COMPARISON OF VIRTUAL SIMULATION WITH PHYSICAL SIMULATION ON STRESS RESPONSES AND LEVEL OF CONFIDENCE AMONG MEDICAL AND NURSING STUDENTS: A RANDOMIZED CONTROL TRIAL

Abstract

Aims: To compare virtual simulation (VS) with physical simulation (PS) on stress responses and confidence levels among the medical and nursing students. Background: Advances in technology have enabled the use of physical and virtual simulation. Simulation provides a valuable learning experience without compromising the patient’s safety. The realistic environment in simulation induces stress that enhances memory retention and concentration. Conversely, the high stressed simulation could impair knowledge acquisition and performance. While previous works focus on the stress levels between students who underwent simulation using standardised patient or high-fidelity mannequin, stress response during virtual simulation has yet to be explored. Methods: A randomised controlled study was conducted with 120 students who were randomly assigned to two simulation groups, PS and VS. Data collected using both subjective (heart rate and blood pressure) and objective (State anxiety) stress measurement while confidence was measured using self-reported confidence-scale. Analysis of Covariance was used to compare the post-test scores across time and between groups. Correlation between the stress and confidence level was also performed. Results: A significant increase (p<0.001) in stress level was observed in both simulation. No significant difference was found on stress and confidence level between the PS and VS groups. However, in the PS group, medical students demonstrated a significant increase in stress level compare to the nursing students. A moderate negative correlation in PS (r=-0.582) and VS (r=-0.414) was found between the state anxiety and confidence level. Conclusion: Both VS and PS caused significant increase in level of stress among students. This high level of stress could potentially lead to a decrease in their confidence level. Implications: With the advancement in the use of a computer, VS stimulate students’ motivation to learn the standards-based curriculum. Scaffolding learning using both PS and VS can, therefore, aid in improving students’ competency in clinical skills.