Encyclopedia of Education and Information Technologies

2020 Edition
| Editors: Arthur Tatnall

Digital Simulations in Healthcare Education

  • Jaana-Maija KoivistoEmail author
Reference work entry
DOI: https://doi.org/10.1007/978-3-030-10576-1_108



Patient care requires strong expertise and professional competence. As self-care increases, patients are being admitted to hospitals with increasingly complex problems. It has commonly been reported that as many as 1 in 10 hospitalized patients are harmed while receiving care, and approximately 43 million patient safety incidences occur every year. These cause great human suffering, but their economic impact is also high; for example, medication errors cost an estimated 42 billion USD annually (WHO 2017).

The World Health Organization (2017) has emphasized patient safety as the most important measure of quality of care. Ensuring patient safety is a fundamental ethical requirement for healthcare professionals. One of the greatest challenges facing...

This is a preview of subscription content, log in to check access.


  1. Arora A, Lau LY, Awad Z, Darzi A, Singh A, Tolley N (2014) Virtual reality simulation training in otolaryngology. Int J Surg 12(2):87–94.  https://doi.org/10.1016/j.ijsu.2013.11.007CrossRefGoogle Scholar
  2. Benedict N, Schonder K, McGee J (2013) Instructional design and assessment: promotion of self-directed learning using virtual patient cases. Am J Pharm Educ 77(7):151.  https://doi.org/10.5688/ajpe777151CrossRefGoogle Scholar
  3. Bland A, Topping A, Wood B (2011) A concept analysis of simulation as a learning strategy in the education of undergraduate nursing students. Nurse Educ Today 31(7):664–670.  https://doi.org/10.1016/j.nedt.2010.10.013CrossRefGoogle Scholar
  4. Boada I, Rodriguez-Benitez A, Garcia-Gonzalez JM, Olivet J, Carreras V, Sbert M (2015) Using a serious game to complement CPR instruction in a nurse faculty. Comput Methods Prog Biomed 122(2):282–291.  https://doi.org/10.1016/j.cmpb.2015.08.006CrossRefGoogle Scholar
  5. Botezatu M, Hult H, Tessma MK, Fors U (2010) Virtual patient simulation: knowledge gain or knowledge loss? Med Teach 32:562–568CrossRefGoogle Scholar
  6. Buttussi F, Pellis T, Cabas Vidani A, Pausler D, Carchietti E, Chittaro L (2013) Evaluation of a 3D serious game for advanced life support retraining. Int J Med Inform 82(9):798–809.  https://doi.org/10.1016/j.ijmedinf.2013.05.007CrossRefGoogle Scholar
  7. Cant RP, Cooper SJ (2017) The value of simulation-based learning in pre-licensure nurse education: a state-of-the-art review and meta-analysis. Nurse Educ Pract 27:45–62.  https://doi.org/10.1016/j.nepr.2017.08.012CrossRefGoogle Scholar
  8. Cobbett S, Snelgrove-Clarke E (2016) Virtual versus face-to-face clinical simulation in relation to student knowledge, anxiety, and self-confidence in maternal-newborn nursing: a randomized controlled trial. Nurse Educ Today 45:179–184.  https://doi.org/10.1016/j.nedt.2016.08.004CrossRefGoogle Scholar
  9. Cook NF, McAloon T, O'Neill P, Beggs R (2012) Impact of a web based interactive simulation game (PULSE) on nursing students’ experience and performance in life support training – a pilot study. Nurse Educ Today 32:714–720CrossRefGoogle Scholar
  10. Dankbaar M (2017) Serious games and blended learning: effects on performance and motivation in medical education. Perspect Med Educ 6:58–60.  https://doi.org/10.1007/s40037-016-0320-2CrossRefGoogle Scholar
  11. Dankbaar MEW, Alsma J, Jansen EEH, van Merrienboer JJ, van Saase JL, Schuit SC (2016) An experimental study on the effects of a simulation game on students’ clinical cognitive skills and motivation. Adv Health Sci Educ 21:505.  https://doi.org/10.1007/s10459-015-9641-xCrossRefGoogle Scholar
