All authors d

The sources

versity of Techn

nology, Sydney.

* Correspondi

1876-1399/$ - se

http://dx.doi.org

Clinical Simulation in Nursing (2014) 10, e277-e280

www.elsevier.com/locate/ecsn

Short Communication

The Virtual Tutor Project: A Student-Friendly Guideto Clinical Skills

Christine Catling, PhDa,*, Haidee White, MN (CritCare)b,Allison Cummins, Ms (Aed)a, Rosemarie Hogan, MScaaLecturer of Midwifery, Faculty of Health, University of Technology, Sydney, NSW 2007, AustraliabLecturer of Nursing, Faculty of Health, University of Technology, Sydney, NSW 2007, Australia

KEYWORDSmidwifery education;nursing education;clinical skills;simulation;virtual environment;clinical skills;videos

eclare no conflicts of in

of funding are Teaching

ology, Sydney, and Facu

ng author: Christine.catl

e front matter � 2014 Int

/10.1016/j.ecns.2014.01.

Abstract: Using a variety of different teaching methods is an important educational strategy to facil-itate learning. There was a need to provide effective education to nursing and midwifery students thatused current technology, and was user-friendly. The aim of the Virtual Tutor project was to enhancenursing and midwifery students’ learning of key clinical skills: inserting a female urinary catheter,adult resuscitation and priming an intravenous therapy line, using step by step videos for students’self-directed use. Three ‘how to’ videos of the clinical skills were made and embedded into the under-graduate nursing and midwifery clinical subjects. Evaluative feedback was gained from students andthe project team. Surveys were completed by students after they had used one or more of the videos.The results showed that the use of the Virtual Tutor videos was helpful in enhancing the student’s expe-rience of learning clinical skills, and most students stated that they would access the videos again forself-directed study. The conclusion was that practical, accessible videos of how to perform commonclinical skills are a useful learning tool for nursing and midwifery students.

Cite this article:Catling, C., White, H., Cummins, A., & Hogan, R. (2014, May). The virtual tutor project: A student-friendly guide to clinical skills. Clinical Simulation in Nursing, 10(5), e277-e280. http://dx.doi.org/10.1016/j.ecns.2014.01.005.

� 2014 International Nursing Association for Clinical Simulation and Learning. Published by ElsevierInc. All rights reserved.

Simulation provides an opportunity for students to beexposed to professional practice in an effective manner. It isessential, however, that this experience is integrated withinsubjects and that the technology available is well utilised.Using predetermined scenarios in clinical simulations toprepare students in practice-based professions, such as

terests.

and Learning Grant, 2012, Uni-

lty of Health, University of Tech-

ing@uts.edu.au (C. Catling).

ernational Nursing Association for Clinica

005

midwifery and nursing, are an important educational strategyto facilitate learning (Gore, Hunt & Raines 2008, Cant &Cooper 2009). Clinicians respond positively to the use ofsimulation as a teaching strategy and there is evidenceconfirming that those who are involved in learning throughsimulation find it enjoyable, satisfying, and ultimately learnfrom it (Gore, Hunt & Raines 2008; Jeffries & Rizzolo2006, Mould, White & Gallagher 2011; Smith et al. 2012).

The use of multimedia is useful and effective inteaching nursing and midwifery skills (Everett &Wright, 2012; Guhde, 2010; Kelly et al, 2009). An evalu-ation by Everett & Wright (2012) showed that the use of

l Simulation and Learning. Published by Elsevier Inc. All rights reserved.

Virtual Tutor Project e278

videos engaged students and enhanced learning experi-ences. Varied methods of teaching were valued by stu-dents, and this included the use of videos in this study.Similarly, Guhde (2010) evaluated student reflectionsand levels of learning after the use of videos in relation

Key Points� Nursing and mi-dwifery studentsbenefit from adequatepractice of clinicalskills within a simu-lated environment.After learning clinicalskills during lecturer-facilitated labora-tories, students aregiven the option ofself-directed practice.

� Students may miss vi-tal steps of a particularskill when practisingclinical skills alone,or with their peers.

