Systematic Review| Volume 52, ISSUE 4, P429-438, April 2020

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Simulation-Based Learning Experiences in Dietetics Programs: A Systematic Review



      Simulation-based learning experiences (SBLEs) are widely used in education for health professionals, but this literature has not yet been synthesized for dietetics. The aim of this study was to describe presupervised practice SBLEs using simulated patients within programs credentialing dietitians.


      A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 8 databases were searched (MEDLINE by EBSCO HOST, CINAHL Plus with Full Text, Web of Science, PsycINFO, Scopus, ERIC ProQuest, Embase, and ProQuest Education) for studies published up to November 2, 2018 with the terms “dietitian,” “standardized patient,” “student,” and their synonyms.


      Fourteen out of 740 studies were identified. Most focused on development/assessment of communication and counseling skills. Learning outcomes were measured in 12 studies with 8 different tools.

      Conclusions and Implications

      The dietetics profession needs robust and consistent reporting methods to enable the development of a high-quality body of evidence on SBLEs. The quality and quantity of SBLE research need to improve to ensure that simulations are pedagogically sound and are accompanied by measures of quality and impact on learning.

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        • Weller JM
        • Nestel D
        • Marshall SD
        • Brooks PM
        • Conn JJ
        Simulation in clinical teaching and learning.
        Med J Aust. 2012; 196: 594
        • Miles A
        • Friary P
        • Jackson B
        • Sekula J
        • Braakhuis A
        Simulation-based dysphagia training: teaching interprofessional clinical reasoning in a hospital environment.
        Dysphagia. 2016; 31: 407-415
        • Farahat E
        • Rice G
        • Daher N
        • Heine N
        • Schneider L
        • Connell B
        Objective Structured Clinical Examination (OSCE) improves perceived readiness for clinical placement in nutrition and dietetic students.
        J Allied Health. 2015; 44: 208-214
        • Ross LJ
        • Mitchell LJ
        • Williams LT
        Is it possible to enhance the confidence of student dietitians prior to professional placements? A design-based research model.
        J Hum Nutr Diet. 2017; 30: 588-595
        • MacDonald-Wicks L
        • Levett-Jones T
        Effective teaching of communication to health professional undergraduate and postgraduate students: a systematic review.
        JBI Libr Syst Rev. 2012; 10: 1-12
        • Ryall T
        • Judd BK
        • Gordon CJ
        Simulation-based assessments in health professional education: a systematic review.
        J Multidiscip Healthc. 2016; 9: 69
        • Blackstock FC
        • Jull GA
        High-fidelity patient simulation in physiotherapy education.
        Aust J Physiother. 2007; 53: 3-5
        • Lopreiato JO
        • Downing D
        • Gammon W
        • et al.
        Healthcare Simulation Dictionary.
        Date: 2016
        Date accessed: July 3, 2019
        • Okuda Y
        • Bryson EO
        • DeMaria Jr, S
        • et al.
        The utility of simulation in medical education: what is the evidence?.
        Mt Sinai J Med. 2009; 76: 330-343
        • Ker J
        • Bradley P
        Simulation in medical education.
        in: Swanwick T Understanding Medical Education: Evidence Theory and Practice. John Wiley & Sons, Hoboken, NJ2010: 164-180
      1. Health Workforce Australia. Final Report on Simulated Learning Environment Project Conducted for Health Workforce Australia. Canberra, Australia: Health Workforce Australia; 2011.

        • Maran NJ
        • Glavin RJ
        Low‐to high‐fidelity simulation–a continuum of medical education?.
        Med Educ. 2003; 37: 22-28
        • Gaba DM
        The future vision of simulation in health care.
        Qual Saf Health Care. 2004; 13: i2-10
      2. Milkins L, Moore C, Spiteri J. Simulation based education:professional entry student education and training. Gladesville, Australia: Health Education and Training Institute; 2014.