  12. Dankbaar MEW, Roozeboom MB, Esther APB, Oprins FR, Jeroen JG, van Merrienboer JJ, van Saase JL, Schuit SC (2017) Preparing residents effectively in emergency skills training with a serious game. Simul Healthc 12(1):6–9.  https://doi.org/10.1097/SIH.0000000000000194CrossRefGoogle Scholar
  13. de Freitas S (2007) Learning in immersive worlds: a review of game-based learning. JICS. Retrieved from http://videogamelc.bgsu.wikispaces.net/file/view/de%20Freitas%202007.pdf/364559316/de%20Freitas%202007.pdf
  14. de Freitas S, Rebolledo-Mendez G, Liarokapis F, Magoulas G, Poulovassilis A (2010) Learning as immersive experiences: using the four-dimensional framework for designing and evaluating immersive learning experiences in a virtual world. Br J Educ Technol 41(1):69–85.  https://doi.org/10.1111/j.1467-8535.2009.01024.xCrossRefGoogle Scholar
  15. Edwards EA, Lumsden J, Rivas C, Steed L, Edwards LA, Thiyagarajan A, Sohanpal R, Caton H, Griffiths CJ, Munafò MR, Taylor S, Walton RT (2016) Gamification for health promotion: systematic review of behaviour change techniques in smartphone apps. BMJ Open 6:e012447.  https://doi.org/10.1136/bmjopen-2016-012447CrossRefGoogle Scholar
  16. Evans KH, Daines W, Tsui J, Strehlow M, Maggio P, Shieh L (2015) Septris: a novel, mobile, online, simulation game that improves sepsis recognition and management. Acad Med 90(2):180–184.  https://doi.org/10.1097/ACM.0000000000000611CrossRefGoogle Scholar
  17. Foronda CL, Swoboda SM, Warren Hudson K, Jones E, Sullivan N, Ockimey J, Jeffries PR (2016) Evaluation of vSIM for nursing™: a trial of innovation. Clin Simul Nurs 12:128–131CrossRefGoogle Scholar
  18. Forsberg E, Georg C, Ziegert K, Fors U (2011) Virtual patients for assessment of clinical reasoning in nursing: a pilot study. Nurse Educ Today 31:757–762CrossRefGoogle Scholar
  19. Gaba DM (2004) The future vision of simulation in health care. Qual Saf Health Care 13(Suppl 1):i2–i10CrossRefGoogle Scholar
  20. Gaba DM (2007) The future vision of simulation in healthcare. Simul Healthc 2:126–135.  https://doi.org/10.1097/01.SIH.0000258411.38212.32CrossRefGoogle Scholar
  21. Hamari J, Koivisto J, Sarsa H (2014) Does gamification work? – a literature review of empirical studies on gamification. In: 47th Hawaii international conference on system science. Retrieved from https://www.google.fi/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwjelJmPg-XSAhWKkywKHalbC3QQFggbMAA&url=http%3A%2F%2Fpeople.uta.fi%2F~kljuham%2F2014-hamari_et_al-does_gamification_work.pdf&usg=AFQjCNFtsP3EH_BwjQXrx0aG2atsj_RuDA&sig2=7q9P2tn6s-0444OkWj-aGg&cad=rja
  22. Hamari J, Shernoff DJ, Rowe E, Coller B, Asbell-Clarke J, Edwards T (2016) Challenging games help students learn: an empirical study on engagement, flow and immersion in game-based learning. Comput Human Behav 54:170–179.  https://doi.org/10.1016/j.chb.2015.07.045CrossRefGoogle Scholar
  23. Horizon Report (2017) Higher education edition. Retrieved from https://www.nmc.org/publication/nmc-horizon-report-2017-higher-education-edition/
  24. Huotari K, Hamari J (2012) Defining gamification – a service marketing perspective (PDF). In: Proceedings of the 16th international academic MindTrek conference 2012, Tampere, Finland, October 3–5Google Scholar
  25. Jung E-Y, Park DK, Lee YH, Sook Jo H, Su Lim Y, Woong Park R (2012) Evaluation of practical exercises using an intravenous simulator incorporating virtual reality and haptics device technologies. Nurse Educ Today 32:458–463CrossRefGoogle Scholar