� Self-directed practiseof clinical skills withthe use of the VirtualTutor project videoscan help to increasestudents’ confidencein performing theseskills.

to patient assessment skills.This study found thatcombining discussion withviewing videos was suc-cessful in stimulating thestudents’ critical thinkingand improvements in clin-ical skills. A more‘‘blended’’ approach to theuse of videos wasconcluded by Kelly et al.(2009). These authorsfound that videos (and ane-learning package) weresuccessful when used tocomplement, and notreplace, the demonstrationof skills by lecturers.

Traditionally, nursingand midwifery studentshave practice-focused sub-jects with time-limited tu-torials held in clinicallaboratories (the ‘‘labs’’),along with facilitationfrom lecturers. This leadsto the development of clin-ical skills in readiness fortheir hospital placements.

Structured tutorials do not always provide sufficienttime for each student to engage in the necessary repetitivepractice to build confidence and competence; hence, thereis opportunity for students to organise extra, self-directedlaboratory sessions. During these sessions, students havereported to academic staff that they have concerns theymay not be practising their skills correctly when they areself or peer directed. For example, having been taughthow to perform a wound dressing, students may miss vitalsteps when practising independently in the labs, as theycannot recognise what they are missing. Students havealso indicated that when returning to university afterperiods away in hospital placements, they would like theopportunity to further refine their skills in the labs as away of building on their clinical experience and furtherdeveloping their expertise. In response to this, wedeveloped the Virtual Tutor projectda set of three videosto help students learn clinical skills. This was funded by aUniversity of Technology, Sydney (UTS), Teaching andLearning Grant, with extra funding from the Faculty ofHealth.

pp e277-e

To choose which clinical skills to focus on, we askednursing and midwifery student groups which skills theythoughtwould be beneficial to them in the formof a video.Wealso sourced existing online videos demonstrating clinicalskills (e.g., on YouTube) before the project proposal. Noneactually modelled best practice at the Australian standard,and the equipment used was quite different to that in theUniversity’s clinical labs (wherewe have standardNewSouthWales health equipment). To enable full engagement bystudents, it was deemed important that the Virtual Tutoractivities and equipment were the same in the video as in ourlabs. Finally, the Virtual Tutor project team, in collaborationwith the students, decided to develop structured guides tolearning: inserting a female indwelling urinary catheter,priming an intravenous giving set, and basic adult resuscita-tion (including an adaptation for pregnancy).

Development and Deployment of the VirtualTutor

TheVirtual Tutor project funding enabled the employment ofa project officer to oversee the work, write the scripts, andorganise filming. An experienced midwife was employed for15 hours of work on this project. The development of thescript by the project officer occurred with input from all teammembers. Best practice regarding the clinical skills wasensured through familiarisation with current evidence andcollaboration with the team. The employment of the projectofficer proved invaluable to ensure coordination of teammembers, as well as enabling a collaborative approach to thescript content, and ensuring best practice.

We used different methods of filming. One video wasprofessionally filmed, edited, and produced by an externalfilm company and the other two were made utilising theskills of one of the project team members and theSimulation Technical Officer within the Faculty. Costswere further minimised by utilising ‘‘actors’’ who werenursing and midwifery lecturers and other members of theVirtual Tutor team. No professional actors were used, andteam members were willing participants. The scenes werecommon clinical scenarios, so the dialogue in the script wasnot unfamiliar to the lecturers; some had >20 years ofclinical experience. There was an element of ‘‘ad lib’’allowed at the time of filming, as long as it contributed tothe meaning and objective of the scene. Support for clinicalequipment was given by the Technical Officer in the labs.

The Faculty of Health at UTS opened state-of-the-artclinical practice labs in their city campus in 2011. Thesehave provided excellent opportunities for nursing andmidwifery students to practice clinical skills using simula-tion in a safe environment. Students were given free accessto the videos via a shared University website known as‘‘UTSOnline’’. This online portal for communication andinformation for students at UTS was also used in class.

