Using Web-based Guided Reflection With Video to Enhance High Fidelity Undergraduate Nursing Clinical Skills Education

The United States is currently facing a crisis in health care and health professions education. Various studies (Committee on Quality of Health Care in America 2000; 2001; General Accounting Office, 2001) have documented astonishing death rates from medical errors as well as nursing and physician shortages. Thus it is obvious that the traditional “hands on” model historically used to teach and assess clinical judgment competence is or has become inadequate. New advances in simulation and web-based technologies can, if leveraged well, help educators address these challenges. Thus far, high fidelity simulation (HFS) clinical skills education sessions have been primarily conducted and debriefed in real time and the use of any related video recordings has been confined to faculty regarding its review. The goal of this project was to pilot test the impact of providing students the opportunity to review the video of their simulated session while reflecting on their performance within a structured format. The live debriefing that is a part of HFS sessions is also a form of reflection. The guided reflection prompt exercise used in this pilot is a secondary form of reflection. This paper describes the theoretical basis for this exercise, the findings of its initial evaluation and post study research that illuminates its limitations.