title: Simulation can contribute a part of cardiorespiratory physiotherapy clinical education: two randomized trials.
abstract: BACKGROUND
  Simulated learning environments (SLEs) are used worldwide in health professional education, including physiotherapy, to train certain attributes and skills. To date, no randomized controlled trial (RCT) has evaluated whether education in SLEs can partly replace time in the clinical environment for physiotherapy cardiorespiratory practice.
  
  
  METHODS
  Two independent single-blind multi-institutional RCTs were conducted in parallel using a noninferiority design. Participants were volunteer physiotherapy students (RCT 1, n = 176; RCT 2, n = 173) entering acute care cardiorespiratory physiotherapy clinical placements. Two SLE models were investigated as follows: RCT 1, 1 week in SLE before 3 weeks of clinical immersion; RCT 2, 2 weeks of interspersed SLE/clinical immersion (equivalent to 1 SLE week) within the 4-week clinical placement. Students in each RCT were stratified on academic grade and randomly allocated to an SLE plus clinical immersion or clinical immersion control group. The primary outcome was competency to practice measured in 2 clinical examinations using the Assessment of Physiotherapy Practice. Secondary outcomes were student perception of experience and clinical educator and patient rating of student performance.
  
  
  RESULTS
  There were no significant differences in student competency between the SLE and control groups in either RCT, although students in the interspersed group (RCT 2) achieved a higher score in 5 of 7 Assessment of Physiotherapy Practice standards (all P < 0.05). Students rated the SLE experience positively. Clinical educators and patients reported comparability between groups.
  
  
  CONCLUSIONS
  An SLE can replace clinical time in cardiorespiratory physiotherapy practice. Part education in the SLE satisfied clinical competency requirements, and all stakeholders were satisfied.
authors.affiliation: Department of Physiotherapy, School of Allied Health, La Trobe University, Bundoora, VIC, Australia.
authors.forename: Felicity C
authors.initials: FC
authors.lastname: Blackstock
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Watson
authors.forename: Norman R
authors.initials: NR
authors.lastname: Morris
authors.forename: Anne
authors.initials: A
authors.lastname: Jones
authors.forename: Anthony
authors.initials: A
authors.lastname: Wright
authors.forename: Joan M
authors.initials: JM
authors.lastname: McMeeken
authors.forename: Darren A
authors.initials: DA
authors.lastname: Rivett
authors.forename: Vivienne
authors.initials: V
authors.lastname: O'Connor
authors.forename: Raymond F
authors.initials: RF
authors.lastname: Peterson
authors.forename: Terry P
authors.initials: TP
authors.lastname: Haines
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Watson
authors.forename: Gwendolen Anne
authors.initials: GA
authors.lastname: Jull
mesh_terms: D001315:Australia; D002983:Clinical Competence / Q000592:standards*; D004521:Educational Measurement; D006801:Humans; D009096:Multi-Institutional Systems; D016544:Patient Simulation; D026741:Physical Therapy Modalities; D026761:Physical Therapy Specialty / Q000193:education; D012140:Respiratory Tract Diseases / Q000628:therapy*; D020377:Self Efficacy; D016037:Single-Blind Method