title: Evaluating the impact of high- and low-fidelity instruction in the development of auscultation skills.
abstract: BACKGROUND
  A principal justification for the use of high-fidelity (HF) simulation is that, because it is closer to reality, students will be more motivated to learn and, consequently, will be better able to transfer their learning to real patients. However, the increased authenticity is accompanied by greater complexity, which may reduce learning, and variability in the presentation of a condition on an HF simulator is typically restricted.
  
  
  OBJECTIVE
  This study was conducted to explore the effectiveness of HF and low-fidelity (LF) simulation for learning within the clinical education and practice domains of cardiac and respiratory auscultation and physical assessment skills.
  
  
  METHODS
  Senior-level nursing students were randomised to HF and LF instruction groups or to a control group. Primary outcome measures included LF (digital sounds on a computer) and HF (human patient simulator) auscultation tests of cardiac and respiratory sounds, as well as observer-rated performances in simulated clinical scenarios.
  
  
  RESULTS
  On the LF auscultation test, the LF group consistently demonstrated performance comparable or superior to that of the HF group, and both were superior to the performance of the control group. For both HF outcome measures, there was no significant difference in performance between the HF and LF instruction groups.
  
  
  CONCLUSIONS
  The results from this study suggest that highly contextualised learning environments may not be uniformly advantageous for instruction and may lead to ineffective learning by increasing extraneous cognitive load in novice learners.
authors.affiliation: School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Ruth
authors.initials: R
authors.lastname: Chen
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Grierson
authors.forename: Geoffrey R
authors.initials: GR
authors.lastname: Norman
mesh_terms: D003198:Computer Simulation; D004508:Education, Nursing, Baccalaureate / Q000379:methods*; D006326:Heart Auscultation; D006347:Heart Sounds / Q000502:physiology*; D006801:Humans; D007858:Learning; D008168:Lung / Q000502:physiology; D008348:Manikins; D017145:Models, Educational; D016544:Patient Simulation; D012119:Respiration