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Does the Sequence of Instruction Matter During Simulation?

Stefaniak, Jill E. PhD, CPLP; Turkelson, Carman L. DNP, RN, CCRN, CHSE

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare: February 2014 - Volume 9 - Issue 1 - p 15–20
doi: 10.1097/SIH.0b013e3182a8336f
Empirical Investigations

Introduction: Instructional strategies must be balanced when subjecting students to full-immersion simulation so as not to discourage learning and increase cognitive overload. The purpose of this study was to determine if participating in a simulation exercise before lecture yielded better performance outcomes among novice learners.

Methods: Twenty-nine participants were divided into 2 groups as follows: group 1 participated in simulation exercises followed by a didactic lecture and group 2 participated in the same learning activities presented in the opposite order. Participants were administered a multiple-choice cognitive assessment upon completion of a workshop.

Results: Learners who participated in the simulated exercises followed by the didactic lecture performed better on postassessments as compared with those who participated in the simulation after the lecture. A repeated-measures or nested analysis of variance generated statistically significant results in terms of model fit F (α = 0.05; 4.54) = 176.07 with a P < 0.0001. Despite their higher levels of increased performance, 76% of those who participated in simulation activities first indicated that they would have preferred to participate in a lecture first.

Conclusions: The findings of this study suggest that differences occur among learners when the sequencing of instructional components is altered. Learners who participated in simulation before lecture demonstrated increased knowledge compared with learners who participated in simulation after a lecture.

From the Instructional Design and Technology Program (J.E.S.), Department of STEM Education & Professional Studies, Old Dominion University, Norfolk, VA; and Beaumont Health System (C.L.T.), Royal Oak, MI.

Reprints: Jill E. Stefaniak, PhD, CPLP, Instructional Design and Technology, Department of STEM Education and Professional Studies, Old Dominion University, Darden College of Education, Room 251-1, Norfolk, VA 23529 (e-mail:

The authors declare no conflict of interest.

© 2014 Society for Simulation in Healthcare