When clinical placements are hard to secure, can a screen-based simulation really help students become practice-ready? This Canadian evaluation asked that question across 1,715 healthcare students. Canada is experiencing a shortage of healthcare providers, making it increasingly challenging for healthcare educators to secure quality clinical placements.

The evaluation examined virtual simulations created for the Virtu-WIL program, a pan-Canadian project designed to develop, test, and offer virtual simulations to enrich healthcare clinical education in Canada. The driving force for the program was the ever-increasing challenge of providing quality work-integrated learning experiences for students, which became markedly difficult during the COVID-19 pandemic.

Work-integrated learning experiences help students develop employability skills, and deliberately integrating theory with practice can help students engage in self-development, become proficient and ethical practitioners, use information wisely, collaborate, and apply theory in novel situations.

Because quality clinical placements are difficult to find, educators are exploring innovations in work-integrated learning, with virtual simulations becoming a rapidly emerging method for providing realistic work experiences to healthcare students. Virtual simulations are an interactive learning process in which students use screen-based platforms or software that portray realistic clinical events.

They offer realistic, interactive learning experiences, often with immediate feedback, which is critically important to learning. Virtual simulations provide an environment where students can safely develop clinical skills and repeat patient cases as often as needed. For Virtu-WIL, another goal was to better prepare students for clinical placements and make difficult curriculum segments more interactive.

Faculty and virtual simulation facilitators were encouraged, but not required, to embed the simulations in the curriculum, and all followed a pedagogical process that included a prebrief and a debrief. Because the project was national, use varied: some institutions embedded the virtual simulations in the curriculum, while others used them as a standalone activity.

The Exit Survey was developed to evaluate students’ experiences with Virtu-WIL and the program’s impact on student readiness for the labour market. It was pilot-tested with 181 participants from six schools, and item analysis indicated that the survey was functioning adequately, with minor revisions to some demographic items.

The survey included 26 items across four domains: overall experience, virtual simulation player experience, debriefing experience, and perceived impact on clinical practice. The virtual simulation player experience and debriefing experience were measured with the mini Player Experience Inventory short form and the Debriefing Experience Scale, two existing tools with good validity evidence.

All 1,715 students enrolled at the end of 2022 and beginning of 2023 in Virtu-WIL from 18 schools and four provinces responded to the survey. Over 60 percent provided feedback to the two open-ended items. Table two reports Mini-PXI item means and standard deviations for the total sample and nursing, medical laboratory technology, and paramedicine programs.

The total PXI mean was forty-five point five out of fifty-five, while functional items addressed usability and clarity, and psychosocial items addressed focus, confidence, meaning, and enjoyment. The authors note that nursing item means were all four or higher, with program-level variation also reported for medical laboratory technology and paramedicine.

The mean total score for all groups on the mini Player Experience Inventory was 45.5 out of a possible 55, indicating a very positive experience for most students. The mean for the Functional subscale was 4.2 out of a possible 5, suggesting that students generally found the virtual simulation easy to use, audio and visually appealing, and sufficiently challenging.

The mean for the Psychosocial subscale was 4.12 out of a possible 5, indicating that students felt immersed in the simulations and found the situations meaningful. All mini Player Experience Inventory items for the total group had mean scores of 4.0 or higher.

Table four reports how students perceived the Virtu-WIL Program’s impact on practice, using mean scores and standard deviations across all participants and the nursing, medical laboratory technology, and paramedicine programs. For the total group, all three items had mean scores of four or greater out of five: learning a lot, using knowledge and skills in practice, and feeling more competent and ready for practice.

The authors note that paramedicine ratings followed the same pattern but were lower across these items, highlighting variation by program. Across programs, participants tended to agree that virtual simulations enhanced knowledge and skills they believed they could use in practice and increased their sense of competence; all three practice items for the total group had mean scores of 4 or greater out of a possible 5.

The program pattern differed: Paramedicine rated each item lower, and some of the lowest survey mean scores were for Paramedicine’s impact-on-practice items. Statistically significant differences were identified between Paramedicine and Medical Laboratory Technology, and between Paramedicine and Nursing, on all three items, with p less than .001.

No significant differences were identified between Medical Laboratory Technology and Nursing. Students listed practice skills they felt they had learned from the virtual simulations, including administering a puffer to a patient with asthma, caring for a patient with dementia, operating a PCA pump, and treating anaphylaxis.

Other examples of the practice skills students described included managing a blood transfusion reaction, feeding a patient with dysphagia, and caring for a post-operative patient. In describing the practice skills they had learned, students identified assessment, treatment, and documentation as skills used in these clinical situations.

The virtual simulations helped develop these skills because the situations were realistic and provided opportunities to observe and practice. One Nursing student said the virtual simulations allowed the student to recognize mistakes and correct them.

Virtual simulations can play an important role in preparing students for clinical practice, especially when they align with the curriculum. Across programs, playing a virtual simulation that reflects clinical practice and that students see as useful in enhancing their skills strongly contributes to perceptions of readiness for practice.

The virtual simulations gave students an opportunity to see professional roles in action and take on those roles, while thinking things through, making mistakes, and learning from mistakes in a safe environment. For students who had not yet been to clinical, seeing a clinical scenario unfold and seeing how health professionals managed the situation was invaluable.

Careful curriculum integration is essential, and the timing or sequencing of virtual simulations needs further study; ideally, students would practice at several points in their program. One limitation is that the study did not collect information on students’ pre-program clinical experience, such as previous educational qualifications and life experience.

Prior experience may have influenced students’ perceptions of virtual simulation realism and therefore influenced learning and satisfaction outcomes. Most participants were from Nursing, although the distribution of students is representative of the population of students.

Virtual simulations were engaging and were associated with stronger perceived preparation for practice, but simply adding them is not enough. Curriculum alignment, careful planning, and simulation pedagogy matter.