Date of Award


Document Type



Edith Cowan University

Degree Name

Doctor of Philosophy


School of Medical and Health Sciences

First Supervisor

Professor Cobie Rudd

Second Supervisor

Associate Professor Owen Carter


Experiential learning (EL), whereby students are able to integrate theory with practice, is an essential component of learning for health professionals. Traditionally, EL in the health education context has been achieved through clinical placements (CPs) that see students ‘apprentice’ in real clinical settings. The literature suggests there are a number of factors that diminish a student’s ability to learn in such environments, including limited opportunities to practice, being confined primarily to observation roles as opposed to participate in tasks, being exposed to skills/procedures outside their level of learning/understanding, and institutional learning objectives being secondary to workplace goals. Simulation-based learning environments (SLEs) have been espoused as an effective alternative to traditional CPs, as they provide EL opportunities void of patient risk, and can be targeted to suit the needs of both teacher and learner. While many advocate that SLEs are the logical teaching modality for preparing students to practice in real clinical environments, the fast adoption of SLEs in health education has far exceeded evidence of its effectiveness in comparison to learning occurring via CPs. Research investigating SLEs to date has, for the most part, relied upon subjective measures of student satisfaction, confidence and competence and has utilised single-group analyses providing no yardstick for comparison. The present research sought to explore the value of SLEs for undergraduate health students in comparison to CPs, as well as investigate methods of improving the educational benefit of SLEs.

This thesis is presented as a series of papers (i.e. PhD by publication) addressing the role of SLEs in health education. Study One investigates how social evaluation anxiety (SEA) impacts on performance amongst a sample of final-year nursing students. It was found that through increasing the number of professional actors in a simulation-based clinical scenario, social evaluation anxiety increased to an extent sufficient to detrimentally affect student performance. Thus, the study concluded that students would likely benefit from additional authentic exposures to EL opportunities earlier throughout their curriculum, so as to acclimatise them to real patient and person interaction. Studies Two and Three explore the differences and relationship between SLEs and CPs amongst first-year paramedicine students. The extent to which SLEs provide additional learning benefit in subsequent CPs was first established, followed by evidence suggesting this is most likely attributable to the increased opportunity for repetitive and targeted practice meant and why I did it. To my father, Rick Mills, unexpectedly losing you in December last year was unquestionably the most tragic time of my life, but the life lessons you embedded so strongly within me saw this thesis through to completion. I cannot thank you enough, and dedicate this accomplishment to you.

Access Note

Access to Chapters 3 - 7 of this thesis is not available.