        • Rogers GD
        • Mey A
        • Chan PC
        Development of a phenomenologically derived method to assess affective learning in student journals following impactive educational experiences.
        Med Teach. 2017; 39: 1250-1260
        • Gibson SJ
        • Golder J
        • Cant RP
        • Davidson ZE
        An Australian mixed methods pilot study exploring students performing patient risk screening.
        Nurs Health Sci. 2016; 18: 203-209
        • Rogers GD
        • McConnell HW
        • Jones de Rooy N
        • Ellem F
        • Lombard M
        A randomised controlled trial of extended immersion in multi-method continuing simulation to prepare senior medical students for practice as junior doctors.
        BMC Med Educ. 2014; 14: 90
        • McGaghie WC
        • Issenberg SB
        • Petrusa ER
        • Scalese RJ
        Revisiting ‘A critical review of simulation-based medical education research: 2003–2009.’.
        Med Educ. 2016; 50: 986-991
        • Cant RP
        • Cooper SJ
        Simulation‐based learning in nurse education: systematic review.
        J Adv Nurs. 2010; 66: 3-15
        • Ward EC
        • Hill AE
        • Nund RL
        • et al.
        Developing clinical skills in paediatric dysphagia management using human patient simulation (HPS).
        Int J Speech Lang Pathol. 2015; 17: 230-240
        • MacBean N
        • Theodoros D
        • Davidson B
        • Hill AE
        Simulated learning environments in speech-language pathology: an Australian response.
        Int J Speech Lang Pathol. 2013; 15: 345-357
        • Hill AE
        • Davidson BJ
        • McAllister S
        • Wright J
        • Theodoros DG
        Assessment of student competency in a simulated speech-language pathology clinical placement.
        Int J Speech Lang Pathol. 2014; 16: 464-475
        • Dzulkarnain AA
        • Wan Mhd Pandi WM
        • Rahmat S
        • Zakaria N
        Simulated learning environment (SLE) in audiology education: a systematic review.
        Int J Audiol. 2015; 54: 881-888
        • Mori B
        • Carnahan H
        • Herold J
        Use of simulation learning experiences in physical therapy entry-to-practice curricula: a systematic review.
        Physiother Can. 2015; 67: 194-202
        • Bradley N
        • Grove E
        • Hudson R
        • Knight A
        • Parkin T
        A Guide to Innovative Practice Education Placements.
        BDA, Birmingham, UK2014
        • Thompson KL
        • Gutschall MD
        The time is now: a blueprint for simulation in dietetics education.
        J Acad Nutri Diet. 2015; 115: 183-194
        • Breese MS
        • Welch AC
        • Schimpfhauser F
        Computer-simulated clinical encounters. I. Development, utilization, and evaluation of a program.
        J Am Diet Assoc. 1977; 70: 382-384
        • Canter DD
        • Beach BL
        Computer-assisted instruction for decision making in food systems management.
        J Am Diet Assoc. 1981; 78: 338-342
        • Raidl MA
        • Wood OB
        • Lehman JD
        • Evers WD
        Computer-assisted instruction improves clinical reasoning skills of dietetics students.
        J Am Diet Assoc. 1995; 95: 868-873
        • Puri R
        • Bell C
        • Evers WD
        Dietetics students’ ability to choose appropriate communication and counseling methods is improved by teaching behavior-change strategies in computer-assisted instruction.
        J Am Diet Assoc. 2010; 110: 892-897
        • Kicklighter JR
        • Dorner B
        • Hunter AM
        • et al.
        Visioning Report 2017: a preferred path forward for the nutrition and dietetics profession.
        J Acad Nutri Diet. 2017; 117: 110-127
        • Grant MJ
        • Booth A
        A typology of reviews: an analysis of 14 review types and associated methodologies.
        Health Info Libr J. 2009; 26: 91-108
        • Moher D
        • Liberati A
        • Tetzlaff J
        • Altman DG
        • PRISMA Group
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Ann Intern Med. 2009; 151: 264-269
        • Haddaway NR
        • Collins AM
        • Coughlin D
        • Kirk S
        The role of Google Scholar in evidence reviews and its applicability to grey literature searching.
        PLoS One. 2015; 10e0138237
        • Katrak P
        • Bialocerkowski AE
        • Massy-Westropp N
        • Kumar S
        • Grimmer KA
        A systematic review of the content of critical appraisal tools.
        BMC Med Res Methodol. 2004; 4: 22
        • Crowe M
        • Sheppard L
        A review of critical appraisal tools show they lack rigor: alternative tool structure is proposed.
        J Clin Epidemiol. 2011; 64: 79-89
        • Cheng A
        • Kessler D
        • Mackinnon R
        • et al.
