Overview of implementation and learning outcomes of simulation in pharmacy education

Simulation, an educational, assessment, and research technique used to mimic real‐world situations, is increasingly used in pharmacy education. The most‐used simulation methods include high‐fidelity simulation (HFS), low‐fidelity simulation (LFS), standardized patients, and game‐based simulation. A common element of simulation is its ability to offer learners the chance to practice a skill or acquire knowledge in a safe and accessible space. Simulation methods differ in key aspects, including cost and other resource investment as well as ideal venue for use in education. HFS provides a more realistic simulation environment than LFS but is typically more expensive. Standardized patients offer learners the opportunity to engage with a live person but may elicit greater variability in responses to learners' input than HFS. Computer‐based simulation uses technology to supply a wide variety of learning opportunities; however, it may require the use of proprietary software and devices. Despite widespread use, literature describing learning outcomes of simulation in pharmacy education is limited. Some existing reports with positive findings have focused on learner satisfaction with or perceived benefit of simulation activities. The few existing publications summarizing changes in skills or knowledge demonstrate a positive impact. Simulation is a promising modality for educating pharmacy students and residents; however, more data summarizing the benefit of learning outcomes are needed.

[1]  Moom R. Roosan,et al.  PGxKnow: a pharmacogenomics educational HoloLens application of augmented reality and artificial intelligence. , 2022, Pharmacogenomics.

[2]  J. Guy,et al.  Game-Based Learning in Pharmacy Education , 2022, Pharmacy.

[3]  Michelle A Fravel,et al.  An Exploratory Mixed Methods Study of Standardized Patient Comments on Empathy and Student Communication Scores , 2021, American Journal of Pharmaceutical Education.

[4]  Julaine Fowlin,et al.  Improving Student Pharmacists' Learning Through the Use of Pediatric Simulation. , 2021, The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG.

[5]  A. Awaisu,et al.  The utilization of simulated patients for teaching and learning in the pharmacy curriculum: exploring pharmacy students’ and recent alumni’s perceptions using mixed-methods approach , 2021, BMC medical education.

[6]  Ronald E. Ragan,et al.  Mid-fidelity manikins improve first-year pharmacy students' confidence and accuracy with performing physical assessment. , 2021, Currents in pharmacy teaching & learning.

[7]  Spencer E. Harpe,et al.  Analysis of pharmacy student communication self-evaluation skills during standardized patient encounters. , 2021, Currents in pharmacy teaching & learning.

[8]  S. White,et al.  Experiencing a virtual patient to practice patient counselling skills. , 2021, Currents in pharmacy teaching & learning.

[9]  Courtney L. Bradley,et al.  Communicating definitive uncertainty: Teaching pharmacy students to say "I don't know". , 2021, Currents in pharmacy teaching & learning.

[10]  C. Friel,et al.  Development and use of augmented reality models to teach medicinal chemistry. , 2021, Currents in pharmacy teaching & learning.

[11]  Kristen Cook,et al.  Electronic Health Records in Pharmacy Skills-based Curricula , 2021, American Journal of Pharmaceutical Education.

[12]  K. Taxis,et al.  The International Pharmacy Game: A Comparison of Implementation in Seven Universities World-Wide , 2021, Pharmacy.

[13]  Amy L. Seybert,et al.  Use of an immersive, simulated learning game to teach pharmacy students clinical concepts of toxicology. , 2021, Currents in pharmacy teaching & learning.

[14]  M. King,et al.  Experiential Learning in a Gamified Pharmacy Simulation: A Qualitative Exploration Guided by Semantic Analysis , 2021, Pharmacy.

[15]  D. Tompkins,et al.  Implementation and evaluation of a virtual learning advanced pharmacy practice experience , 2021, Currents in Pharmacy Teaching and Learning.

[16]  Clark Kebodeaux,et al.  Meeting pharmacy educational outcomes through effective use of the virtual simulation MyDispense. , 2021, Currents in pharmacy teaching & learning.

[17]  Noam Morningstar-Kywi,et al.  Using Interactive Fiction to Teach Clinical Decision-Making in a PharmD Curriculum , 2021, Medical Science Educator.

[18]  S. MacDonald,et al.  Fostering Undergraduate Medicine, Nursing, and Pharmacy Students’ Readiness for Interprofessional Learning Using High Fidelity Simulation , 2021, Cureus.

