J Korean Acad Nurs.  2013 Apr;43(2):185-193. 10.4040/jkan.2013.43.2.185.

Comparison of Learning Effects using High-fidelity and Multi-mode Simulation: An Application of Emergency Care for a Patient with Cardiac Arrest

  • 1Department of Nursing, Shinsung University, Dangjin, Korea.
  • 2Red Cross College of Nursing, Chung-Ang University, Seoul, Korea. rnhaeunho@cau.ac.kr
  • 3Graduate School of Nursing, Inha University, Incheon, Korea.


Simulation-based learning has become a powerful method to improve the quality of care and help students meet the challenges of increasingly complex clinical practice settings. The purpose of this study was to identify the learning effects using high-fidelity SimMan and multi-mode simulation.
Participants in this study were 38 students who were enrolled in an intensive course for a major in nursing at R college. Collected data were analyzed using Chi-square, t-test, and independent t-test with the SPSS 18.0 for Windows Program.
There were no statistically significant differences in learning effects between high-fidelity SimMan and multi-mode simulation group. However, skills in clinical performance in the high-fidelity SimMan group were higher than in the multi-mode group (p=.014), communication in clinical performance in multi-mode simulation group was higher than in the high-fidelity SimMan group (p<.001).
Multi-mode simulation with a standardized patient is an effective learning method in many ways compared to a high-fidelity simulator. These results suggest that multi-mode simulation be offered to students in nursing colleges which cannot afford to purchase a high-fidelity simulator, or offered as an alternative.


Learning; Patient simulation

MeSH Terms

Education, Nursing, Baccalaureate
Emergency Medical Services
Heart Arrest/*nursing
*Patient Simulation
Students, Nursing/psychology


  • Figure 1. Study process.

