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© Borgis - New Medicine 4/2011, s. 138-142
*Eszter Borján1, Zoltán Balogh1, Judit Mészáros2
Three-year teaching experience in simulation education
1Department of Nursing, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
Head of Department: Zoltán Balogh, PhD
2Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
Dean of the Faculty of Health Sciences: Prof. Judit Mészáros, PhD
Aim. The aim of this study was to determine our students’ perception about a new educational tool, the high-fidelity simulator, and about the new teaching strategy of simulation.
Material and methods. 111 baccalaureate students participated in the study at Semmelweis University, Faculty of Health Sciences in Budapest, Hungary. A questionnaire was developed by the authors. The environment, the advantages of simulation, the difficulties during lessons, and the effectiveness of different teaching tools were evaluated by a modified Likert-type scale. Descriptive statistics were used to analyze survey responses.
Results. Our students recognized the advantages of simulation, but they did not have enough experience to realize all the benefits. Besides the advantages of using simulators there are some difficulties that educators have to resolve. Students are aware of the difference between the traditional and modern teaching strategies but they need more time to accept this new method completely.
Conclusions. Students of the 21st century require innovative teaching methods to prepare for real clinical practice. High-fidelity simulators can help to achieve the required learning outcomes in the most effective way.
The most common use of simulation is known from the military and aviation industry. The main advantage of simulation is the practice without risk in a lifelike environment (1-4). Teaching the students clinical skills is a core component of healthcare education. Prior to the 1950s, most skills were taught in classrooms and were practiced on patients. After the 1950s the technology was rapidly changing and educators began combining technology with basic human models (5, 6). Mrs. Chase was the first simulator to teach physical assessment to student nurses in the UK in the 1950s (4). In the 1960s the Resusci Anne for cardiopulmonary resuscitation and the Sim One, the first computer-controlled simulator, were developed (7, 8).
The level of simulators can be defined as low-, medium-, and high-fidelity. Low-fidelity simulators are static and demonstrate few features of realism. Medium-fidelity simulators are more realistic and show some lifelike phenomena, such as heart and breath sounds. High-fidelity simulators may have a physiological response to the provided care, medication and other treatment, for example fluid administration and oxygen therapy (9). Healthcare educators usually use low-, medium-, and high-fidelity simulators alternatively, always choosing the most appropriate tool to achieve the learning objective.
The most important aim of the development and use of simulators in medical and nursing education was to ensure patients’ safety (1, 7). Hospital staff and patients expect competent professionals in healthcare education (10, 11). Simulation may help the students in transferring skills learned in simulation laboratories to clinical practice (12).
The METI (Medical Education Technologies, Inc.) Emergency Care Simulator (ECS) “arrived” at our faculty in the 2007-2008 academic year. First we offered it as an optional subject for nursing, physiotherapy, midwifery, and dietitian students and later started to integrate it into the curriculum for all baccalaureate students. Each of the students has an opportunity to practice basic assessment and basic skills with the simulator. Nursing and midwifery students have more possibilities to use the simulator in their curriculum to prepare for clinical practice using the METI PNCI (Program for Nursing Curriculum Integration) learning package. METI scenarios offer teachers and students complex clinical cases from different clinical fields. While using the human patient simulator we have experienced the benefits of this new teaching and learning strategy.
Aim of the study
The purpose of this study was to find out our students’ opinions about a new educational tool, the ECS simulator, and about the new teaching method of simulation.
The research questions of this study were as follows:
1. How do students evaluate the advantages of simulation education?
2. What do students think about the realism of environment and realism of cases in scenarios?
3. How do students evaluate difficulties when using the simulator?
4. Do students feel any difference between the effectiveness of various teaching tools and methods?
We wanted to determine factors that educators have to take into consideration in order to achieve the most effective teaching.
Material and methods
This descriptive study examined the students’ perceptions of simulation in healthcare education. The questionnaire was developed by the authors based on the literature and their previous survey asking students’ opinion about simulation education.
The questionnaire included the following groups of questions: demographic data (age, gender, number of lessons, previous healthcare experience), realism of the environment, realism of the cases, advantages of simulation, difficulties during the lessons, effectiveness of different teaching tools, and open-ended questions (their assessment about the improvement of their knowledge, requests, suggestions).
We use a modified Likert-type scale to evaluate the environment, the advantages of simulation, the difficulties during the lesson and the effectiveness of different teaching tools. (see table 2) Data analysis was performed using the statistical program SPSS for Windows version 15.0.
Baccalaureate students were enrolled in the study at Semmelweis University, Faculty of Health Sciences in the fall semester of the 2010/11 academic year. 111 students completed the questionnaires; all of them could be evaluated.
Participants were chosen from nursing, midwifery and physiotherapy baccalaureate degree programs. These students have the closest connection with patients in practice, so we thought their perceptions were the most relevant. All students had human patient simulator experience. The demographic data are summarized in table 1.
Table 1. Demographic data.
Age distributionN=11121
Gender distribution


Number of lessons/semesterN=11111.4
Previous healthcare experience
None – students have never met a real patient
Previous experience – clinical practice
Previous working experience


The mean age was 21 years. The majority of the participants were women (95.5%).
The mean number of lessons in a semester was 11.4. Students were asked about their previous healthcare experience. Most of them (94.6%) had never met a real patient before the first occasion of the simulation.
Research Question 1: How do students evaluate the advantages of simulation education?
The survey question was: “What is your opinion about the advantages of simulation?”

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otrzymano: 2011-11-02
zaakceptowano do druku: 2011-11-24

Adres do korespondencji:
*Eszter Borján
Semmelweis University, Faculty of Health Sciences,
Department of Nursing
1085 Budapest, Vas u. 17.
tel.: +36 (1) 4865930; fax: 4865931

New Medicine 4/2011
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