Clinical placement before or after simulated learning environments? A naturalistic study of clinical skills acquisition amongst early-stage paramedicine students

Background There is conflicting evidence surrounding the merit of clinical placements (CP) for early-stage health-profession students. Some contend early-stage CPs facilitate contextualisation of subsequently learned theory. Others argue attending CP before attaining skills competency is problematic and should only occur after training in simulated-learning environments (SLE). The evidentiary basis surrounding the extent to which either is true remains limited. Methods First-year paramedicine students (n=85) undertook three days of CP and SLEs as part of course requirements. Students undertook CP either before or after participation in SLEs creating two groups (Clin→Sim/Sim→Clin). Clinical skills acquisition was measured via objectively-structured clinical examinations (OSCE) conducted at four distinct time-points over the semester. Perceptions of difficulty of CP and the SLE were measured via the NASA-TLX. Results Students’ OSCE scores in both groups improved significantly from beginning to end of semester (+35%, pp=.021). Both groups found SLEs more demanding than CP (47.6% vs. 31.4%, pp=.003). Conclusions Differences in temporal demand suggest Clin→Sim students had fewer opportunities to practice clinical skills during CP than Sim→Clin students due to a more limited scope of practice. Sim→Clin students contextualised SLE within subsequent CP resulting in greater improvement in clinical competency by semester’s end in comparison to Clin→Sim students that were forced to contextualise skills retrospectively