[19]  M. Brennan,et al.  Real-time, simulation-enhanced interprofessional education in the care of older adults with multiple chronic comorbidities: a utilization-focused evaluation. , 2020, mHealth.

[20]  A. Darr,et al.  Comparison of Pharmacy Students' Performance in a Laboratory Course Delivered Live Versus by Virtual Facilitation , 2020, American Journal of Pharmaceutical Education.

[21]  K. Taxis,et al.  The Pharmacy Game-GIMMICS® a Simulation Game for Competency-Based Education , 2020, Pharmacy.

[22]  Christine Fanning,et al.  Simulation as a Platform for Development of Entrustable Professional Activities: A Modular, Longitudinal Approach , 2020, Cureus.

[23]  M. Sohn,et al.  Academic electronic health records as a vehicle to augment the assessment of patient care skills in the didactic pharmacy curriculum. , 2020, Currents in pharmacy teaching & learning.

[24]  L. Deeks,et al.  Evaluation of Vaccination Training in Pharmacy Curriculum: Preparing Students for Workforce Needs , 2020, Pharmacy.

[25]  M. Cawley,et al.  Advanced cardiac life support certification for student pharmacists improves simulated patient survival. , 2020, Currents in pharmacy teaching & learning.

[26]  Hayley Croft,et al.  Student Acceptance of Using Augmented Reality Applications for Learning in Pharmacy: A Pilot Study , 2020, Pharmacy.

[27]  A. Esterman,et al.  "Who Am I and Why Am I Here?" A Scoping Review Exploring the Templates and Protocols That Direct Actors in Their Roles as Simulated (Standardized) Patients. , 2020, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[28]  J. Schneider,et al.  Introducing Augmented Reality Technology to Enhance Learning in Pharmacy Education: A Pilot Study , 2020, Pharmacy.

[29]  L. B. Andrews,et al.  Simulation as a Tool to Illustrate Clinical Pharmacology Concepts to Healthcare Program Learners , 2020, Current Pharmacology Reports.

[30]  J. Bartlett,et al.  Large-group, asynchronous, interprofessional simulation: Identifying roles and improving communication with student pharmacists and student nurses. , 2020, Currents in pharmacy teaching & learning.

[31]  J. Trovato,et al.  Using Electronic Health Record Technology to Teach Inpatient Medication Order Verification to Pharmacy Students , 2020, American Journal of Pharmaceutical Education.

[32]  C. Lucas,et al.  Enhancing pre-licenced pharmacists' communication and interprofessional collaboration utilizing the RIPE model of interprofessional learning: A qualitative study. , 2020, Research in social & administrative pharmacy : RSAP.

[33]  K. McKeirnan,et al.  Considerations in training student pharmacists to perform physical assessment. , 2020, Currents in pharmacy teaching & learning.

[34]  Kathryn J Smith Incorporating the Pharmacists' Patient Care Process Into An Interprofessional Second Year Capstone. , 2019, Currents in pharmacy teaching & learning.

[35]  Nancy T. Lombardo,et al.  A Mixed Methods Approach to Assess the Impact of an Interprofessional Education Medical Error Simulation , 2019, American Journal of Pharmaceutical Education.

[36]  Jonathan C. Cho,et al.  Pharmacy faculty and students' perceptions of standardized patients for objective structured clinical examinations. , 2019, Currents in pharmacy teaching & learning.

[37]  Kylie A. Williams,et al.  Virtual Pharmacy Programs to Prepare Pharmacy Students for Community and Hospital Placements , 2019, American Journal of Pharmaceutical Education.

[38]  Amy L. Seybert,et al.  Evidence for simulation in pharmacy education , 2019, Journal of the American College of Clinical Pharmacy.

[39]  E. Boyce,et al.  RESEARCH ARTICLE: Training students on the Pharmacist Patient Care Process using an electronic health record and simulations , 2019 .

[40]  Jeanne E. Frenzel,et al.  Measuring health care students' attitudes toward interprofessional learning, perceptions of effectiveness as an interprofessional team member, and competence in managing adult cardiac arrest. , 2019, Currents in pharmacy teaching & learning.

