Research on simulation in radiography education: a scoping review protocol

New technology and methods for diagnosis and treatment require that health personnel keep abreast with new practices [1]. Traditionally, clinical and communication skills were taught at the bedside [2]. However, in the clinical environment, it is challenging to make adequate observations and to perform feedback and to have enough time for reflection and discussion [2]. Also, today, changes in health delivery have resulted in shorter hospital stays and reduced patient availability for learning [3]. Several other factors make clinical teaching challenging, patients being too sick or unwilling to participate in teaching, and increasing efficiency demands leading to a shorter time for patient consultations [2]. The World Health Organization (WHO) recognizes that patient safety knowledge applies to all areas of practice and to all health care professions ([4], p. 22). To facilitate this, the WHO has provided a Patient Safety Curriculum Guide which recommends learning about patient safety through hands-on experience and simulation ([4], p. 84). Simulation is an important pedagogical method widely used by healthcare professions and may involve a range of learning activities [5]. Motola et al. highlight that simulation is a pedagogical method which has the potential to improve skills and skill retention through training in a controlled environment. Results from systematic reviews show that simulation has a positive effect on learning knowledge and skills [6‐8], and can potentially improve patient-related outcomes [6, 9‐13].

Issenberg and Scalese [3] state that the aim of the simulation is “to imitate real patients, anatomic regions, or clinical tasks or to mirror the real-life situations in which medical services are rendered.” Different types of simulators are used for simulation: part-task trainers, simulated patients, simulated environments, virtual reality and haptic systems, computer-based systems, and integrated simulators (instructor-driven simulators or model-driven simulators) [14]. Simulation is frequently described as high fidelity or low fidelity [15]. A simulation that offers complex and immersive scenarios by providing realistic feedback is described as high fidelity [16]. The use of a static model or task trainer that feels less real to the learner and offers no or low responsiveness is referred to as low-fidelity simulation [17]. To achieve optimal and efficient utilization of resources when designing simulation-based activities, it is recommended to perform a needs assessment, define learning outcomes, design a scenario to provide the context for the simulation including the levels of fidelity, ensure a facilitative approach, conduct pre-briefing and debriefing and feedback/evaluation, make available resources for preparing the participants, and pilot test the simulation scenario before implementation [18].

Simulation is regarded as a highly suitable strategy for learning radiography [11, 19]. The use of simulation in radiography education has been shown to enhance the radiographers’ perceptions of self-efficacy and critical thinking skills in image evaluation and patient assessment ([19], p.93). The professional practice in radiography is characterized by the use of advanced technologies and equipment for diagnostic purposes or for the treatment of medical conditions [20]. Important skills for simulation-based learning are related to positioning, exposure, physics, patient care, and quality assurance ([19], p.52). Students need opportunities to practice in a safe environment to ensure quality in the profession, and simulation offers the possibility for training without putting the patient at risk [3]. Simulation also offers the benefit of repeated learning of outcomes that promote increased cognitive recall and higher confidence with clinical tasks [21‐23]. The term radiographer refers to “professional roles in the fields of diagnostic imaging, nuclear medicine, interventional radiology, and radiation therapy” ([24], p.20).

Simulation in radiography has previously been addressed in a literature review which focused on the simulation of conventional diagnostic radiography [11]. Most studies published after this review were studies with small sample sizes, evaluating different aspects of simulation [5, 21, 25‐31]. Several of these studies used mixed methods [27]. Examples of topics covered were related to emotional preparedness when encountering open wounds [31] or when being exposed to clinical burns cases [29], confidence levels before and after simulation [30], and perceptions of learning in different high-fidelity computed tomography simulation environments [27]. Other experimental studies compared the use of virtual reality versus traditional placements [26], virtual reality against existing simulation techniques [25], and virtual reality against clinical role-play [21]. Simulation was also compared against traditional therapeutic radiography placements in a randomized controlled trial [5].

According to Lee et al. [27], reviews addressing the use of simulation across the different radiography specialties are lacking. Further knowledge on simulation in radiography education is needed to inform curriculum design and future research. The aim of this proposed scoping review is to explore, map, and summarize the extent, range, and nature of published research on simulation in radiography education. To achieve the aim of this review, we will:

We will follow the methodological framework for scoping reviews originally described by Arksey and O’Malley [32] and later advanced by Levac et al. [33] and by Khalil et al. [34]. This framework consists of the following five stages: (1) identifying the research question by clarifying and linking the purpose and research question, (2) identifying the relevant studies using a three-step literature search in order to balance the breadth and comprehensiveness, (3) careful selection of the studies using a team approach, (4) charting the data in a tabular and narrative format, and (5) collating the results to identify the implications of the study findings for policy, practice, or research [34].

We drafted the protocol using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P checklist, Additional file 1) [35]. For the scoping review, we plan to follow the newly developed reporting guidelines for scoping reviews: the PRISMA Extension for Scoping Reviews (PRISMA-ScR) [36]. We have registered our protocol in the Open Science Framework. Due to the iterative nature of the scoping review, methodology changes to the protocol can occur. We will report any changes to the protocol.

To the best of our knowledge, this will be the first scoping review identifying the research published on simulation in radiography education. This process will provide an overview of the current state of evidence in research about simulation in radiography education, and we will be able to identify in which research areas systematic reviews or primary research are needed.