Does additional training using a human patient simulator improve cardiorespiratory physiotherapy clinical performance?

Jones, Anne (2010) Does additional training using a human patient simulator improve cardiorespiratory physiotherapy clinical performance? PhD thesis, James Cook University.

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Simulation as an educational intervention is currently a discussion point around the world. It has been proposed that simulation may protect patient safety and reduce the time required by students in clinical practice. These reported benefits come from repeated practice in a safe environment, and the ability to modify patient cases and the complexity of those cases. One area in which physiotherapy may use simulation is in cardiorespiratory physiotherapy.

Physiotherapy education provides students with the skills and knowledge required to work in a clinical environment. According to Bandura, self efficacy is the link between how a person uses their skills and knowledge. Self efficacy may determine how well students perform in an academic and clinical setting. Therefore, it may be more useful to assess students' self efficacy as well as performance instead of just performance following an educational intervention.


This thesis aims to compare traditional training with traditional training plus an additional eight hours of simulation training in the area of cardiorespiratory physiotherapy. The primary outcome measure was improved clinical performance as assessed using the Assessment of Physiotherapy Practice (APP), a standardised physiotherapy clinical assessment tool. Self efficacy was also measured to determine whether it correlated to pre-clinical academic performance or clinical performance, and thus whether it changed following the simulation intervention.


A randomised controlled trial was undertaken in which physiotherapy students were allocated to either the control group, with no additional training, or the intervention group, with two four-hour additional training sessions using a human patient simulator. A self efficacy questionnaire was developed to assess students' self efficacy following traditional training or simulation training. Following the training period, participants commenced clinical placement. They were assessed weekly with the APP for six weeks to determine their clinical performance. Correlation was undertaken between self efficacy and pre-clinical cardiorespiratory academic performance, and self efficacy and cardiorespiratory clinical performance. Between group analysis was undertaken to determine whether participants who had additional training either:

a. scored higher on clinical performance

b. became competent one week earlier than those without additional training, or

c. whether those who had a pass grade (50−64.99%) for their pre-clinical cardiorespiratory subjects improved more with additional simulation training.


Participants who had two additional four-hour simulation training sessions did not have improved performance when assessed weekly on clinical placement and did not reach competence one week earlier. Those students with a pass grade did not have improved performance with simulation training. Self efficacy had a moderate correlation with pre-clinical performance. Those students with no additional training had a positive correlation between self efficacy and clinical performance in a number of areas over a number of different weeks, but mainly in the area of performing treatment. Those students with additional simulation training had negative correlations in the area of written communication and performing treatment. It appears that the simulation training may have improved students' self efficacy but not their clinical performance. It was not possible to see whether self efficacy changed following the simulation training due to the lack of student responses prior to attending simulation training.


This research demonstrates that simulation training performed in this manner did not improve clinical performance. However, it may have had an effect on self efficacy. This is an important finding given the importance of self efficacy for a person's use of their skills and knowledge. This research highlights the need to develop evidence based education to determine when and how simulation may be best used in physiotherapy, and particularly in cardiorespiratory physiotherapy.

Item ID: 19041
Item Type: Thesis (PhD)
Keywords: cardiorespiratory physiotherapy, clinical education, self-efficacy, simulation training, allied health professional curriculum, clinical practice, Assessment of Physiotherapy Practice, clinical performance, health teaching methods, health student placements
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Additional Information:

Appendix 2 (administrative documentation) and appendix 3 (permissions) are not available through this repository.

Publications arising from this thesis are available from the Related URLs field. The publications are:

Chapter 3 & Appendix 5.1: Jones, A., and Sheppard, L. (2008) Physiotherapy education: a proposed evidence-based model. Advances in Physiotherapy 10(1): 9-13.

Chapter 5 & Appendix 5.2: Jones, A., and Sheppard, L. (2011) Developing a measurement tool for assessing physiotherapy students self efficacy: a pilot study. Assessment and Evaluation in Higher Education. DOI: 10.1080/02602938.2010.534765.

Chapter 6 & Appendix 5.3: Jones, A., and Sheppard, L. (2011) Use of a human patient simulator to improve physiotherapy cardiorespiratory clinical skills in undergraduate physiotherapy students: a randomised controlled trial. Internet Journal of Allied Health Sciences and Practice 9(1): 1-11.

Chapter 7 & Appendix 5.4: Jones, A., and Sheppard, L. (2011) Self-efficacy and clinical performance: a physiotherapy example. Advances in Physiotherapy 13(2): 79-83.

Appendix 1.1: Jones, A., and Sheppard, L. (2007) Can human patient simulators be used in physiotherapy education? Internet Journal of Allied Health Sciences and Practice 5(2): 1-5.

Date Deposited: 28 Nov 2011 22:53
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110317 Physiotherapy @ 34%
13 EDUCATION > 1302 Curriculum and Pedagogy > 130209 Medicine, Nursing and Health Curriculum and Pedagogy @ 33%
13 EDUCATION > 1302 Curriculum and Pedagogy > 130213 Vocational Education and Training Curriculum and Pedagogy @ 33%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920201 Allied Health Therapies (excl. Mental Health Services) @ 34%
93 EDUCATION AND TRAINING > 9305 Education and Training Systems > 930501 Education and Training Systems Policies and Development @ 33%
93 EDUCATION AND TRAINING > 9399 Other Education and Training > 939902 Education and Training Theory and Methodology @ 33%
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