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Impact of providing case-specific knowledge in simulation: a theory based study of learning
  1. Jocelyn Cox1,
  2. Marion McGregor2,
  3. Dominic Giuliano3,
  4. Loretta Howard4
  1. 1Department of Chiropractic, D'Youville College, Buffalo, New York, USA
  2. 2Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
  3. 3Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
  4. 4Leadership, Higher and Adult Education, University of Toronto Ontario Institute for Studies in Education, Toronto, Ontario, Canada
  1. Correspondence to Dr Dominic Giuliano, Canadian Memorial Chiropractic College, 6100 Leslie Street, North York ON M2H 3J1, Canada; dgiuliano{at}


Background Simulation-based education (SBE) has been lauded for its ability to help students recognise and react appropriately to common and rare circumstances. While healthcare professions have started to implement SBE into their curriculum, there is no evidence to suggest which educational theory is best for implementation. This study explores the usage of cognitive load theory (CLT) and the unified theory of emotional learning (UTEL).

Study design A mixed methods ordered-allocation cohort study.

Methods 23 patient management teams were allocated into 2 groups. The first group received prior information about the simulation scenario; the second group did not. Each team had 1 student assigned to the role of doctor. The scenarios were filmed at time 1 (T1), time 2 (T2) and follow-up (F/U). The ‘doctor’ role was then graded with a validated checklist by a three-judge panel. The scores were evaluated to determine if prior information enabled better performance. Secondary analysis evaluated the role of gender on performance and also evaluated anxiety at the onset of the simulation.

Results 23 doctors were evaluated. There was no difference between groups in performance (t=1.54, p=0.13). Secondary analysis indicated that gender did not play a role. There was no difference in anxiety between groups at baseline (t=0.67, p=0.51).

Conclusions Trends were observed, suggesting that when students enter a simulation environment with prior knowledge of the event they will encounter, their performance may be higher. No differences were observed in performance at T2 or F/U. Withholding information appeared to be an inappropriate proxy for emotional learning as no difference in anxiety was observed between groups at baseline. All trends require confirmation with a larger sample size.

  • Simulation
  • Health Care
  • Education
  • Learning Theory

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  • Contributors All authors were involved in the planning, conduct and/or reporting of this study. JC prepared the study proposal, collected data, conducted simulation laboratory tests and created the manuscript. MM served as a scientific advisor, critically reviewed and appraised the study proposal, performed the statistics and revised the final manuscript. DG conducted simulation laboratory tests and revised the final manuscript. LH served as a scientific advisor, critically reviewed and appraised the study proposal, and revised the final manuscript.

  • Competing interests None declared.

  • Ethics approval Canadian Memorial Chiropractic Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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