title: Comparing self-guided learning and educator-guided learning formats for simulation-based clinical training.
abstract: OBJECTIVE
  In this paper, we tested the over-arching hypothesis that progressive self-guided learning offers equivalent learning benefit vs. proficiency-based training while limiting the need to set proficiency standards.
  
  
  BACKGROUND
  We have shown that self-guided learning is enhanced when students learn on simulators that progressively increase in fidelity during practice. Proficiency-based training, a current gold-standard training approach, requires achievement of a criterion score before students advance to the next learning level.
  
  
  METHODS
  Baccalaureate nursing students (n = 15/group) practised intravenous catheterization using simulators that differed in fidelity (i.e. students' perceived realism). Data were collected in 2008. Proficiency-based students advanced from low- to mid- to high-fidelity after achieving a proficiency criterion at each level. Progressive students self-guided their progression from low- to mid- to high-fidelity. Yoked control students followed an experimenter-defined progressive practice schedule. Open-ended students moved freely between the simulators. One week after practice, blinded experts evaluated students' skill transfer on a standardized patient simulation. Group differences were examined using analyses of variance.
  
  
  RESULTS
  Proficiency-based students scored highest on the high-fidelity post-test (effect size = 1.22). An interaction effect showed that the Progressive and Open-ended groups maintained their performance from post-test to transfer test, whereas the Proficiency-based and Yoked control groups experienced a significant decrease (P < 0.05). Surprisingly, most Open-ended students (73%) chose the progressive practice schedule.
  
  
  CONCLUSIONS
  Progressive training and proficiency-based training resulted in equivalent transfer test performance, suggesting that progressive students effectively self-guided when to transition between simulators. Students' preference for the progressive practice schedule indicates that educators should consider this sequence for simulation-based training.
authors.affiliation: The Wilson Centre, University of Toronto, Ontario, Canada. r.brydges@gmail.com
authors.forename: Ryan
authors.initials: R
authors.lastname: Brydges
authors.forename: Heather
authors.initials: H
authors.lastname: Carnahan
authors.forename: Don
authors.initials: D
authors.lastname: Rose
authors.forename: Adam
authors.initials: A
authors.lastname: Dubrowski
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002404:Catheterization; D002983:Clinical Competence; D003198:Computer Simulation; D003194:Computer-Assisted Instruction; D004508:Education, Nursing, Baccalaureate / Q000379:methods* / Q000592:standards; D004521:Educational Measurement / Q000379:methods*; D005181:Faculty, Nursing; D006801:Humans; D007858:Learning; D008875:Middle Aged; D015402:Nursing Education Research; D016544:Patient Simulation; D011380:Programmed Instructions as Topic; D013338:Students, Nursing / Q000523:psychology; D013663:Teaching / Q000379:methods; D055815:Young Adult