[41]  Laura Baumgartner,et al.  High-fidelity simulation increases pharmacy resident perceived competence during medical emergencies. , 2019, Currents in pharmacy teaching & learning.

[42]  Caitlin M. Gibson,et al.  Impact of a low-cost simulated electronic medical record on perceptions of APPE readiness. , 2019, Currents in pharmacy teaching & learning.

[43]  C. Lee Ventola,et al.  Virtual Reality in Pharmacy: Opportunities for Clinical, Research, and Educational Applications. , 2019, P & T : a peer-reviewed journal for formulary management.

[44]  Leanne Coyne,et al.  The Past, Present, and Future of Virtual Reality in Pharmacy Education , 2019, American Journal of Pharmaceutical Education.

[45]  M. Suneja,et al.  Assessing Entrustable Professional Activities Using an Orientation OSCE: Identifying the Gaps. , 2019, Journal of graduate medical education.

[46]  A. Galloway,et al.  Interprofessional education telephone simulation for campus-based pharmacy students and distance-learning family nurse practitioner students. , 2019, Currents in pharmacy teaching & learning.

[47]  Celeste M. Alfes,et al.  A Systematic Review of the Use of Standardized Patients as a Simulation Modality in Nursing Education , 2019, Nursing education perspectives.

[48]  A. Zarbock,et al.  High-fidelity is not superior to low-fidelity simulation but leads to overconfidence in medical students , 2019, BMC medical education.

[49]  L. Curley,et al.  Pharmacy Students’ Perspectives on Interprofessional Learning in a Simulated Patient Care Ward Environment , 2018, American Journal of Pharmaceutical Education.

[50]  C. Lucas,et al.  "Two heads are better than one"- pharmacy and nursing students' perspectives on interprofessional collaboration utilizing the RIPE model of learning. , 2019, Research in social & administrative pharmacy : RSAP.

[51]  J. Goad,et al.  Use of virtual games for interactive learning in a pharmacy curriculum. , 2019, Currents in pharmacy teaching & learning.

[52]  Tanya Petrovich,et al.  Qualitative evaluation of how a virtual dementia experience impacts medical and pharmacy students’ self-reported knowledge and attitudes towards people with dementia , 2020, Dementia.

[53]  Amy L. Seybert,et al.  Virtual Electronic Health Record Technology with Simulation-Based Learning in an Acute Care Pharmacotherapy Course , 2018, Pharmacy.

[54]  Jennifer N Smith,et al.  Impact of a simulated electronic health record on pharmacy students' perceptions of preparedness for clinical practice. , 2018, Currents in pharmacy teaching & learning.

[55]  M. Lloyd,et al.  Simulation-based training: applications in clinical pharmacy , 2018 .

[56]  R. Hess,et al.  Comparing Teaching Methods on Skin Disorders Using Standardized Patients Dressed in Moulage vs Paper Cases , 2018, American Journal of Pharmaceutical Education.

[57]  M. Orlu,et al.  Educational potential of using virtual patients for promoting interprofessional learning between medical and pharmacy students: A qualitative study , 2018, Journal of interprofessional care.

[58]  Suzanne M Galal,et al.  Use of Standardized Patient Simulations to Assess Impact of Motivational Interviewing Training on Social–Emotional Development , 2018, Pharmacy.

[59]  N. Fusco,et al.  Measuring changes in pharmacy and nursing students’ perceptions following an interprofessional high-fidelity simulation experience , 2018, Journal of interprofessional care.

[60]  Dorela Priftanji,et al.  Performance and retention of basic life support skills improve with a peer-led training program. , 2018, Currents in pharmacy teaching & learning.

[61]  S. Anoopkumar‐Dukie,et al.  Simulated patient cases using DecisionSim™ improves student performance and satisfaction in pharmacotherapeutics education. , 2018, Currents in pharmacy teaching & learning.

[62]  Sarah E. Kelling,et al.  Virtual simulation to personalize student learning in a required pharmacy course. , 2018, Currents in pharmacy teaching & learning.

[63]  Peter J. Hughes,et al.  Simulation as a Central Feature of an Elective Course: Does Simulated Bedside Care Impact Learning? , 2018, Pharmacy.

[64]  Jessica W. Skelley,et al.  Implementation of an electronic medical record simulation activity aligned with the Pharmacist Patient Care Process in an ambulatory care elective course , 2018 .

