The Application of Scenario Simulation Teaching Combined with Case Teaching in Medical Education: Taking Nursing Practice Teaching as An Example

 

Meng Xiao1, Wei Yang2*

 

1Department of Nursing, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China

2Department of Hepatopancreatobiliary Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China

 

*Correspondence to: Wei Yang, Department of Hepatopancreatobiliary Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130012, Jilin Province, China; Email: jlccyangwei@jlu.edu.cn

 

DOI: 10.53964/jmnpr.2023008

 

Abstract

Objective: This study aims to investigate the application effect of scenario simulation teaching combined with case teaching method in nursing practice teaching, and compare it with traditional nursing practice teaching.

 

Methods: One hundred nursing students from a university in 2019 were selected as the research subjects, and were randomly divided into an experimental group and a control group, with 50 students in each group. The experimental group received nursing practice teaching using scenario simulation teaching combined with case teaching method, while the control group received traditional nursing practice teaching. The effectiveness of the two teaching methods was evaluated through examination scores, clinical competency assessment, non-technical skill level comparison, and student satisfaction survey.

 

Results: The students in the experimental group performed better than those in the control group in terms of examination scores, clinical competency assessment, non-technical skill level, and student satisfaction. Specifically, the excellent rate and passing rate of the examination scores and clinical competency assessment of the experimental group were significantly higher than those of the control group, with statistically significant differences (P<0.05); after the teaching, the non-technical skill level scores of the experimental group were higher than those of the control group (P<0.05); the satisfaction ratings of the experimental group on teaching content, teaching methods, teaching environment, teacher’s teaching style, and teaching resources were significantly higher than those of the control group (P<0.05).

 

Conclusion: Scenario simulation teaching combined with case teaching method has good application effect in nursing practice teaching, which can effectively improve students’ learning performance and clinical competency assessment scores, enhance students’ understanding and application ability of teaching content, and increase students’ learning interest and participation.

 

Keywords: simulation teaching, case-based teaching, medical education, nursing practice teaching

 

1 INTRODUCTION

Traditional medical education mainly focuses on teaching theoretical knowledge, and students lack opportunities for practical operations and practices, which results in many problems such as non-standard operations and high error rates in actual clinical operations[1]. Therefore, how to improve the practical operation and problem-solving abilities of medical students, enhance their autonomous learning ability and learning interest has become an urgent issue in medical education[2].

 

Scenario simulation teaching method is a new teaching model introduced into the clinical experimental teaching of Chinese medical colleges in recent years. At present, different scholars have different definitions and interpretations of it. Its main meaning is to combine professional background and industry characteristics, create intuitive and simulated working scenarios for students, design topics (cases) according to actual job contents, let students simulate professional role positions, and do specific things according to the actual work operation procedures and methods. Students consolidate and expand professional knowledge, and cultivate professional skills and qualities during the simulation operation process. In the nursing specialty teaching of higher vocational colleges, simulation teaching uses modern education technology, uses simulated or standardized patients, establishes simulated wards, integrates laboratory teaching resources as much as possible, and constructs a simulated teaching platform similar to hospital configuration[3-5].

 

Case-based teaching is a teaching model based on typical cases, which combines theory with practice to help students better understand and recognize the diagnosis and treatment process. Its main feature is “case-guided, student-centered, teacher-assisted”[6].

 

In recent years, scenario teaching method and case analysis method have been applied in clinical nursing teaching with good teaching effects. However, the effect of their combined application in nursing teaching is not yet clear and needs further analysis. In view of this, this study aims to explore the application effect of scenario simulation teaching combined with case-based teaching in nursing practice teaching, in order to provide new ideas and methods for the reform of medical education. The report is as follows:

 

2 MATERIALS AND METHODS

2.1 Research Subjects

This study selected 100 nursing students from a certain university’s 2019 cohort as research subjects and randomly divided them into an experimental group and a control group, with 50 students in each group. The experimental group received nursing practical teaching using the combination of situation simulation teaching and case-based teaching, while the control group received traditional nursing practical teaching methods. Both groups of students received the same teaching content and evaluation methods. The inclusion criteria were: (1) undergraduate nursing students; (2) having completed the study of nursing basic knowledge courses and needing to participate in nursing practical teaching; (3) willing to participate in the study and sign an informed consent form. At the same time, exclusion criteria were: (1) students with severe physical or mental illnesses; (2) students who have already participated in similar situation simulation teaching and case-based teaching courses; (3) students who are unable to complete the learning tasks. The inclusion and exclusion criteria for research subjects were established to ensure the reliability and validity of the study.