280 � Clinical Simulation in Nursing � Volume 10 � Issue 5

Table 1 Student Responses to the Question: ‘‘How Helpfulwas the Video to You When Learning This Skill?’’ Scale 1 to 5(1 ¼ Not Helpful at all and 5 ¼ Very Helpful)

Scale 1 2 3 4 5TotalResponses

Inserting a femaleurinary catheter

0 0 0 9 13 22

Adult resuscitation 1 0 5 26 39 71Priming anintravenous line

0 0 4 6 7 18

Overall response 1 0 9 41 59 111

Virtual Tutor Project e279

Students were encouraged to watch the videos whileaccessing the clinical laboratories in non-facilitated time.Nursing and midwifery lecturers ensured the links to thevideos were accessible and introduced students to theVirtual Tutor series at the beginning of each semester.

Evaluation Strategies

The Virtual Tutor project was evaluated both from theperspective of the students and the project team involved inmaking the videos. The students completed a two-questionevaluation form at the end of a laboratory session afterviewing one or more of the videos. This evaluation did notrequire ethical clearance, and consent was implied bystudent participation (NHMRC, 2013).

While making the Virtual Tutor project, we endeavouredto undertake a process of concurrent evaluation to be ableto inform further projects. Notes were taken by the projectofficer on the best way to film the scenarios and the mostefficient way to organise, film, edit, and produce the videos.The project team were asked to consider their contributionto making the videos and provide feedback regarding theirexperience.

The student evaluation of the Virtual Tutor project videoswas undertaken by the completion of a two-question form.The students were given the opportunity to state if the videosassisted them in learning the three clinical skills. Studentswere asked to state on a scale of 1 to 5 how helpful the videoswere to their learning (1dnot helpful at all, 2da littlehelpful, 3dhelpful, 4dquite helpful, and 5dvery helpful)and a yes/no response was asked for the question of whetherthey would access the videos again.

Table 2 Number of Affirmative or Negative Answers to theQuestion: ‘‘Would You Access the Video Again?’’

Videos Yes No MaybeTotalResponses

Inserting a femaleurinary catheter

16 2 4 22

Adult resuscitation 59 10 2 71Priming anintravenous line

11 10 1 22

Overall response 86 32 7 115

Results

Project Team Evaluation

On canvassing opinion and reflection from the teammembers, comments included ‘‘It was especially nice towork collegially in this manner, as we all had a commongoal to achieve in developing a teaching resource for ourstudents’’ and ‘‘scripts were well researched and wellwritten’’. Comments were also given from team membersabout the desire to expand the series, use professional filmcrews, and expand the videos to other related skills (i.e.,video instructions for the defibrillator to be embedded intothe adult resuscitation video). Other comments includedthose related to time management, in particular the need toschedule adequate time when filming.

Student Evaluation

Overall, the evaluations from a cross section of 115 firstand second year midwifery and nursing students were

pp e277-e

positive (see Table 1). Most students rated the videos asquite or very helpful.

The evaluation forms also asked whether the studentswould access the video again out of class (i.e., eitherprivately at home or within a self-directed learning group inthe labs) (see Table 2). For the catheterisation and resusci-tation videos, most students replied that they would accessthese videos again. The students were divided on whetherthey would access the priming an intravenous line videoagain, with close to a 50:50 response as to whether theywould and would not. Some students noted on the evalua-tion forms their reasons (which were unsolicited); onestated that she was able to get ‘‘real experience in her clin-ical placement’’ and another stated ‘‘the [priming an intra-venous line] video was very clear, easy to follow, and I wasable to adopt the steps in class.’’ Comments about the resus-citation video included ‘‘it was very helpful and presentedin a clear and easy to understand manner,’’ ‘‘it will helpme to remember what to do,’’ ‘‘it has stuck in my head,’’and its use ‘‘made me feel more prepared and less fearfulof emergency situations.’’ Other comments about the cath-eterisation video included ‘‘because there can be limitedclass time, the video is a good substitute’’ and ‘‘it wasvery helpful for revision prior to the OSCE (objective struc-tured clinical examinationdan examination of various clin-ical skills in the student’s first and second years atUniversity).’’ One student who rated the video as ‘‘not atall helpful’’ explained that this was because she had at-tended many resuscitation workshops before.

