's interventions, and whether such IPE and simulation techniques would equally benefit learners of all health disciplines.

The Michener NCM provides a key example of how the integration of simulation and IPE can enhance the impact of traditional didactic learning opportunities, with significant benefits to student preparedness for the clinical practicum environment. While Woodward et al. (2010), stress that not all solutions effective at one simulation center or program may be universally beneficial or applicable to another, the Michener NCM provides key insights into the implementation of a comprehensive curriculum reform designed to transition student from didactic education to clinical practice. As applied health educators continue to innovate in curriculum development, and institutions bear a collective responsibility for improved student preparedness, insights from all health professions must inform the design and implementation of simulation and interprofessional techniques as a means of better transitioning students from trained technicians to complete medical professionals.

Limitations

The task of evaluating the Michener NCM impact proved to be a complex, multivariate process. Due to its complexity, researchers focused the attention of this pilot study on assessing student preparedness for clinical as it compared to previous cohorts, with future longitudinal studies better able to focus on objective, rating-based analysis of student proficiency. Researchers used subjective assessments from clinical educators, given their unique opportunity to compare multiple student cohorts in the same clinical setting, providing the opportunity to submit a holistic rating of student preparedness. Student grades were not used for comparison, due to the limited scope of previous curriculum assessments and the inability to compare across cohorts; those assessments were designed to only assess discipline-specific technical skills, without any insight into IPC or core skill differences.

Outside metrics were compared; however, certification examination scores, employment rates, and graduation rates were not aligned with new curriculum outcomes and unable to accurately measure non-cognitive or interpersonal performances impacted by the NCM. Instead, researchers sought subjective feedback from multiple stakeholders (clinical educators, students, faculty), in order to provide a multiple-perspective analysis. This pilot study was designed to provide key insights to curriculum planners and educators about the implementation of an interprofessional, simulation-enhanced model in applied health and to precede a genuine longitudinal evaluation of future cohort performance.

Conclusion

The infusion of simulation and IPE into Michener's applied health curricula resulted in improved student preparedness for clinical across all disciplines, with benefits complementary to traditional didactic and clinical practicum courses. Stakeholders stressed that these tools must be properly implemented, using genuine patient care scenarios and technical equipment, in order to ensure the best learning opportunities for students. Although responding to trends in curricular reform will be essential to improved practitioner preparedness moving forward, educators must also be dedicated to the appropriate professional development to support those curricular changes, as well as the continued evaluation of those reforms to ensure that improvements are revealed through stakeholder feedback. Finally, it must be stressed that while simulation is undoubtedly valuable when paired with traditional applied health learning models, it cannot replace practical experience in the clinical environment, a sentiment shared by all Michener stakeholders.

Applied health professionals comprise an essential segment of the health care team, with a significant impact on practitioner training and the continued prevention of medical errors, adverse events, and near misses. Applied health institutions represent a key voice in the design, delivery, and evaluation of patient-centered medical education, including the implementation of simulation and interprofessional techniques. Given the shared responsibility of curriculum planners and educators to prepare students for collaborative, patient-centered practice, innovative teaching methods and issues of implementation must continue to be shared with all medical teachers. As applied health institutions continue to innovate, bridging the gap between didactic education and clinical practice, they provide unique insights into curriculum reform that must be shared with educators of all health care professions.

Declaration of interest: The authors report no declarations of interest.

Appendix 1: Clinical Educator Survey

Clinical Educator assessments of cohort differences

Clinical Coordinator Online Survey:

(Conducted after three months of clinical placement, November 2008–10):

Student Program of Study:

Number of Michener/UT students that you are currently educating (Grad class 2010):

Number of years you have been educating Michener/UT students in a clinical environment

Table

Survey scale for questions #1-2:

– Much worse than previous cohorts

– Somewhat worse than previous cohorts

– No difference

– Somewhat better than previous cohorts

– Much better than previous cohorts

N/A – No opportunity to observe

1. Compared with previous cohorts, how well prepared for their clinical education were the Michener students who started clinical in September 2008 (Graduating class 2009)?

2. Compared with previous cohorts, how well were Michener students who started clinical in September 2008 able to perform the following types of skills:

   1. Core skills (e.g. clear and effective communication, professionalism, ethical decision making):

   2. Technical skills (profession-specific skills required to complete the daily tasks of the job):

   3. Inter/Intra-Professional Collaboration skills (e.g. ability to work in teams, ability to resolve conflict, collaborative decision making)

3. Have the Michener/UT students you worked with most recently encountered any difficulties due to gaps in readiness? YES/NO

4. Did previous Michener cohorts encounter similar difficulties (gaps in readiness)? YES/NO

5. Were your expectations for the students who took Michener's clinical prep semester met with respect to their readiness for clinical? YES/NO

6. Please provide any general observations you may have about Michener students who have taken the new curriculum model:

Appendix 2: Student Course Evaluations

Student assessments of clinical readiness

Relevant Questions

Student Simulation Semester – Course Evaluations:

(Course evaluation conducted during simulation semester, July 2008–10):

1. I feel better prepared to enter my clinical education as a result of the simulation course.

   • 1 – Strongly Disagree

   • 2 – Disagree

   • 3 – Agree

   • 4 – Strongly Agree

Student Clinical Course Evaluations:

(Clinical Evaluations conducted over multiple clinical rotations, Sept-May 2008-11)

1. The simulation semester taken at the Michener prepared me well for my clinical course/rotation.

   • 1 – Strongly Disagree

   • 2 – Disagree

   • 3 – Agree

   • 4 – Strongly Agree

Appendix 3: Simulation Semester Qualitative Focus Groups

Student Simulation Semester – Focus Group Questions

(Conducted at culmination of simulation semester, August 2008–10):

1. What were your expectations for the summer semester?

2. Now that you have experienced the simulation semester, do you think that you will approach clinical differently?

3. How has the simulation semester impacted your integration of theory into clinical practice (practical lab skills)?

4. Are you better prepared for clinical rotation now than at the end of the didactic semester? If yes, how?

5. What has been the single most valuable thing that you will take away from the summer semester?

6. What changes would you make to the simulated clinical semester?

Faculty Simulation Semester – Focus Group Questions

(Conducted at culmination of simulation semester, August 2008–10):

1. What are your expectations of students now that they have completed the summer semester?

2. Compared to previous cohorts, do you think students are better prepared for clinical? If so, in what ways?

3. What do you think is the most valuable thing students will take away from the summer semester?

4. Any final comments or suggestions to improve the summer semester?