Using Virtual Screen-Based Simulation to Scaffold Learning and Confidence in Paramedic Education

Title: Using Virtual Screen-Based Simulation to Scaffold Learning and Confidence in Paramedic Education

Introduction: Simulation-based education is increasingly recognized in paramedicine as a method to enhance skill acquisition and student confidence before clinical placements. Virtual simulation (VS), including screen-based VS, is an emerging modality that provides opportunities for scaffolding knowledge and repeated practice through the experiential learning cycle. However, empirical evidence supporting the effectiveness of virtual simulation in paramedic education is limited.

Objective: This study investigated whether participation in a virtual screen-based simulation improves performance, confidence, and perceptions of preparedness among paramedic students in a subsequent in-person simulation scenario and whether similar effects extend to students observing the scenario.

Methods: A quasi-experimental study involved two cohorts (N=40) of paramedic students who completed simulation exercises before practicum placements. The control group completed an asynchronous VS focused on conflict resolution and communication, while the Intervention group completed an asynchronous VS closely aligned with a subsequent in-person scenario involving neurogenic shock. Both groups attended synchronous, group-based debriefings following VS. Students were blind to the target simulation for the study. After the target in-person simulation scenario, all students completed surveys assessing confidence, perceptions, and effectiveness of VS preparation. Independent raters, blind to condition, assessed student performance using the Global Rating Scale for the Assessment of Paramedic Clinical Competence. Using an observer guide, students observing the simulation rated participants on relevant clinical actions and developed a working diagnosis and treatment plan.

Results: No significant differences were observed between Control and Intervention groups on GRS performance measures. However, the Intervention group demonstrated significantly quicker initiation of fluid resuscitation (p=.047), while the Control group was significantly faster in initiating patient transport (p<.001). Intervention participants were significantly more likely to perceive the VS as influential on performance (p=.038). Intervention students reported greater variability in confidence ratings, including higher proportions rating themselves as "Highly Confident," while the Control group exhibited consistently higher but moderate confidence.

Conclusions: While performance outcomes did not differ significantly overall, targeted virtual simulation scenarios may positively influence confidence, perceived preparedness, and select clinical actions in paramedic education. Further research with larger samples and multiple institutions is warranted to explore the potential benefits of VS in scaffolding paramedic competencies.