Vicarious learning during simulations: is it more effective than hands-on training?

CONTEXT: Doctor-patient communication skills are often fostered by using simulations with standardised patients (SPs). The efficiency of such experiences is greater if student observers learn at least as much from the simulation as do students who actually interact with the patient.
OBJECTIVES: This study aimed to investigate whether the type of simulation-based learning (learning by doing versus vicarious learning) and the order in which these activities are carried out (learning by doing → vicarious learning versus vicarious learning → learning by doing) have any effect on the acquisition of knowledge on effective doctor-patient communication strategies. In addition, we wished to examine the extent to which an observation script and a feedback formulation script affect knowledge acquisition in this domain.
METHODS: The sample consisted of 200 undergraduate medical students (126 female, 74 male). They participated in two separate simulation sessions, each of which was 30 minutes long and was followed by a collaborative peer feedback phase. Half of the students first performed (learning by doing) and then observed (vicarious learning) the simulation, and the other half participated in the reverse order. Knowledge of doctor-patient communication was measured before, between and after the simulations.
RESULTS: Vicarious learning led to greater knowledge of doctor-patient communication scores than learning by doing. The order in which vicarious learning was experienced had no influence. The inclusion of an observation script also enabled significantly greater learning in students to whom this script was given compared with students who were not supported in this way, but the presence of a feedback script had no effect.
CONCLUSIONS: Students appear to learn at least as much, if not more, about doctor-patient communication by observing their peers interact with SPs as they do from interacting with SPs themselves. Instructional support for observing simulations in the form of observation scripts facilitates both vicarious learning and learning by doing. An observation script may focus learners' attention on the important aspects of doctor-patient communication and increase the content-related accuracy of peer feedback. © Blackwell Publishing Ltd 2012.