Introduction reflects on the diversity of the needed knowledge


In medical
education, simulation teaching is commonly used to teach clinical skills and to
assess competencies. Unlike standardized patients, simulators are easily
available, may repeat in several clinical settings and provide realistic experience
to learners.1 The practice with high-standards simulators had
suggested promising role in the development of problem solving and clinical
reasoning skills.2

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Previous studies
showed that effective use of medium fidelity simulator helped students in the
management of medical emergencies3 and learning outcomes increased in
terms of application of knowledge, mastering skills in a safe environment,
communication skills, handling medical emergencies confidently and willingness
to participate in emergency situation.5 Study with novice faculty members and students found that the experience
allowed them to choose effective way of teaching and learning clinical skills.4
As the new teaching modality, recent studies attempted in Saudi Arabia to
demonstrate that through simulation teaching student cognitive and psychomotor
skills could be assured.6-8

The primary aim of this study was to assess the medical
student experience of simulation for regarding their clinical skills. In
addition, to explore further the challenges and implication
of simulation method in clinical practice in order to help the medical educators to improve the simulation
teaching for curriculum development and experiential learning.









This was a
mixed method design in which the quantitative investigation was collected with a
structured questionnaire on five point Likert scale and a qualitative
evaluation using an interpretivist framework collected through semi structured
focus group interviews with internees.

We used mixed method to get a better understanding
of the problems than using either method alone (Crosswell & Plano Clarke,
2007). The combination of quantitative and qualitative methods provides an
accurate nature of the subject matter and reflects on the diversity of the needed
knowledge (Flemming, 2007). With triangulation the
results may be used to produce a comprehensive representation of the problem
being studied (Sands & Roer-Strier, 2006).

Theoretical framework

The underpinning theoretical
framework of this study framed on Kolb’s experiential learning. Simulation use
in teaching stimulates student’s experience of critical thinking, decision
making, clinical skills and professional behaviour. Experiential learning is
capable of stimulating students to reflect on the potential benefit of their
learning experience. This type of experiential learning also provide
opportunities to acquire decision making, motivation to engage in problem
situation by using critical thinking (Facione et al 2000). An interpretivist
framework was used in which data collected through semi structured interviews.

Subject of the study

For inclusion of the participants, non-probability
convenience sampling technique was utilized. All pre-clinical and clinical years students
(n=900) exposed to simulation based learning
were invited to participate in the present study.



Focus group interviews

The investigators
recruited volunteer internees n=6 from National Guard
Health Affairs hospital. A semi structured focus group interview was conducted
by the first author using open ended questions. Since the use of
simulation is new method of experiential learning, these results are important
to improve the curriculum and learning strategies.


A self-administered structured questionnaire
consisting of 20 items on a Likert scale was used to get the responses of the
students. Items were scored as 5 – for strongly agree, 4 – for agree, 3 – for don’t
know, 2 – for disagree and 1 – for strongly disagree. The main
variables included in the questionnaire were quality of tutor’s feedback, deliberate practice, simulation fidelity, skills
acquisition, problem solving and availability of facilities. The reliability of the
scale was checked the overall Cronbach’s alpha was 0.76.

Sample Size Estimation

Sample size was calculated by using the Raosoft software.
Keeping confidence level of 95 percent and margin of error at 10%, with
the population size with 50% response distribution the calculated sample size
was 270 students.

Ethical consideration

This study sought ethical approval
from King Abdullah International Medical Research Center (KAIMRC) of the
University to protect the rights of the participants. Information regarding
study objective was given to participants. They were assured about the privacy and confidentiality of the information.


Subsequently, a written consent from the
students was obtained. A pre-structured questionnaire with demographic information was distributed
after simulated sessions. The whole procedure took not more than 10
to 20 minutes. The information on all the domains of the questionnaire was
checked for any missing information in student’s presence. Student was
requested to provide missing information.

Following, focus group
interview was recorded and transcribed verbatim in addition to interviewer’s notes. No incentive for
participation was offered.  Data was
filed and organized in computer folders.

Data analysis

For quantitative
study, the data was encoded into SPSS Version 20 sheet. Mean and Standard
Deviation was calculated for continuous variables like age while
percentage/proportion was reported for categorical variables like year
currently studying. ANOVA was used to assess the differences across domains and
demographics. Qualitatively,
interviews were transcribed and open coded for emergent
themes and subthemes and analyzed by using the Glaser (1965)9 constant
comparison method. Theme codes were categorized as main and sub themes. This
was done by two researchers to include areas of agreement and to avoid disputed


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