 

2.2 Methods

2.2.1 Control Group

The control group adopted conventional nursing teaching methods. According to the standardized nursing teaching criteria and teaching outline of the university, course arrangements were made, teaching focuses and difficulties were identified, and the teaching instructor, with the combination of clinical teaching experience, explained and demonstrated the teaching content and patiently guided the nursing students. The nursing teaching lasted for a total of 21 class hours.

 

2.2.2 Experimental Group

On the basis of the control group, the experimental group added scenario teaching methods and case analysis. The specific measures are as follows: (1) Determine the scenario simulation teaching scene: Based on the teaching objectives and the actual situation of the students, determine a scenario simulation scene that is realistic and practical, such as simulating a ward or an emergency room. (2) Compile 18 scenario simulation cases: Based on the scenario simulation teaching scene and the actual needs of the students, write relevant cases, including patient information, nursing problems, nursing measures, etc. Through specific case analysis, help students better understand and apply nursing practice knowledge and skills. (3) Establish scenario simulation teaching equipment and models: Based on the scenario simulation teaching scene, establish corresponding equipment and models, such as beds, ventilators, medicines, etc. (4) Guide students in scenario simulation teaching: In the scenario simulation teaching, the role of the teacher is more of a guide and counselor, and they need to guide and assist students to better master the process of nursing practice. (5) Evaluate the effectiveness of scenario simulation teaching: Through evaluations of students’ exam scores, clinical ability assessments, and student satisfaction, the effectiveness of scenario simulation teaching will be determined.

 

2.3 Evaluation Indicators

The effectiveness of the two teaching methods will be evaluated based on indicators such as exam scores, clinical skills assessment, and student satisfaction survey.

 

2.3.1 Exam Scores

After applying the “scenario simulation teaching combined with case teaching method” in nursing practice teaching, students will take a nursing knowledge exam. A score above 90 is considered excellent, a score between 80-90 is considered good, a score between 70-80 is considered average, a score between 60-70 is considered passing, and a score below 60 is considered failing.

 

2.3.2 Clinical Skills Assessment

The self-evaluation nursing student actual nursing operation assessment tool developed by the hospital will be used, including the following items: skill operation ability, skill operation proficiency, skill operation safety, skill operation team collaboration, and skill operation judgment ability. The scoring standards are generally divided into five levels, and specific scoring standards can be formulated according to actual conditions, including the following aspects: (1) Excellent: proficient and safe skill operation, good teamwork collaboration, able to complete nursing operations independently and make judgments and handle special situations; (2) Good: proficient and safe skill operation, good teamwork collaboration, able to complete nursing operations independently but may need guidance in special situations; (3) Average: basic proficiency in skill operation and safety, average teamwork collaboration, needs guidance to complete nursing operations; (4) Passing: basic mastery of skill operation but with certain safety hazards, poor teamwork collaboration, needs guidance to complete nursing operations; (5) Failing: no mastery of skill operation, serious safety hazards, very poor teamwork collaboration, unable to complete nursing operations.

 

2.3.3 The Nursing Non-technical Skill Questionnaire

Nursing non-technical skill survey was conducted using the nursing non-technical skill questionnaire developed by Zhou et al[7]. The questionnaire includes 5 dimensions, namely, humanistic care, communication, teamwork, clinical thinking, and problem-solving, comprising a total of 18 items. The Likert 5-point scale was used to rate each item, with scores ranging from 1 to 5, indicating from “very poor” to “very excellent” respectively. The total score ranged from 19 to 90, with a higher score indicating better results.

 

2.3.4 Self-evaluation Satisfaction Questionnaire

Student satisfaction was evaluated using a self-evaluation satisfaction questionnaire developed by our institution. The questionnaire consists of 5 aspects: teaching content, teaching methods, teaching environment, teacher’s teaching style, and teaching resources. Students rated their experience using a Likert 5-point scale, ranging from “very dissatisfied” to “very satisfied”, with scores of 1 to 5 respectively. The total score was 25, with a higher score indicating higher satisfaction.

 

2.4 Statistical Analysis

Statistical analysis was performed using SPSS 19.0 software package to calculate the frequency (n, %) and mean±SD for categorical and continuous variables, respectively. Chi-square (χ2) and t-tests were used for comparison between groups. A P-value less than 0.05 was considered statistically significant for indicating significant differences between groups for the same parameter.

 

3 RESULTS

3.1 Comparison of Basic Information

There were no significant differences in basic information such as gender, age, education level, admission time, prerequisite courses, and registered permanent residence between the two groups of study subjects (P>0.05), indicating comparability. See Table 1.

