A framework for the integration of simulation in undergraduate physiotherapy: contextualised for South Africa
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Date
2020-04
Authors
Van der Merwe, Anke
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
This thesis aims to describe the process of developing a framework for integrating simulation in the South African undergraduate physiotherapy programme. An exploratory multi-method research design comprising three study phases was utilised in the framework development. A systematic review, utilising deductive content analysis, identified the key elements making up the frameworks that were designed to facilitate the curricular integration of simulation. Following the review, a Delphi survey was compiled to develop a conceptual framework for integrating simulation in the South African undergraduate physiotherapy programme. Contextualisation and credibility were ensured by means of a validation meeting. The systematic review included eight articles, which have an almost equal distribution of low and high finding reliability. In total 18 descriptive themes, grouped under four analytical themes, were identified. Analytical themes identified were planning, implementation, evaluation and revision. All articles noted thoughtful planning of simulation-based learning experiences (SBLEs), including stipulating learning outcomes, considering resources and debriefing. Only three articles included the execution of needs analyses and identified the need for simulation-based educator training prior to simulation integration. Data obtained from the review was formulated into a Delphi survey and distributed to purposively selected international and national experts in healthcare education and/or simulation. Results from the Delphi survey confirm the importance of curriculum development, SBLE design, resource availability and development of learning outcomes. Panel members also highlighted educator competence as essential. Analysis of both institutional and student needs were deemed essential, with societal needs being regarded as merely useful. The majority of statements pertaining to student preparation, student assessment and mastery learning/deliberate practice only achieved stability during the Delphi survey. Following the Delphi survey, the conceptual framework was developed by the researcher, and it was refined further during a validation meeting. Participants in the validation meeting suggested modifying the unidirectional framework illustration, which resulted in adjustment of the framework. Noteworthy was the importance of addressing all stakeholder needs, including societal needs. A collaborative approach to simulation integration was emphasised by participants especially in a resource-restricted South African setting. Participants refined terminology, so that it was more applicable to the South African education environment. The framework was finalised by the researcher, who applied constructive and cognitive load education theories and the data of the current study. A framework depicting both the fluidity between framework elements and the need to adjust education approaches to optimise student training was designed/developed. The framework emphasises the preparation required by both educators and students. Curriculum and SBLE authenticity are essential framework components for optimising preparation of graduates for practice, which expects graduates to possess increased and complex skills early in their careers. The final product is a credible and contextualised framework for the integration of simulation in the South African undergraduate physiotherapy programme. Though it is generic in nature, it may be applicable for use in any healthcare programme. It is recommended that a dedicated simulation expert, who is well versed in simulation-based education, is appointed to drive framework implementation; to ensure that all stakeholder needs are addressed, and to promote the sustainability of the integrated framework. Engagement with national regulating bodies regarding the inclusion of simulation as part of the mandatory undergraduate physiotherapy training requirements is recommended. Further research, exploring the practical use of SBLEs for mastery learning/deliberate practice and assessment purposes, is required. Investigation into a standardised approach to peer assessment in SBLEs is advised, to encourage student participation. In light of national resource restrictions, the researcher recommends research is undertaken in relation to the development and/or identification of validated outcome measures that calculate the return on investment of simulation integration at institutional level.
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Keywords
Thesis (Ph.D. (Physiotheraphy))--University of the Free State, 2020, Physiotherapy Students - South Africa, Physical therapy, Therapeutics, Physiological, Simulation-based education - South Africa