title: Simulation based virtual learning environment in medical genetics counseling: an example of bridging the gap between theory and practice in medical education.
abstract: BACKGROUND
  Simulation based learning environments are designed to improve the quality of medical education by allowing students to interact with patients, diagnostic laboratory procedures, and patient data in a virtual environment. However, few studies have evaluated whether simulation based learning environments increase students' knowledge, intrinsic motivation, and self-efficacy, and help them generalize from laboratory analyses to clinical practice and health decision-making.
  
  
  METHODS
  An entire class of 300 University of Copenhagen first-year undergraduate students, most with a major in medicine, received a 2-h training session in a simulation based learning environment. The main outcomes were pre- to post- changes in knowledge, intrinsic motivation, and self-efficacy, together with post-intervention evaluation of the effect of the simulation on student understanding of everyday clinical practice were demonstrated.
  
  
  RESULTS
  Knowledge (Cohen's d = 0.73), intrinsic motivation (d = 0.24), and self-efficacy (d = 0.46) significantly increased from the pre- to post-test. Low knowledge students showed the greatest increases in knowledge (d = 3.35) and self-efficacy (d = 0.61), but a non-significant increase in intrinsic motivation (d = 0.22). The medium and high knowledge students showed significant increases in knowledge (d = 1.45 and 0.36, respectively), motivation (d = 0.22 and 0.31), and self-efficacy (d = 0.36 and 0.52, respectively). Additionally, 90 % of students reported a greater understanding of medical genetics, 82 % thought that medical genetics was more interesting, 93 % indicated that they were more interested and motivated, and had gained confidence by having experienced working on a case story that resembled the real working situation of a doctor, and 78 % indicated that they would feel more confident counseling a patient after the simulation.
  
  
  CONCLUSIONS
  The simulation based learning environment increased students' learning, intrinsic motivation, and self-efficacy (although the strength of these effects differed depending on their pre-test knowledge), and increased the perceived relevance of medical educational activities. The results suggest that simulations can help future generations of doctors transfer new understanding of disease mechanisms gained in virtual laboratory settings into everyday clinical practice.
authors.affiliation: Department of Psychology, University of Southern Denmark, Odense, Denmark. gmakransky@health.sdu.dk.
authors.forename: Guido
authors.initials: G
authors.lastname: Makransky
authors.affiliation: Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Mads T
authors.initials: MT
authors.lastname: Bonde
authors.affiliation: Department of Psychology, University of Southern Denmark, Odense, Denmark.
authors.forename: Julie S G
authors.initials: JS
authors.lastname: Wulff
authors.affiliation: Department of Education, University of Aarhus, Aarhus, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Wandall
authors.affiliation: School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Hood
authors.affiliation: School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Creed
authors.affiliation: Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark.|Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Iben
authors.initials: I
authors.lastname: Bache
authors.affiliation: Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Asli
authors.initials: A
authors.lastname: Silahtaroglu
authors.affiliation: Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Nørremølle
mesh_terms: D003479:Curriculum; D004521:Educational Measurement; D005260:Female; D005817:Genetic Counseling; D005826:Genetics, Medical / Q000193:education*; D006801:Humans; D008297:Male; D009042:Motivation; D020377:Self Efficacy; D013337:Students, Medical / Q000523:psychology; D014584:User-Computer Interface
keywords: Cytogenetics; E-Learning; Learning simulations; Medical genetics education; Virtual laboratory