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CONSIDER:  

·          Was the study designed to assess the outcomes of an intervention?

·          Is the research question ‘focused’ in terms of:

•    Population studied  

•    Intervention given

•    Comparator chosen

•    Outcomes measured?

The study addressed a clearly focused research question. This is evident by the fact that the researchers designed the study to assess the effects of implementing a clinical virtual simulation on the levels of learning satisfaction, knowledge retention, self-efficacy, and clinical reasoning among nursing students. The research question is also focused in relation to the population studied, intervention, comparator, and the outcomes measured.

CONSIDER:  

•         How was randomisation carried out? Was the method appropriate?

•         Was randomisation sufficient to eliminate systematic bias?

•         Was the allocation sequence concealed from investigators and participants?

The assignment of participants to the interventions was randomised through simple random sampling. The randomization was sufficient to eliminate systematic bias. In randomized controlled trials, randomization helps to eliminate bias and improve the rigor of the study (Hariton & Locascio, 2018). The allocation sequence was concealed from investigators and participants through anonymization of students.

CONSIDER:  

•         Were losses to follow-up and exclusions after randomisation accounted for?

•         Were participants analysed in the study groups to which they were randomised (intention-to-treat analysis)?

•         Was the study stopped early? If so, what was the reason?

All participants who entered the study were accounted for at its conclusion. The researchers have accounted for losses to follow-up and exclusions after randomization. They have also analyzed the participants separately in the intervention and control groups.

intervention they were given?

·        Were the investigators ‘blind’ to the intervention they were giving to participants?

·        Were the people assessing/analysing outcome/s ‘blinded’?

Yes                        No                         Can’t tell

Yes                          No                         Can’t tell

CONSIDER:  

·       Were the baseline characteristics of each study group (e.g. age, sex, socio-economic group) clearly set out?  

·       Were there any differences between the study groups that could affect the outcome/s?

The intervention and the control groups were similar at the start of the randomized controlled trial. The reason is that the baseline characteristics of each study group were clearly set out.

CONSIDER:  

·      Was there a clearly defined study protocol?

·     If any additional interventions were given (e.g. tests or treatments), were they similar between the study groups?

·     Were the follow-up intervals the same for each study group?

Each study group received the same level of care apart from the treatment group. Precisely, the follow-up intervals were the same for each study group.

CONSIDER:  

•        Was a power calculation undertaken?

•        What outcomes were measured, and were they clearly specified?

•         How were the results expressed? For binary outcomes, were relative and absolute effects reported?

•         Were the results reported for each outcome in each study group at each follow-up interval?

•        Was there any missing or incomplete data?

•        Was there differential drop-out between the study groups that could affect the results?

•         Were potential sources of bias identified?

•         Which statistical tests were used?

•         Were p values reported?

The researchers comprehensively reported the effects of the intervention. The power calculation was undertaken at a statistical power of 0.80. The specific outcomes measures in the study include the levels of learning satisfaction, knowledge retention, self-efficacy, and clinical reasoning among nursing students. The results were clearly expressed and reported for each study group after the implementation of the intervention and during follow-up. The data was complete and the researchers have not reported any differential drop-out between the study groups that could affect the results. Potential sources of bias were not reported. A number of statistical tests were performed and they include the Kolmogorov-Smirnov test with the Lilliefors correction, unpaired t-test, the Welch correction, and multivariate analysis of variance (MANOVA). The statistical significance was tested at P<.05.

CONSIDER:  

•         Were confidence intervals (CIs) reported?

The precision of the estimate of the intervention or treatment effect was not reported. The researchers did not report confidence intervals (CIs).

CONSIDER:  

·         What was the size of the intervention or treatment effect? 

·         Were harms or unintended effects reported for each study group?

·         Was a cost-effectiveness analysis undertaken? (Cost-effectiveness analysis allows a comparison to be made between different interventions used in the care of the same condition or problem.)

The benefits of the experimental intervention outweigh the harms. However, it is not clear whether they outweigh the costs or not. The researchers have used an effect size of d=0.80 which signifies a large effect of the intervention on the studied sample size (Bujang, 2021).

CONSIDER:

•         Are the study participants similar to the people in your care?  

•         Would any differences between your population and the study participants alter the outcomes reported in the study?

•         Are the outcomes important to your population?  

•         Are there any outcomes you would have wanted information on that have not been studied or reported?  

•         Are there any limitations of the study that would affect your decision?

The study res

results can be applied in my context. The reason is that the study participants are nursing students and they resemble nurses who are involved in patient care in my practice setting. Any difference between my population and study participants might alter the outcomes reported in the study. The outcomes are clear and are important to my population. The reported limitation would not affect my decision regarding the study outcomes.

CONSIDER:  

·         What resources are needed to introduce this intervention taking into account time, finances, and skills development or training needs?

·         Are you able to disinvest resources in one or more existing interventions in order to be able to re-invest in the new intervention?

The experimental would indeed provide greater value to the people in my care. The organization needs to set aside finances, time, and trainers in order to introduce the intervention into the organization. However, this does not call for the need to disinvest resources in other existing interventions.

The key point from the critical appraisal is that RTCs have unique features, particularly randomization and the use of control groups, which distinguish them from other types of studies. The conclusion that can be drawn from the paper is that clinical virtual simulation is effective in improving knowledge retention and initial clinical reasoning over time. It also improves student satisfaction with learning. However, clinical virtual simulation does not influence the perception of general efficiency. Based on these findings, I would use clinical virtual simulation to change practice or recommend changes to care used by my organization. I can judiciously implement the intervention without delay due to its proven effectiveness in improving knowledge retention, enhancing initial clinical reasoning over time, and improving student satisfaction with learning.