Simulated Practice Learning

Fifty percent of a nursing degree is delivered through clinical placement, and all student nurses must complete 2,300 hours of placement to graduate and register as qualified nurses (NMC, 2023) so it is an integral part of their university experience. During the COVID-19 pandemic, this essential component of the curriculum was severely disrupted on a national level. Many learners across the world were unable to attend placements due to self-isolation or capacity constraints, and first-year students across England were removed from placement entirely. This posed a critical threat to learner progression, confidence, and creation of the future nursing workforce. This required a radical rethink of the way we deliver practice-based learning in the UK order to ensure learners to complete their course. In response, I led the development and implementation of a large-scale simulated placement programme at Sheffield Hallam University (SHU, 2025), ensuring that over 3,000 nursing students could continue to develop essential clinical skills and graduate on time. This served as an exemplar which has been replicated at other HEI’s across England and is now an enduring and integral part of our nursing curriculum.

Aim of the case study

This case study explores the design, implementation and embedding of a novel simulated placement model at Sheffield Hallam University, incorporating virtual reality technologies. It examines the practical and pedagogic factors that enabled the innovation to move from an emergency response to a sustainable curriculum enhancement.
Key areas of focus include:

• Developing a shared vision across the academic team and establishing a coherent pedagogical framework for simulated practice learning.
• Creating the organisational infrastructure required to support implementation, including virtual learning environments, assessment processes, placement documentation, timetabling arrangements, allocation systems and communication with learners.
• Building staff capability through the recruitment, induction and mentoring of early-career academics in simulation-based education.
• Establishing cultures of peer support through observation, feedback and collaborative reflection.
• Securing and integrating VR hardware, software and simulation equipment within existing institutional systems and procurement processes.
• Exploring strategies for gaining institutional and sector-wide recognition of simulated placements as a legitimate form of practice learning (Saunders & Kirkham, 2021).
• Leading cross-college collaboration to ensure a high-quality and consistent student learning experience.

At a time when traditional placement provision was under significant pressure, this initiative demonstrated how simulation and virtual reality could provide an innovative, scalable and pedagogically robust alternative. The case study highlights the leadership, partnership working and educational design principles that supported implementation, as well as the opportunities and challenges encountered in embedding the approach within health professions education.

Benefits of the case study

This experience deepened my understanding of pedagogical leadership in times of crisis. It reinforced my commitment to inclusive, student-centred innovation and the importance of supporting colleagues through change. The simulated placement model I developed is now a permanent feature of our curriculum, experienced by over 1,000 students annually. 

Approach Taken

I designed synchronous and asynchronous simulated placement modules at each level of study (4-7), mapped them to level specific proficiencies which learners would be assessed against, and then led a cross-department team of academics and technical staff to co-design the simulated placements. The simulated placements were designed to replicate a 38.5-hour clinical working week, with learners able to claim up to six hundred hours across the duration of their whole course. I ensured the programme was:

• Mapped to clinical proficiencies (e.g., vital signs, end-of-life care, communication)
• Suitable for learners from adult, child, mental health and learning disability fields of nursing.
• Learner-centred, with a focus on confidence-building, inclusivity, and clarity
• Ensured robust learner support mechanisms were in place for any queries or issues.
• Inclusive and met the needs of all learners, including those with additional learning needs
• Aligned with NMC emergency standards and institutional quality assurance processes

Inclusivity was at the heart of my simulated placement model, and I was committed to ensuring that every level of the program reflected this, and that staff felt supported to deliver inclusive simulated placement content. I focused on supporting staff to decolonize the teaching materials e.g. case studies and scenarios, and incorporating diversity into our simulation mannequins, actors, and clinical skills kits. I encouraged staff to put forward kit requests so that we could purchase mannequins that represented different ages, ethnicities, and physical abilities. I led on a bid for funding from NHS England to purchase equipment and manage the spend. After supporting, influencing, and encouraging staff, I sent team members to a national simulation conference (ASPIH), and they returned with requests which led to the purchase of the UK's first transgender simulation mannequin and mannequin with Down's Syndrome. I also encouraged them to ensure that task trainers, such as cannula arms and resuscitation dolls, in a range of skin tones were used in teaching.

