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The online version of this article (doi:10.1186/1757-1146-4-16) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
PAL conceived, designed, researched data, contributed to discussion, wrote and reviewed/edited the manuscript. ELM researched data, contributed to discussion, wrote and reviewed/edited the manuscript. PMR designed, researched data, contributed to discussion and reviewed/edited the manuscript. FMB contributed to discussion, wrote and reviewed/edited the manuscript. SJ, EMK and GMP designed and reviewed/edited the manuscript. MCK conceived and reviewed/edited the manuscript. All authors have read and approved the final manuscript.
Foot ulcers are a frequent reason for diabetes-related hospitalisation. Clinical training is known to have a beneficial impact on foot ulcer outcomes. Clinical training using simulation techniques has rarely been used in the management of diabetes-related foot complications or chronic wounds. Simulation can be defined as a device or environment that attempts to replicate the real world. The few non-web-based foot-related simulation courses have focused solely on training for a single skill or "part task" (for example, practicing ingrown toenail procedures on models). This pilot study aimed to primarily investigate the effect of a training program using multiple methods of simulation on participants' clinical confidence in the management of foot ulcers.
Sixteen podiatrists participated in a two-day Foot Ulcer Simulation Training (FUST) course. The course included pre-requisite web-based learning modules, practicing individual foot ulcer management part tasks (for example, debriding a model foot ulcer), and participating in replicated clinical consultation scenarios (for example, treating a standardised patient (actor) with a model foot ulcer). The primary outcome measure of the course was participants' pre- and post completion of confidence surveys, using a five-point Likert scale (1 = Unacceptable-5 = Proficient). Participants' knowledge, satisfaction and their perception of the relevance and fidelity (realism) of a range of course elements were also investigated. Parametric statistics were used to analyse the data. Pearson's r was used for correlation, ANOVA for testing the differences between groups, and a paired-sample t-test to determine the significance between pre- and post-workshop scores. A minimum significance level of p < 0.05 was used.
An overall 42% improvement in clinical confidence was observed following completion of FUST (mean scores 3.10 compared to 4.40, p < 0.05). The lack of an overall significant change in knowledge scores reflected the participant populations' high baseline knowledge and pre-requisite completion of web-based modules. Satisfaction, relevance and fidelity of all course elements were rated highly.
This pilot study suggests simulation training programs can improve participants' clinical confidence in the management of foot ulcers. The approach has the potential to enhance clinical training in diabetes-related foot complications and chronic wounds in general.
Additional file 1: Movie file S1 - Example of a portion of a FUST Clinical Scenario. (WMV 20 MB)13047_2010_340_MOESM1_ESM.wmv
Authors’ original file for figure 113047_2010_340_MOESM2_ESM.pdf
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