The effect of replacing 1 week of content teaching with an intensive simulation-based learning activity on physiotherapy student clinical placement performance.

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Tuttle, Neil
Horan, Sean A
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Background: Simulation-based learning (SBL) activities are increasingly used to replace or supplement clinical placements for physiotherapy students. There is limited literature evaluating SBL activities that replace on-campus teaching, and to our knowledge, no studies evaluate the role of SBL in counteracting the negative impact of delay between content teaching and clinical placements. The aims of this study were to (i) determine the effect on clinical placement performance of replacing 1 week of content teaching with a SBL activity and (ii) determine if a delay between content teaching and clinical placement impacted clinical placement performance. Methods: This study is a retrospective cohort study. Participants included students in the first two clinical placements of a graduate-entry, masters-level program. Six hundred twenty-nine student placements were analysed-285 clinical placements where students undertook a 20-h SBL activity immediately prior to clinical placement were compared with 344 placements where students received traditional content. Of the placements where students received the SBL, 147 occurred immediately following content teaching and 138 had a delay of at least 5 weeks. Performance on clinical placement was assessed using the Assessment of Physiotherapy Practice (APP). Results: There was a significant main effect of SBL with higher APP marks for the experimental group (3.12/4, SD = 0.25 vs 3.01/4, SD = 0.22), and post hoc analysis indicated marks were significantly higher for all seven areas of assessment. Students whose placements immediately followed content teaching performed better on mid-placement APP marks in two areas of assessment (analysis and planning, and intervention) compared to students for whom there was a delay. There were no statistically significant differences in relation to delay for end of placement APP marks. Conclusion: Replacing 1 week of classroom teaching with a targeted, SBL activity immediately before placement significantly improved student performance on that clinical placement. A negative impact of delay was found on mid-placement, but not the end of placement APPs. Findings of improved performance when replacing a week of content teaching with a targeted SBL activity, and poorer performance on mid-placement marks with a delay between content teaching and clinical placement, may have implications for curriculum design.

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Advances in Simulation

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Suppl 1

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© The Author(s). 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Specialist studies in education

Clinical placement

Curriculum design


Simulated learning

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Tuttle, N; Horan, SA, The effect of replacing 1 week of content teaching with an intensive simulation-based learning activity on physiotherapy student clinical placement performance., Advances in Simulation, 2019, 4 (Suppl 1), pp. 14:1-14:8