[65]  Erini S. Serag-Bolos,et al.  Evaluation of pharmacy students' knowledge and perceptions of pharmacogenetics before and after a simulation activity. , 2018, Currents in pharmacy teaching & learning.

[66]  S. Ngorsuraches,et al.  Interprofessional education in pharmacology using high-fidelity simulation. , 2017, Currents in pharmacy teaching & learning.

[67]  Claire Englund,et al.  The description and evaluation of virtual worlds in clinical pharmacy education in Northern Sweden. , 2017, Currents in pharmacy teaching & learning.

[68]  M. Shirazi,et al.  Training and Validation of Standardized Patients for Assessing Communication and Counseling Skills of Pharmacy Students: A Pilot Study , 2017, Journal of research in pharmacy practice.

[69]  D. Kraemer,et al.  Teaching End-of-Life Care Using Interprofessional Simulation. , 2017, The Journal of nursing education.

[70]  A. Flannery,et al.  Use of simulation training to prepare pharmacy residents for medical emergencies. , 2017, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[71]  C. Gillette,et al.  Student performance on a knowledge-based exam may predict student ability to communicate effectively with a standardized patient during an objective structured clinical examination. , 2017, Currents in pharmacy teaching & learning.

[72]  John Lutz,et al.  Blended Simulation Progress Testing for Assessment of Practice Readiness , 2017, American Journal of Pharmaceutical Education.

[73]  Leah Sera,et al.  Game on: The gamification of the pharmacy classroom. , 2017, Currents in pharmacy teaching & learning.

[74]  Ehren B. Ngo,et al.  Healthcare students interprofessional critical event/disaster response course. , 2017, American journal of disaster medicine.

[75]  Sharon Wilson,et al.  Dyspnea in a Hospitalized Patient: Using Simulation to Introduce Interprofessional Collaborative Practice Concepts , 2016, MedEdPORTAL : the journal of teaching and learning resources.

[76]  K. Ragucci,et al.  Impact of an Advanced Cardiac Life Support Simulation Laboratory Experience on Pharmacy Student Confidence and Knowledge , 2016, American Journal of Pharmaceutical Education.

[77]  Paula T Ross,et al.  Providing Informed Consent: A Standardized Case , 2016, MedEdPORTAL : the journal of teaching and learning resources.

[78]  D. Ogilvie-Harris,et al.  Cognitive and Psychomotor Entrustable Professional Activities: Can Simulators Help Assess Competency in Trainees? , 2016, Clinical orthopaedics and related research.

[79]  D. Nestel,et al.  Simulated Patients in Physical Therapy Education: Systematic Review and Meta-Analysis , 2016, Physical Therapy.

[80]  Daniel Katz,et al.  A Systematic Review of Serious Games in Training Health Care Professionals , 2016, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[81]  M. Aebersold The History of Simulation and Its Impact on the Future , 2016, AACN advanced critical care.

[82]  M. F. van der Schaaf,et al.  Vertically integrated medical education and the readiness for practice of graduates , 2015, BMC medical education.

[83]  J. Mills,et al.  Standardized patients in pharmacy education: An integrative literature review , 2015 .

[84]  K. Momary,et al.  Simulated Order Verification and Medication Reconciliation during an Introductory Pharmacy Practice Experience , 2015, American Journal of Pharmaceutical Education.

[85]  Steve Bhimji,et al.  Agency for Healthcare Research and Quality (AHRQ) , 2015 .

[86]  J. Gonzales,et al.  Changes in Perceptions and Attitudes of Healthcare Profession Students Pre and Post Academic Course Experience of Team-Based 'Care for the Critically Ill'. , 2015, Journal of professional nursing : official journal of the American Association of Colleges of Nursing.

[87]  S. Meyer,et al.  Changes in Student Performance and Confidence with a Standardized Patient and Standardized Colleague Interprofessional Activity , 2015, American Journal of Pharmaceutical Education.

[88]  Elizabeth W. Blake,et al.  Incorporating Standardized Colleague Simulations in a Clinical Assessment Course and Evaluating the Impact on Interprofessional Communication , 2015, American Journal of Pharmaceutical Education.