  26. Kiili K, de Freitas S, Arnab S, Lainema T (2012) The design principles for flow experience in educational games. Procedia Comput Sci 15:78–91.  https://doi.org/10.1016/j.procs.2012.10.060CrossRefGoogle Scholar
  27. Koivisto J-M, Multisilta J, Niemi H, Katajisto J, Eriksson E (2016a) Learning by playing: a cross-sectional descriptive study of nursing students’ experiences of learning clinical reasoning. Nurse Educ Today 45:22–28.  https://doi.org/10.1016/j.nedt.2016.06.009CrossRefGoogle Scholar
  28. Koivisto J-M, Haavisto E, Niemi H, Katajisto J, Multisilta J (2016b) Elements explaining learning clinical reasoning using simulation games. Int J Serious Games 3(4):29–43.  https://doi.org/10.17083/ijsg.v1i4.47CrossRefGoogle Scholar
  29. Koivisto J-M, Haavisto E, Niemi H, Haho P, Nylund S, Multisilta J (2018) Design principles for simulation games for learning clinical reasoning: a design-based research approach. Nurse Educ Today 60:114–120.  https://doi.org/10.1016/j.nedt.2017.10.002CrossRefGoogle Scholar
  30. Laver KE, George S, Thomas S, Deutsch JE, Crotty M (2011) Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev (9):CD008349.  https://doi.org/10.1002/14651858.CD008349.pub2
  31. LeFlore J-L, Anderson M, Zielke MA, Nelson KA, Thomas PE, Hardee G, John LD (2012) Can a virtual patient trainer teach student nurses how to save lives: teaching nursing students about pediatric respiratory diseases. Simul Healthc 7(1):10–17CrossRefGoogle Scholar
  32. Lewett-Jones T, Hoffman K, Dempsey J, Yeun-Sim Jeong S, Noble D, Norton CA, … Hickey N (2010) The ‘five rights’ of clinical reasoning: an educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients. Nurse Educ Today 30(6):515–520.  https://doi.org/10.1016/j.nedt.2009.10.020
  33. Petit dit Dariel OJP, Raby T, Ravaut F, Rothan-Tondeur M (2013) Developing the serious games potential in nursing education. Nurse Educ Today 33(12):1569–1575.  https://doi.org/10.1016/j.nedt.2012.12.014CrossRefGoogle Scholar
  34. Roh YS, Lee WS, Chung HS, Park YM (2013) The effects of simulation-based resuscitation training on nurses’ self-efficacy and satisfaction. Nurse Educ Today 33:123–128CrossRefGoogle Scholar
  35. Rosser JC, Lynch PJ, Cuddihy L, Gentile DA, Klonsky J, Merrell R (2007) The impact of video games on training surgeons in the 21st century. Arch Surg 142(2): 181–186.  https://doi.org/10.1001/archsurg.142.2.181CrossRefGoogle Scholar
  36. Ryan RM, Deci EL (2000) Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 55(1):68–78.  https://doi.org/10.1037/0003-066X.55.1.68CrossRefGoogle Scholar
  37. Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, … Deakin CD (2015) European resuscitation council guidelines for resuscitation 2015, section 3: adult advanced life support. Resuscitation 95:100–147.  https://doi.org/10.1016/j.resuscitation.2015.07.016
  38. Verkuyl M, Romaniuk D, Atack L, Mastrilli P (2017) Virtual gaming simulation for nursing education: an experiment. Clin Simul Nurs 13:238–244CrossRefGoogle Scholar
  39. WHO (2017) Patient safety: making health care safer. WHO/HIS/SDS/2017.11 http://www.who.int/patientsafety/publications/patient-safety-making-health-care-safer/en/
  40. Zhu E, Hadadgar A, Masiello I, Zary N (2014) Augmented reality in healthcare education: an integrative review. Peer J.  https://doi.org/10.7717/peerj.469

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Häme University of Applied Sciences (HAMK)HämeenlinnaFinland

Section editors and affiliations

  • Jari Multisilta
    • 1
  1. 1.Satakunta University of Applied SciencesPoriFinland