title: Clinical Placement Before or After Simulated Learning Environments?: A Naturalistic Study of Clinical Skills Acquisition Among Early-Stage Paramedicine Students.
abstract: BACKGROUND
  There is conflicting evidence surrounding the merit of clinical placements (CPs) for early-stage health-profession students. Some contend that early-stage CPs facilitate contextualization of a subsequently learned theory. Others argue that training in simulated-learning experiences (SLEs) should occur before CP to ensure that students possess at least basic competency. We sought to investigate both claims.
  
  
  METHODS
  First-year paramedicine students (n = 85) undertook 3 days of CP and SLEs as part of course requirements. Students undertook CP either before or after participation in SLEs creating 2 groups (Clin → Sim/Sim → Clin). Clinical skills acquisition was measured via direct scenario-based clinical assessments with expert observers conducted at 4 intervals during the semester. Perceptions of difficulty of CP and SLE were measured via the National Aeronautics and Space Administration Task Load Index.
  
  
  RESULTS
  Students' clinical assessment scores in both groups improved significantly from beginning to end of semester (P < 0.001). However, at semester's end, clinical assessment scores for the Sim → Clin group were statistically significantly greater than those of the Clin → Sim group (P = 0.021). Both groups found SLEs more demanding than CP (P < 0.001). However, compared with the Sim → Clin group, the Clin → Sim group rated SLE as substantially more time-demanding than CP (P = 0.003).
  
  
  CONCLUSIONS
  Differences in temporal demand suggest that the Clin → Sim students had fewer opportunities to practice clinical skills during CP than the Sim → Clin students due to a more limited scope of practice. The Sim → Clin students contextualized SLE within subsequent CP resulting in greater improvement in clinical competency by semester's end in comparison with the Clin → Sim students who were forced to contextualize skills retrospectively.
authors.affiliation: From the Office of the Deputy Vice-Chancellor (Strategic Partnerships), Edith Cowan University (B.W.M., O.B.J.C., C.J.R.), School of Medicine, Deakin University (N.P.R.), School of Medical Sciences (L.A.C.), Edith Cowan University, WA, Australia.
authors.forename: Brennen W
authors.initials: BW
authors.lastname: Mills
authors.forename: Owen B J
authors.initials: OB
authors.lastname: Carter
authors.forename: Cobie J
authors.initials: CJ
authors.lastname: Rudd
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Ross
authors.forename: Louise A
authors.initials: LA
authors.lastname: Claxton
mesh_terms: D000293:Adolescent; D000328:Adult; D000488:Allied Health Personnel / Q000193:education*; D002982:Clinical Clerkship / Q000458:organization & administration*; D002983:Clinical Competence; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000066908:Simulation Training / Q000458:organization & administration*; D014481:United States; D055815:Young Adult