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Ackermann A D. 2009. Investigation of learning outcomes for the acquisition and retention of CPR knowledge and skills learned with the use of high-fidelity simulation. Clinical Simulation in Nursing. 5(6):e213–e222. http://dx.doi.org/10.1016/j.ecns.2009.05.002.
Agency for Healthcare Research and Quality. 2011, July 16. TeamSTEPPS: National implementation. Retrieved March 20, 2012, from. http://team-stepps.ahrq.gov/abouttoolsmaterials.htm.
Alinier G., Hunt B., Gordon R &., Harwood C. 2006. Effectiveness of intermediate-fidelity simulation training technology in undergraduate nursing education. Journal of Advanced Nursing. 54(3):p. 359–369. http://dx.doi.org/10.1111/j.1365-2648.2006.03810.x.
Becker K L., Rose L E., Berg J B., Park H &., Shatzer J H. 2006. The teaching effectiveness of standardized patients. Journal of Nursing Education. 45(4):103–111.
Crea K A. 2011. Practice skill development through the use of human patient simulation. American Journal of Pharmaceutical Education. 75(9):188. http://dx.doi.org/10.5688/ajpe759188.
Crofts J F., Bartlett C., Ellis D., Hunt L P., Fox R &., Draycott T J. 2006. Training for shoulder dystocia: A trial of simulation using low-fidelity and high-fidelity mannequins. Obstetrics and Gynecology. 108(6):1477–1485. http://dx.doi.org/10.1097/01.AOG.0000246801.45977.c8.
Crofts J F., Bartlett C., Ellis D., Winter C., Donald F., Hunt L P. . 2008. Patient-actor perception of care: A comparison of obstetric emergency training using manikins and patient-actors. Quality & Safety in Health Care. 17(1):p. 20–24. http://dx.doi.org/10.1136/qshc.2006.02 1873.
Dreifuerst K T. 2012. Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. Journal of Nursing Education. 51(6):326–333. http://dx.doi.org/10.3928/01484834-20120409-02.
Gates M G., Parr M B &., Hughen J E. 2012. Enhancing nursing knowledge using high-fidelity simulation. Journal of Nursing Education. 51(1):9–15. http://dx.doi.org/10.3928/01484834-20111116-01.
Gordon J A., Brown D F &., Armstrong E G. 2006. Can a simulated critical care encounter accelerate basic science learning among preclinical medical students? A pilot study. Simulation in Healthcare. 1:13–17.
Hatala R., Issenberg S B., Kassen B., Cole G., Bacchus C M &., Scalese R J. 2008. Assessing cardiac physical examination skills using simulation technology and real patients: A comparison study. Medical Education. 42(6):628–636. http://dx.doi.org/10.1111/j.1365-2923.2007.02953.x.
Kardong-Edgren S., Anderson M &., Michaels J. 2007. Does simulation fidelity improve student test scores? Clinical Simulation in Nursing. 3(1):e21–e24. http://dx.doi.org/10.1016/j.ecns.2009.05.035.
Kardong-Edgren S., Lungstrom N &., Bendel R. 2009. VitalSim® versus SimMan®. A comparison of BSN student test scores, knowledge retention, and satisfaction. Clinical Simulation in Nursing. 5(3):e105–e111. http://dx.doi.org/10.1016/j.ecns.2009.01.007.
Kneebone R., Kidd J., Nestel D., Asvall S., Paraskeva P &., Darzi A. 2002. An innovative model for teaching and learning clinical procedures. Medical Education. 36(7):628–634.
Lee S J., Roh Y S., Kim J O., Jang K I., Ryoo E N &., Park Y M. 2010. Comparison of multi-mode simulation and SimMan® simulation on evaluation of nursing care for patients with dyspnea. Journal of Korean Academy Society of Nursing Education. 16(1):51–60.
Marken P A., Zimmerman C., Kennedy C., Schremmer R &., Smith K V. 2010. Human simulators and standardized patients to teach difficult conversations to interprofessional health care teams. American Journal of Pharmaceutical Education. 74(7):120.
Maxson P M., Dozois E J., Holubar S D., Wrobleski D M., Dube J A., Klipfel J M. . 2011. Enhancing nurse and physician collaboration in clinical decision making through high-fidelity interdisciplinary simulation training. Mayo Clinic Proceedings. 86(1):31–36. http://dx.doi.org/10.4065/mcp.2010.0282.
McGaghie W C., Issenberg S B., Petrusa E R &., Scalese R J. 2010. A critical review of simulation-based medical education research: 2003-2009. Medical Education. 44(1):50–63. http://dx.doi.org/10.1111/j.1365-2923.2009.03547.x.
Park J S. 2012, March. Accreditation standards for nursing education accreditation assessment. Paper presented at the Korean Accreditation Board of Nursing Education. Seoul:
Riley R H. 2010. Manual of simulation in healthcare. Korean Society for Simulation in Healthcare, Trans. Seoul: Yedangbook (Original work published 2008).
Ryan C A., Walshe N., Gaffney R., Shanks A., Burgoyne L &., Wiskin C M. 2010. Using standardized patients to assess communication skills in medical and nursing students. BMC Medical Education. 10:24. http://dx.doi.org/10.1186/1472-6920-10-24.
Schlegel C., Woermann U., Shaha M., Rethans J J &., van der Vleuten C. 2012. Effects of communication training on real practice performance: A role-play module versus a standardized patient module. Journal of Nursing Education. 51(1):16–22. http://dx.doi.org/10.3928/01484834-20111116-02.
Seybert A L &., Kane-Gill S L. 2011. Elective course in acute care using online learning and patient simulation. American Journal of Pharmaceutical Education. 75(3):54.
Sleeper J A &., Thompson C. 2008. The use of hi fidelity simulation to enhance nursing students' therapeutic communication skills. International Journal of Nursing Education Scholarship. 5:1–12. http://dx.doi.org/10.2202/1548-923x.1555.
Taekman J M &., Shelley K. 2010. Virtual environments in healthcare: Immersion, disruption, and flow. International Anesthesiology Clinics. 48(3):101–121. http://dx.doi.org/10.1097/AIA.0b013e3181eace73.
Thomas C &., Mackey E. 2012. Influence of a clinical simulation elective on baccalaureate nursing student clinical confidence. Journal of Nursing Education. 51(4):236–239. http://dx.doi.org/10.3928/01484834-20120224-03.
Wisborg T., Brattebo G., Brinchmann-Hansen A &., Hansen K S. 2009. Mannequin or standardized patient: Participants' assessment of two training modalities in trauma team simulation. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 17:59. http://dx.doi.org/10.1186/1757-7241-17-59.
Wotton K., Davis J., Button D &., Kelton M. 2010. Third-year undergraduate nursing students' perceptions of high-fidelity simulation. Journal of Nursing Education. 49(11):632–639. http://dx.doi.org/10.3928/01484834-20100831-01.
Yoo M S &., Yoo I Y. 2001. The effectiveness of standardized patient managed instruction for a fundamentals of nursing course. Journal of Nursing Query. 10(1):89–109.
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