[89]  Fadi Munshi,et al.  Low- versus high-fidelity simulations in teaching and assessing clinical skills , 2015 .

[90]  Michael J. Cawley,et al.  Retention of Advanced Cardiac Life Support Knowledge and Skills Following High-Fidelity Mannequin Simulation Training , 2015, American Journal of Pharmaceutical Education.

[91]  Marcus McDonald,et al.  Barriers and Enablers to the Use of Virtual Worlds in Higher Education: An Exploration of Educator Perceptions, Attitudes and Experiences , 2015, J. Educ. Technol. Soc..

[92]  Ken Lee Chin,et al.  Comparing Effectiveness of High-Fidelity Human Patient Simulation vs Case-Based Learning in Pharmacy Education , 2014, American Journal of Pharmaceutical Education.

[93]  Janice Palaganas,et al.  Defining excellence in simulation programs , 2014 .

[94]  Billie J. Bartel Impact of High-Fidelity Simulation and Pharmacist-Specific Didactic Lectures in Addition to ACLS Provider Certification on Pharmacy Resident ACLS Performance , 2014, Journal of pharmacy practice.

[95]  J. V. Chmil,et al.  Interprofessional Education Among Student Health Professionals Using Human Patient Simulation , 2014, American Journal of Pharmaceutical Education.

[96]  D. Davis,et al.  High-Fidelity Simulation Training in Advanced Resuscitation for Pharmacy Residents , 2014, American Journal of Pharmaceutical Education.

[97]  Iulian Radu Augmented reality in education: a meta-review and cross-media analysis , 2014, Personal and Ubiquitous Computing.

[98]  S. Issenberg,et al.  Simulation in healthcare education: A best evidence practical guide. AMEE Guide No. 82 , 2013, Medical teacher.

[99]  Amy L. Seybert,et al.  Advancing interprofessional education through the use of high fidelity human patient simulators , 2013, Pharmacy practice.

[100]  Philip J. Wenger,et al.  Comparison of Patient Simulation Methods Used in a Physical Assessment Course , 2013, American Journal of Pharmaceutical Education.

[101]  Brenda S. Bray,et al.  Use of Simulation-based Teaching Methodologies in US Colleges and Schools of Pharmacy , 2013, American Journal of Pharmaceutical Education.

[102]  Jennifer L. Kirwin,et al.  A Simulated Hospital Pharmacy Module Using an Electronic Medical Record in a Pharmaceutical Care Skills Laboratory Course , 2013, American Journal of Pharmaceutical Education.

[103]  J. Barletta,et al.  High-Fidelity Simulation for Advanced Cardiac Life Support Training , 2013, American Journal of Pharmaceutical Education.

[104]  Jeanne E. Frenzel,et al.  Comparison of Low- and Higher-Fidelity Simulation to Train and Assess Pharmacy Students’ Injection Technique , 2013, American Journal of Pharmaceutical Education.

[105]  Cleopatra Branch Pharmacy Students' Learning and Satisfaction With High-Fidelity Simulation to Teach Drug-Induced Dyspepsia , 2013, American Journal of Pharmaceutical Education.

[106]  S. K. Sporrong,et al.  Communications Training in Pharmacy Education, 1995-2010 , 2013, American Journal of Pharmaceutical Education.

[107]  Alan Richardson,et al.  Use of a Three-Dimensional Virtual Environment to Teach Drug-Receptor Interactions , 2013, American Journal of Pharmaceutical Education.

[108]  Deepti Vyas,et al.  Patient Simulation to Demonstrate Students’ Competency in Core Domain Abilities Prior to Beginning Advanced Pharmacy Practice Experiences , 2012, American Journal of Pharmaceutical Education.

[109]  Michael A. Veronin,et al.  Pharmacy cases in Second Life: an elective course , 2012, Advances in medical education and practice.

[110]  Shaunta’ M. Ray,et al.  Pharmacy Student Knowledge Retention After Completing Either a Simulated or Written Patient Case , 2012, American Journal of Pharmaceutical Education.

[111]  Amy L. Seybert,et al.  Comparing Effectiveness of 3 Learning Strategies: Simulation-Based Learning, Problem-Based Learning, and Standardized Patients , 2012, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[112]  Amy L. Seybert,et al.  Simulation-Based Learning Versus Problem-Based Learning in an Acute Care Pharmacotherapy Course , 2012, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[113]  R. McCulloh,et al.  An Interprofessional Course Using Human Patient Simulation to Teach Patient Safety and Teamwork Skills , 2012, American Journal of Pharmaceutical Education.