280 � Clinical Simulation in Nursing � Volume 10 � Issue 5

Virtual Tutor Project e280

Discussion

The Virtual Tutor project developed three videos of clinicalskills to aid nursing and midwifery students both in classand during self-directed practice. The limitations of theproject are that the data were not synthesised to determinehow many students accessed the videos within theirself-directed study at home or at university; only theirintentions of further use were ascertained. Future researchwill detect more detailed use of the videos, includingwhether the perceived usefulness was higher when studentsviewed the videos at university (as opposed to home), andwhether numbers of students participating in self-directedlearning increased after the introduction of the videos.

In addition to learning vital clinical skills, the VirtualTutor project encouraged student collaboration and groupwork, which was part of a strategy to enhance studentretention (Zepke, 2013). It also enhanced the implementa-tion of the University of Technology, Sydney (UTS) modelof learning. This model involves ensuring students havemultifaceted modes of practice-oriented education and anintegrated exposure to professional practice. This wascongruent with a constructivist model of learning in whichstudents can build on their knowledge and understandingfrom active engagement. In addition, students were morelikely to build confidence and competence in the acquisi-tion of clinical skills when they actively participate inlearning. The project also may have increased student’sawareness and accessibility in utilising self-directedlearning opportunities in the clinical laboratories.

Conclusion

The Virtual Tutor project was a project developed from aTeaching and Learning grant at UTS and funding from theFaculty of Health, UTS. It aimed to assist with immersionand engagement in learning in the laboratories by developing

pp e277-e

a guide for students to ensure they were practising clinicalskills correctly. This small project was helpful in enhancingthe student’s experience of learning clinical skills which mayhave enhanced their clinical placement experience.

References

Cant, R., & Cooper, S. (2009). Simulation-based learning in nurse

education: Systematic review. Journal of Advanced Nursing,

66(1), 3-15. http://dx.doi.org/10.1111/j.1365-2648.2009.05240.x.

Everett, F., & Wright, W. (2012). Using multimedia to teach students

essential skills. Nursing Times, 108(30/31), 18-19.

Gore, T., Hunt, C., & Raines, K. (2008). Mock hospital unit simulation: A

teaching strategy to promote safe patient care. Clinical Simulation in

Nursing, 4(3), e57-e64. http://dx.doi.org/10.1016/j.ecns.2008.08.006.

Guhde, J. (2010). Combining simulation, instructor-produced videos, and

online discussions to stimulate critical thinking in nursing students.

Computers, Informatics, Nursing, 28(5), 274-279. http://dx.doi.org/10.

1097/NCN.0b013e3181ec2540.

Jeffries, P., & Rizzolo, M. (2006). Designing and implementing models for

the innovative use of simulation to teach care of ill adults and children:

A national, multi-site, multi-method study. National League for

Nursing. Retrieved December 2nd 2013, from: http://www.nln.org/

beta/research/LaerdalReport.pdf.

Kelly, M., Lyng, C., McGrath, M., & Cannon, G. (2009). A multi-method

study to determine the effectiveness of, and student attitudes to, online

instructional videos for teaching clinical nursing skills. Nurse Education

Today, 29(3), 292-300. http://dx.doi.org/10.1016/j.nedt.2008.09.004.

Mould, J., White, H., & Gallagher, R. (2011). Evaluation of a critical care

simulation series for undergraduate nursing students. Contemporary

Nurse, 38(1-2), 180-190. http://dx.doi.org/10.5172/conu.2011.38.1-2.

180.

National Health and Medical Research Committee, Australian Research

Council, & Australian Vice-Chancellors’ Committee, 2013. National

Statement on Ethical Conduct in Human Research, Commonwealth of

Australia, Canberra.

Smith, R., Gray, J., Raymond, J., Catling-Paull, C., & Homer, C. S. E.

(2012). Simulated learning activities: Improving midwifery students’

understanding of reflective practice. Clinical Simulation in Nursing,

8(9), e451-e457. http://dx.doi.org/10.1016/j.ecns.2011.04.007.

Zepke, N. (2013). Student engagement: A complex business supporting the

first year experience in tertiary education. The International Journal of

the First Year in Higher Education, 4(2), 1-14. http://dx.doi.org/10.

5204/intjfyhe.v4i2.183.

280 � Clinical Simulation in Nursing � Volume 10 � Issue 5