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Transfer of learning from simulation to clinical practice in pre-registration healthcare student education.

Goodhand, Kate


Kate Goodhand


Liz Hancock


Simulation has become an established pedagogy for teaching clinical skills to healthcare professionals and has been incorporated into pre-registration curricula internationally. Simulation can often be used to replace clinical practice hours and it is projected that the use of simulation will rise as placement opportunities decline. Simulation is also both resource and cost-intensive. Therefore, it becomes incumbent on educators to demonstrate the effectiveness of simulation. The broad purpose of this thesis is to extend the healthcare education knowledge base around the transfer of clinical skills to clinical practice after simulation. Three studies were undertaken, each with their own discrete aims. Firstly, an integrative literature review, to identify what evidence exists to support transfer of learning following simulation activities to clinical practice. Secondly, an explanatory sequential mixed-methods study, to ascertain and explore nurse academics’ views on current practice in Scottish higher education institutions (HEIs) in relation to the use of simulation best-practice statements and staff development. Thirdly, a convergent mixed-methods feasibility study exploring the parameters of evaluating the transfer of learning respiratory assessment skills from simulation to clinical practice for healthcare students. The paradigm underpinning this work is pragmatism using an iterative mixed-methods approach, which was applied in the following way: 1) an integrative review on transfer of learning; 2) an explanatory sequential mixed-methods study incorporated an e-Delphi study followed by telephone interviews that were thematically analysed using a qualitative descriptive approach; 3) a convergent mixed-methods study design was adopted for the feasibility study, so that quantitative data from questionnaires and qualitative data from interviews could be integrated. The integrative review found that there is limited published evidence on the effectiveness of simulation transferring to clinical practice in both health care education generally and pre-registration nurse education specifically. The current evidence-base could be improved by improving methodological rigor and being transparent around the intervention of simulation. The explanatory sequential mixed-methods study found that differences in simulation practices across Scottish HEIs were reported; however, participants unanimously agreed that they would welcome the use of simulation best practice statements in the future. They also identified a need for staff development and leadership in simulation. Whilst there are challenges involved in conducting studies evaluating transfer of learning to practice, such as the length of time required, the feasibility study demonstrated that a larger study would be worthwhile and so parameters of a future main study were explored. In conclusion, this thesis developed some key recommendations for both research and educational practice. Research into the effectiveness of simulation to transfer skills to clinical practice could be enhanced by greater collaboration between HEIs, which would enable larger samples to be reached across multiple research sites. Adopting a quasi-experimental research design might avoid methodological limitations of previous simulation evaluation studies. If institutions collaborated, then tools to evaluate the transfer of skills after simulation to clinical practice could be validated. The intervention of simulation could be strengthened using best-practice statements, which would standardise future multi-site research. Recommendations for educational practice in Scottish HEIs include the following: stronger leadership for simulation to drive and promote change; development in simulation pedagogy for healthcare educators; the use of simulation best-practice statements to provide a framework for simulation educators to standardise, evaluate and improve simulation activities; the introduction of simulation champions intra-institution to mentor, guide and support simulation educators (this could include sharing of simulation resources nationally); Scottish Schools of Nursing are currently not able to consider simulation as a significant replacement for clinical hours.


GOODHAND, K. 2019. Transfer of learning from simulation to clinical practice in pre-registration healthcare student education. Robert Gordon University [online], DPP thesis. Available from:

Thesis Type Thesis
Deposit Date Jan 27, 2020
Publicly Available Date Jan 27, 2020
Keywords Simulations in education; Simulations in healthcare; Nursing students; Scotland
Public URL
Award Date Sep 30, 2019


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