[114]  J. McNeill,et al.  Use of High-Fidelity Simulation to Teach End-of-Life Care to Pharmacy Students in an Interdisciplinary Course , 2012, American Journal of Pharmaceutical Education.

[115]  Autumn L. Stewart,et al.  Comparison of Active-Learning Strategies for Motivational Interviewing Skills, Knowledge, and Confidence in First-Year Pharmacy Students , 2012, American Journal of Pharmaceutical Education.

[116]  Bridget C. O’Brien,et al.  The impact of an interprofessional standardized patient exercise on attitudes toward working in interprofessional teams , 2012, Journal of interprofessional care.

[117]  Pamela L. Smithburger,et al.  Transitioning Knowledge Gained From Simulation to Pharmacy Practice , 2011, American Journal of Pharmaceutical Education.

[118]  K. Crea Practice Skill Development Through the Use of Human Patient Simulation , 2011, American Journal of Pharmaceutical Education.

[119]  Amy L. Seybert Patient Simulation in Pharmacy Education , 2011, American Journal of Pharmaceutical Education.

[120]  N. Yuksel Pharmacy Course on Women's and Men's Health , 2011, American Journal of Pharmaceutical Education.

[121]  Lindsay B. Curtin,et al.  Computer-based Simulation Training to Improve Learning Outcomes in Mannequin-based Simulation Exercises , 2011, American Journal of Pharmaceutical Education.

[122]  Amy L. Seybert,et al.  Elective Course in Acute Care Using Online Learning and Patient Simulation , 2011, American Journal of Pharmaceutical Education.

[123]  Steven R. Abel,et al.  A Virtual Clean Room to Teach USP 797 Regulations for Intravenous Medications , 2011, American Journal of Pharmaceutical Education.

[124]  Brenda S. Bray,et al.  Using Human Patient Simulation to Prepare Student Pharmacists to Manage Medical Emergencies in an Ambulatory Setting , 2011, American Journal of Pharmaceutical Education.

[125]  D. Cook,et al.  Computerized Virtual Patients in Health Professions Education: A Systematic Review and Meta-Analysis , 2010, Academic medicine : journal of the Association of American Medical Colleges.

[126]  Eric Wombwell,et al.  High-Fidelity Patient Simulation Series to Supplement Introductory Pharmacy Practice Experiences , 2010, American Journal of Pharmaceutical Education.

[127]  Jeanne E. Frenzel Using Electronic Medical Records to Teach Patient-Centered Care , 2010, American Journal of Pharmaceutical Education.

[128]  Amy L. Seybert,et al.  Impact of simulation-based learning on medication error rates in critically ill patients , 2010, Intensive Care Medicine.

[129]  W. Vincent,et al.  A High-Fidelity Simulation Mannequin to Introduce Pharmacy Students to Advanced Cardiovascular Life Support , 2010, American Journal of Pharmaceutical Education.

[130]  Nathaniel M Rickles,et al.  The impact of a standardized patient program on student learning of communication skills. , 2009, American journal of pharmaceutical education.

[131]  Kathleen R Rosen,et al.  The history of medical simulation. , 2008, Journal of critical care.

[132]  David M. Gaba,et al.  The Role of Debriefing in Simulation-Based Learning , 2007, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[133]  Amy L. Seybert,et al.  Simulation-based learning to teach blood pressure assessment to doctor of pharmacy students. , 2007, American journal of pharmaceutical education.

[134]  D. Nestel,et al.  Using volunteer simulated patients in development of pre-registration pharmacists: Learning from the experience † , 2007 .

[135]  Zubin Austin,et al.  Simulated patients vs. standardized patients in objective structured clinical examinations. , 2006, American journal of pharmaceutical education.

[136]  A. Ziv,et al.  Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review , 2005, Medical teacher.

[137]  H. Barrows,et al.  THE PROGRAMMED PATIENT: A TECHNIQUE FOR APPRAISING STUDENT PERFORMANCE IN CLINICAL NEUROLOGY. , 1964, Journal of medical education.