title: Simulated learning in musculoskeletal assessment and rehabilitation education: comparing the effect of a simulation-based learning activity with a peer-based learning activity.
abstract: BACKGROUND
  Musculoskeletal disorders and diseases are leading causes of pain, physical disability, and doctor visits throughout the world. Health professionals must be trained to assess, treat through rehabilitation and monitor patients with these disorders. Yet, due to overcrowded curricula, some health education programs struggle to accommodate more than minimal training in musculoskeletal conditions. Consequently, educators in these professions must consider how traditional instruction could be complemented effectively to enhance students' preparation for the diverse musculoskeletal disorders and pathologies they may encounter. The purpose of this study was to explore the benefits that can be obtained from laboratory practice in musculoskeletal conditions with a standardised patient, rather than a peer patient, in a condensed time frame.
  
  
  METHODS
  Two groups of students were assigned to either a standardised or a peer patient condition for 2 × 2 hours musculoskeletal assessment and rehabilitation lab sessions. All students completed a pre-post matched questionnaire measuring their clinical knowledge, confidence in clinical skills and motivation for further learning. Their clinical skills were tested at the end. Students and standardised patients' perceptions of the simulated learning environment to practise musculoskeletal assessment and rehabilitation were also elicited.
  
  
  RESULTS
  A t-test for independent samples revealed that students working with standardised patients displayed significantly higher standards of practical clinical skills than those working with peer patients (p=0.018). Using MANOVAs with repeated measures, no interaction effect for clinical knowledge, confidence in clinical skills, and motivation for future learning were found, both groups displaying significantly enhanced cognition and motivation. Three positive and two negative themes emerged from the analysis of students' perceptions of the simulated learning environments. These were consistent with the simulated patients' perceptions.
  
  
  CONCLUSIONS
  The findings of this study provide support for the value of using standardised patients to enhance clinical skills in musculoskeletal assessment and rehabilitation when the timeframe for laboratory practice is limited. Students' perceptions of their experience contributed to explain why confidence in clinical skills might not necessarily improve when practising with standardised patients. Suggestions are made for optimising learning with standardised patients and for addressing the economic challenge on health education programs of hiring standardised patients.
authors.affiliation: School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia. m.hecimovich@murdoch.edu.au.
authors.forename: Mark
authors.initials: M
authors.lastname: Hecimovich
authors.forename: Simone
authors.initials: S
authors.lastname: Volet
mesh_terms: D000293:Adolescent; D000328:Adult; D002983:Clinical Competence; D015331:Cohort Studies; D016001:Confidence Intervals; D004504:Education, Medical, Undergraduate / Q000379:methods; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000534:rehabilitation*; D016544:Patient Simulation; D010379:Peer Group; D018794:Problem-Based Learning / Q000379:methods*; D013337:Students, Medical; D011795:Surveys and Questionnaires; D014904:Western Australia; D055815:Young Adult