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Letter to the Editor
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Maliheh Salimi Bani *   |
| Student Research Committee, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran |
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Abstract: (85 Views) |
Professor Abbas Ebadi Editor-in-Chief, Critical Care Nursing
Dear Professor Ebadi,
I read with interest and close attention the recent article "The effect of simulator-based blended training on the clinical competence of nurses in mechanical ventilation" by Aghal and colleagues (1), published in your journal. In this study the authors take on one of the most demanding and vital areas of nursing care, and for that their work is valuable and deserves recognition.
That said, a careful look at the study's design and methodology brought a few methodological points and uncertainties to mind, and attention to them could make the results clearer and add to the scientific value of this field. I therefore offer the following for your attention and that of the authors:
1. Comparison bias and the nature of the outcome measure. According to the article, the intervention group received blended training (theory plus hands-on practice with a ventilator simulator), whereas the control group received theoretical instruction only (lecture and PowerPoint). At the same time, the outcome was measured with the Objective Structured Clinical Examination, which is by its nature a practical, skills-based test. It is plain that a group given the chance to work in practice with the device (the simulator) will perform far better on a practical examination than a group taught by theory alone. This design creates an inherent bias in favor of the intervention group. A fairer comparison would have been possible if the control group had also received some form of clinical practice equivalent in hours to the intervention group's hands-on training (for example, working with a real ventilator under supervision on the ward), so that the specific effect of the simulator as a distinct educational medium could be isolated.
2. No mention of assessor blinding. In educational studies, blinding participants and instructors is practically impossible; blinding the outcome assessors, however, is a methodological necessity for preventing detection bias. The article states that one examiner was present at each station of the Objective Structured Clinical Examination, but it says nothing about whether these examiners were blinded to the nurses' group allocation (that is, whether a given nurse belonged to the simulator group or the lecture group). A lack of assessor blinding in a test as sensitive as the Objective Structured Clinical Examination can seriously undermine the validity of the results.
3. Testing effect and the short follow-up interval. The authors carried out their assessments before the intervention and only "two weeks" afterwards. Administering the pre-test as an Objective Structured Clinical Examination itself acts as a learning and training stimulus (the testing effect). Re-assessment with the same format after such a short two-week interval reflects short-term memory and familiarity with the stations more than any lasting acquisition of clinical competence. To claim improved clinical competence in a complex skill such as mechanical ventilation, longer follow-up (for example, one to three months) seems essential.
4. No clinical trial registration number. Quasi-experimental studies that include an intervention group and a control group and that measure health-system outcomes (among them the clinical competence of care staff) require prospective registration in a clinical trial registry (such as the IRCT), in line with the CONSORT statement and the recommendations of the International Committee of Medical Journal Editors (ICMJE). This article mentions only an ethics code, and a trial registration number is notably absent.
In closing, while thanking the research team once again for their valuable efforts and the editor for providing a venue for such applied work, I would be very glad if the authors could respond to these questions and methodological concerns. An exchange of views on these matters would no doubt add to scientific clarity and help guide future researchers in designing more effective educational interventions in critical care units.
With renewed respect |
Article number: 1 |
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Full-Text [PDF 1174 kb]
(30 Downloads)
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Type of Study: Research |
Subject:
Special
Received: 2026/07/11 | Accepted: 2026/01/3 | Published: 2026/01/3
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