        Reporting guidelines for health care simulation research: extensions to the CONSORT and STROBE statements.
        Adv Simul (Lond). 2016; 1: 25
        • Fiedler KM
        • Beach BL
        Microteaching: a model for employee counseling education.
        J Am Diet Assoc. 1979; 75: 674-678
        • Russell ML
        • Caggiula AW
        • Gloninger MF
        Evaluation of clinical skills for nutrition counseling.
        J Am Coll Nutri. 1985; 4: 521-529
        • Pender FT
        • Looy AE
        The testing of clinical skills in dietetic students prior to entering clinical placement.
        J Hum Nutr Diet. 2004; 17: 17-24
        • Hawker J
        • Walker K
        An objective structured clinical examination to assess preclinical skills.
        Nutr Diet. 2010; 67: 102-105
        • Hawker JA
        • Walker KZ
        • Barrington V
        • Andrianopoulos N
        Measuring the success of an objective structured clinical examination for dietetic students.
        J Hum Nutri Diet. 2010; 23: 212-216
        • Dobson R
        • Taylor J
        • Cassidy J
        • Walker D
        • Proctor P
        • Perepelkin J
        Interprofessional and intraprofessional teams in a standardized patient assessment lab.
        Pharm Educ. 2007; 7: 159-166
        • Schwartz VS
        • Rothpletz-Puglia P
        • Denmark R
        • Byham-Gray L
        Comparison of standardized patients and real patients as an experiential teaching strategy in a nutrition counseling course for dietetic students.
        Patient Educ Couns. 2015; 98: 168-173
        • Stephenson TJ
        • Mayes L
        • Combs EM
        • Webber K
        Developing communication skills of undergraduate students through innovative teaching approaches.
        NACTA J. 2015; 59: 313-318
        • Whitehead KA
        • Langley-Evans SC
        • Tischler VA
        • Swift JA
        Assessing communication skills in dietetic consultations: the development of the reliable and valid DIET-COMMS tool.
        J Hum Nutri Diet. 2014; 27: 321-332
        • Beshgetoor D
        • Wade D
        Use of actors as simulated patients in nutritional counseling.
        J Nutr Educ Behav. 2007; 39: 101-102
        • Tada T
        • Moritoshi P
        • Sato K
        • Kawakami T
        • Kawakami Y
        Effect of simulated patient practice on the self-efficacy of Japanese undergraduate dietitians in nutrition care process skills.
        J Nutri Educ Behav. 2018; 50: 610-619
        • Lambert L
        • Pattison D
        • de Looy A
        Dietetic students’ performance of activities in an objective structured clinical examination.
        J Hum Nutr Diet. 2010; 23: 224-229
        • Gibson SJ
        • Davidson ZE
        An observational study investigating the impact of simulated patients in teaching communication skills in preclinical dietetic students.
        J Hum Nutr Diet. 2016; 29: 529-536
        • Cant R
        • Aroni R
        From competent to proficient; nutrition education and counselling competency dilemmas experienced by Australian clinical dietitians in education of individuals.
        Nutr Diet. 2008; 65: 84-89
        • Sevdalis N
        • Nestel D
        • Kardong-Edgren S
        • Gaba DM
        A joint leap into a future of high-quality simulation research—standardizing the reporting of simulation science.
        Simul Healthc. 2016; 11: 236-237
        • Arthur C
        • Levett-Jones T
        • Kable A
        Quality Indicators for the Design and Implementation of Simulation Experiences.
        Newcastle, Australia: University of Newcastle, 2010
        • Morgan K
        • Hughes R
        Professional attributes of the emerging academic dietetic educator workforce in Australia.
        Nutri Diet. 2016; 73: 275-282
        • Arthur C
        • Levett-Jones T
        • Kable A
        Quality indicators for the design and implementation of simulation experiences: a Delphi study.
        Nurse Educ Today. 2013; 33: 1357-1361
        • Jeffries PR
        A framework for designing, implementing, and evaluating simulations used as teaching strategies in nursing.
        Nurs Educ Perspect. 2005; 26: 96-103
        • Chickering AW
        • Gamson ZF
        Seven principles for good practice in undergraduate education.
        AAHE Bull. 1987; : 3-7
        • Hickson M
        • Child J
        • Collinson A
        Future Dietitian 2025: informing the development of a workforce strategy for dietetics.
        J Hum Nutr Diet. 2018; 31: 23-32
        • Bacon R
        • Williams LT
        • Grealish L
        • Jamieson M
        Student-Assisted Services (SAS): an innovative clinical education model that prepares graduates for the future, contributes to health service delivery, and addresses internship shortages.
        J Acad Nutri Diet. 2015; 115: 351-352