Transforming simulation using ‘live’ actors as patients, engaging students in self and peer assessment


When did you first introduce the innovation?

Less than 12 months ago

Please describe the innovation you have developed

The innovation involved the creation of on going patient scenarios that students had to respond to in real time. The patient scenarios were practiced using ‘live’ actors as patients. Students were given a number of patients (as case studies) in the skills laboratory and using ‘live’ actors as patients cared for them, in groups, rotating around each patient situation and videoed.

There were 3 patients and for each:

  • Case scenarios were prepared with the relevant bedside teaching materials (drug and observation charts, notes, fluid balance charts etc.), self and peer assessment documentation devised, student consent to videoing confirmed.
  • Meetings took place between members of the module team.
  • Lecturers, students and actors were prepared and information circulated
  • Actors were made up using moulage to enable them to effectively play their role
  • The students were debriefed, completed the self and peer assessment, discussions took place and verbal feedback from the lecturers and students was given
  • Students were shown their videos of their group simulations and given the opportunity to review their original self and peer assessment of themselves and others
  • An evaluation of the process was undertaken to inform simulation with self and peer assessment and videos.

This innovation demonstrates how nursing simulation can be transformed through the incorporation of using ‘live’ actors as patients, student self and peer assessment and videos. The combination of a ‘live’ simulation with the addition of self and peer assessment can serve to meet the need for more creative, and innovative forms of assessment.

What prompted you to develop this innovation?

Having been involved in many simulations using intermediate technology one of the common suggestions by students for improvement is related to the use of manikins. Students often stated they felt they could perform better with a real person. In response to this evaluation I put forward a bid for funding and was successful. The money was used to pay for props and drama students to come and ‘act’ the part of a patient in simulation with self and peer assessment.

In addition, there is sufficient evidence to suggest a shift is needed in relation to the use of more innovative and creative assessment practices within Higher Education. This involves forms of assessment, which are capable of empowering students. Simulation is purported to be a move in the right direction. There is increasing evidence that nursing students want more simulation as a way of, not just to develop competency in clinical skills performance, but as a means of connecting the skills together with theory in the holistic practice of caring for individual patients.

In your view, what is it about this innovation that makes it different/important?

The innovation undertaken carefully considered the main learning theories in relation to the use of ‘live’ simulation, as not only as a means to develop nursing practice but also facilitate reflection-in-action skills. In addition, when simulation is combined with self and peer assessment, it can facilitate students to link areas of knowledge together. Self and peer assessment needs to be seen as essential graduate attributes.

To what extent does your innovation make use of existing approaches, resources or technologies?

Self-assessment is an approach to assessment that can enable students to ‘own’ their own learning. This focuses the shifting role of students from a passive receiver of information into an active participant, and so breaking the pattern of passive learning.

The use of student self and peer assessment is to strive to prepare students for the professional work environment they will encounter post-graduation. Self- and peer- assessment can provide a much better environment for practicing duties of a mentor, coach and/or facilitator. There is an element of employability in relation to students being able to assess quality not only in themselves but in others, and this has implications for the development of future practitioners as mentors and assessors. It develops the skills required for lifelong learning. In addition, the student can develop competencies and skills outside of the standard learning outcomes assessment led curriculum.

Some insight into the role self- and peer-assessment in simulation might play as an aid to learning can be derived from examining briefly the two dominant traditions currently explaining human learning and development. The socio-cultural theory based on the writings primarily of Vygotsky (1978) and Bruner (1986), and the cognitive development tradition rooted in the writings of Piaget (1962).

Yet these development traditions of learning are often set against each other. Both Vygotsky and Piaget see learning as a form of construction in that the learner is involved in a process of invention or interpretation to give meaning to experiences. This is a process that nurses can go through when involved in self and peer assessment, in that they are individually ‘constructing’ or ‘socially constructing’ experiences in a form that makes assessment accessible to them.

To what degree has this innovation led to changes in education or clinical practice?

A written report of the simulation using self and peer assessment and videos has been sent to the Head of Department requesting this style of learning to continue next semester with 3rd year students, as preliminary work to consider this learning activity as integral to and included in the new curriculum in 2016.

What evidence do you have of the impact of the innovation?

Early observations of the self- and peer-assessment process is that students generally tick the boxes giving positive feedback to themselves and their peers, but tend to give better and more useful written feedback. Comments such as ‘…..both of us need to work quicker and remember to call for help immediately’, ‘….act quicker in assessment’, ‘Could improve knowledge……’, ‘Build on skills to improve…..’.

Student evaluations are positive in that they state ‘it relates to practice’, and that the process seems to be integrating theory into practice for students ‘Oh that is what you mean’, ‘I understand it now’, the students appear to be experiencing ‘penny dropping moments’, helping them learn and recognise these moments.

There are also expressions of how the process can be improved, and work is ongoing with the module teams to strive to improve the experience of simulation using self- and peer-assessment for students. There is development of student led simulation whereby the students are involved in deciding the case scenarios drawn from their own real life clinical practice experience, which can be expressed and converted into case studies and form the basis for simulation. In addition, moving forward also involves students setting the marking criteria and devising their own standards for success.

This work formed part of a submission for a Senior Fellow with the Higher Education Academy (SFHEA), which I have been successful in achieving.

To what degree has the innovation been disseminated in your organisation or elsewhere?

Presented a paper at the RCN Education Forum Conference and Exhibition: Partners in Practice on the 10 March 2015 at the East Midlands Conference Centre, University of Nottingham entitled: Implementation of self and peer assessment in simulation with nursing students: future directions for nurse education.

Please provide details of any plans you have to disseminate the innovation in the future.

I am writing an article on simulation incorporating a combination of self and peer assessment and videos and plan to send additional abstracts for consideration at related conferences e.g. SRHE and ASPiH.