Simulation and mental health outcomes: a scoping review

In healthcare education, simulation is used for both the teaching and assessment of students and staff. There are a variety of simulation-based education (SBE) and training methods, sometimes delivered in combination, dependent on the content and learning outcomes. The levels of difficulty, complexity and challenge can be tailored to suit the context, learning or assessment objectives and the experience level of the students [1]. The versatility of simulation allows it to take place in multiple settings including the classroom, clinical consulting room or hospital ward, simulation laboratory or the virtual world [2]. Many mental healthcare competencies are well-suited to SBE, and it can be used to expose students to clinical situations or events that occur infrequently or pose a high risk in terms of safety or liability [3]. However, some authors believe that simulation could be more widely adopted in the field of mental health education [4–6].

A preliminary literature search by the research team suggested very little information on the impact of simulation on mental health patient outcomes existed. Thus, a scoping study of the literature was performed to identify the extent of this literature gap and map what outcomes have been reported. At present, in the general medical literature, there are relatively few studies on the impact of simulation on patient outcomes and the collateral effects at a population level. This is especially true in the mental health sector [7, 8].

There is however significant research to show that simulation-based health education promotes knowledge acquisition and maintenance of clinical knowledge, attitude and skills [7, 9, 10]. A variety of simulation methodologies have been used in healthcare education including; actors trained to portray a person with a particular health concern (a simulated patient (SP)) [11–13], manikins and computer-generated scenarios [3]. These methods can range from “low-fidelity” where the level of realism is low to “high-fidelity” where there is a high degree of realism such as human patient simulators or manikins that are able to replicate a growing range of physiological signs [14].

Simulation offers many opportunities for the development of skills, knowledge and behaviours for students and clinicians working in mental health settings. Simulation also provides opportunities to address the challenges related to stigma, safety and liability present in the psychiatric clinical setting [3]. For people living with a mental illness, there are often compounding social, cultural, economic, family or other factors that may form part of their presentation or care. Well-trained and briefed simulated patients in well-designed simulation scenarios can portray the complexities of mental illness with high fidelity [15]. Simulation can help familiarise students with mental illnesses before they encounter them in a clinical setting, increasing the student’s ability to appropriately and confidently respond to patient needs.

The authors were unable to identify any literature on simulation as an educational approach affecting mental health patient outcomes. Therefore, this study was broadened to examine the educational impact of simulation on mental health education outcomes.