Clinical Placement Before or After Simulated Learning Environments?: A Naturalistic Study of Clinical Skills Acquisition Among Early-Stage Paramedicine Students

Document Type

Journal Article


Lippincott Williams and Wilkins


Collaborative Research Network (CRN) Project




This article was originally published as: Mills, B. W., Carter, O. B., Rudd, C. J., Ross, N. P., & Claxton, L. A. (2015). Clinical placement before or after simulated learning environments?: a naturalistic study of clinical skills acquisition among early-stage paramedicine students. Simulation in Healthcare, 10(5), 263-269. Original article available here


Background: There is conflicting evidence surrounding the merit of clinical placements (CPs) for early-stage health-profession students. Some contend that early-stage CPs facilitate contextualization of a subsequently learned theory. Others argue that training in simulated-learning experiences (SLEs) should occur before CP to ensure that students possess at least basic competency. We sought to investigate both claims. Methods: First-year paramedicine students (n = 85) undertook 3 days of CP and SLEs as part of course requirements. Students undertook CP either before or after participation in SLEs creating 2 groups (Clin→Sim/Sim→Clin). Clinical skills acquisition was measured via direct scenario-based clinical assessments with expert observers conducted at 4 intervals during the semester. Perceptions of difficulty of CP and SLE were measured via the National Aeronautics and Space Administration Task Load Index. Results: Students' clinical assessment scores in both groups improved significantly from beginning to end of semester (P< 0.001). However, at semester's end, clinical assessment scores for the Sim→Clin group were statistically significantly greater than those of the Clin→Sim group (P = 0.021). Both groups found SLEs more demanding than CP (P



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