Outcomes and Impact

The implementation of simulated placements was crucial for nursing education because it addressed the growing need for immersive, experiential learning that mirrors real-world clinical environments. By leading the initial virtual implementation in January 2021 and transitioning to on-campus delivery as soon as possible, I ensured continuity and innovation in practical learning during a disruptive period. The integration of virtual reality, digital learning packages, and high-fidelity simulation scenarios provided students with safe, realistic, and engaging opportunities to develop clinical skills and critical thinking. Structured debriefs and reflective practices embedded in every session further distinguished this approach from traditional practicals, fostering deeper learning and self-awareness.

A key objective of the initiative was to move simulation-based education from a specialist activity to a more fully integrated and shared element of the curriculum. Achieving this required a shift in how simulation was understood, valued and enacted across Nursing and Allied Health disciplines. To support this change, a programme of online staff development seminars was established, drawing on internal and external expertise in simulation pedagogy, virtual reality and inclusive learning design. These sessions created opportunities for critical discussion, knowledge exchange and collaborative exploration of emerging educational approaches.

Through this community-based approach to professional learning, academic staff were encouraged to engage with simulation as both a pedagogical strategy and a curriculum enhancement tool. The seminars contributed to the development of shared understandings, increased confidence in the use of simulation methodologies, and fostered a culture of innovation within the teaching team. This collaborative capacity-building was an important factor in achieving a sustainable and scalable model of simulation-enhanced learning that could support diverse learner needs and experiences.

Future Developments

The implementation of the simulated placement model generated a number of opportunities for further educational development, scholarly dissemination and cross-disciplinary collaboration.

Later developments have focused on:

• Disseminating findings through scholarly publications and national and international conferences to contribute to the growing evidence base for simulation-enhanced and VR-supported placement models.
• Engaging with national working groups and professional bodies to inform guidance, policy development and discussions surrounding the recognition and quality assurance of simulated placements.
• Extending collaborative practice across the School of Health and Social Care through the sharing of resources, pedagogic approaches and evaluation findings, including the development of a simulated placement community of practice.
• Exploring the potential of peer-learning coach models within simulated placements, enabling students to develop teaching, mentoring and leadership capabilities while supporting the learning of their peers.
• Evaluating the longer-term impact of simulated placements on learner confidence, professional identity formation, preparedness for practice and placement capacity.

Recommendations

Simulated placements are now a permanent feature of our curriculum, experienced by over 1,000 learners annually. They have improved learner confidence, competence, and readiness for clinical practice. The experience of implementing and sustaining this innovation suggests several considerations for colleagues seeking to embed simulation-enhanced learning within health professions education:

• Invest in faculty development alongside technological infrastructure. The success of simulated placements was dependent not only on access to technology and resources but also on developing educators' confidence, pedagogical understanding and willingness to adopt new approaches.
• Adopt a community-based approach to curriculum innovation. Establishing shared ownership across academic teams can support sustainability, reduce reliance on individual champions and facilitate the spread of effective practice.
• Prioritise the pedagogical design of simulated learning experiences. The educational value of simulation appears to be shaped less by the sophistication of the technology used and more by alignment between learning outcomes, authentic activities, structured facilitation and opportunities for reflection.
• Embed systematic evaluation from the outset. Ongoing collection of learner, educator and placement-partner perspectives can help inform continuous enhancement and contribute to the wider evidence base for simulation-enhanced practice learning.
• Consider simulated placements as a complement rather than a replacement for traditional practice learning. Thoughtfully integrated simulation can extend placement capacity, support learner preparedness and provide access to experiences that may be difficult to encounter consistently in clinical environments.
• Create opportunities for peer learning and student partnership. Engaging students as peer coaches, facilitators or co-creators may enhance confidence, professional identity development and collaborative learning within simulated environments.