 

Table 1. Comparison of Basic Information between Two Groups of Study Subjects

 

3.2 Comparison of Nursing Knowledge Exam Scores

The excellent rate (42%) and pass rate (100%) of the experimental group students in the nursing knowledge exam were significantly higher than those of the control group (20% and 84%, respectively), with significant statistical differences (P<0.05). See Table 2.

 

Table 2. Comparison of Nursing Knowledge Exam Scores between the Two Groups (n, %)

 

3.3 Comparison of Clinical Abilities between the Two Groups

The total number of students in the experimental group who were evaluated as excellent or good in clinical ability was 47 (94%), which was significantly higher than the 23 (46%) in the control group, with significant statistical differences (P<0.05). See Table 3.

 

Table 3. Comparison of Clinical Ability between the Two Groups (n, %)

 

3.4 Comparison of Non-technical Skill Levels between the Two Groups of Students after Teaching

After teaching, the scores of various non-technical skills of the experimental group students were higher than those of the control group, and the differences between the two groups were significant (P<0.05), as shown in Figure 1.

 

Figure 1. Comparison of non-technical skill levels between the two groups of students after the teaching (n, score). Note: *P<0.05 compared with the control group.

 

3.5 Comparison of Student Satisfaction between the Two Groups

The satisfaction ratings of the experimental group students for teaching content, teaching methods, teaching environment, teacher teaching methods, and teaching resources were significantly higher than those of the control group students, with significant statistical differences (P<0.05). See Table 4.

 

Table 4. Comparison of Satisfaction Levels between the Two Groups of Students (n, score)

 

4 DISCUSSION

The results of this study indicate that scenario simulation teaching combined with case-based teaching has significant advantages in nursing practice teaching[7]. Compared with traditional nursing practice teaching, scenario simulation teaching and case-based teaching can create a more realistic clinical environment for students, enabling them to better experience the process of nursing practice[8]. At the same time, case-based teaching provides students with concrete examples, helping them better understand and apply nursing practice knowledge[9-11]. With these factors working together, the experimental group students performed significantly better than the control group students in terms of exam scores, clinical ability assessment, and student satisfaction. Since the International Medical Education Organization released the global medical education in April 2002, nursing students have been required to possess non-technical skills such as humanistic care and communication skills. These skills are very important in future nursing construction[12,13]. In addition to theoretical and professional skills, employers also pay close attention to the non-technical skills of nursing students, such as social skills, role adaptation, and analytical and problem-solving abilities. However, the level of non-technical skills among nursing students in China is low, and these skills have not received enough attention, so there are few projects studying this issue[14-16].

 

This study found through calibration that the non-technical skills of the experimental group of students were higher than those of the control group after teaching, indicating that through scenario simulation teaching based on standardized patients, intern students can experience and simulate the patient’s feelings in actual operation, thus better understanding the patient’s needs and situation. This kind of scenario simulation teaching can improve students’ humanistic concept and communication skills, enabling them to better cope with changing nursing situations, quickly identify patient problems, and propose corresponding processing strategies[17,18]. At the same time, this teaching method can also promote students’ clinical thinking ability, enabling them to continue divergent thinking and continuously improve their learning enthusiasm and teaching satisfaction under the guidance of teachers[19]. In summary, scenario simulation teaching based on standardized patients is a very effective teaching method that can help nursing students improve their level of non-technical skills in practice[20].

 

However, this study also has some limitations. First, the sample selected for this study is relatively small, and the results may be affected by sampling errors. Secondly, this study was only conducted in one medical school, and the practical effects may vary in different regions and schools. Therefore, future research can use larger samples and more regions and schools to comprehensively evaluate the application effect of scenario simulation teaching combined with case teaching method in medical education.

 

5 CONCLUSION

The results of this study indicate that the application of scenario-based simulation teaching combined with case teaching methods in medical education is significantly more effective than traditional nursing practice teaching methods. Scenario-based simulation teaching and case teaching can create a more realistic clinical environment for students, help them better experience the process of nursing practice, and increase their learning interest and engagement. Therefore, we suggest that scenario-based simulation teaching combined with case teaching methods should be widely applied in medical education to improve the practicality and effectiveness of medical education.

 

Acknowledgements

Not applicable.

 

Conflicts of Interest

The authors declared no conflict of interest.

 

Author Contribution

Xiao M designed this study and wrote the article; Yang W collected the data and performed the statistical analysis. Both authors contributed to the manuscript and approved the final version.

 

Informed Consent Statement

One hundred nursing students were willing to participate in the study and sign an informed consent form.

 

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