{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T17:43:38Z","timestamp":1790099018565,"version":"4.0.1"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,2,25]],"date-time":"2024-02-25T00:00:00Z","timestamp":1708819200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,2,25]],"date-time":"2024-02-25T00:00:00Z","timestamp":1708819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100011094","name":"Public Health Agency of Canada","doi-asserted-by":"publisher","award":["Immunization Partnership Fund"],"award-info":[{"award-number":["Immunization Partnership Fund"]}],"id":[{"id":"10.13039\/100011094","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011094","name":"Public Health Agency of Canada","doi-asserted-by":"publisher","award":["Immunization Partnership Fund"],"award-info":[{"award-number":["Immunization Partnership Fund"]}],"id":[{"id":"10.13039\/100011094","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Educ"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Although healthcare providers (HCPs) are the most trusted source of vaccine information, there is a paucity of easily accessible, multidisciplinary educational tools on vaccine communication for them. Virtual simulation games (VSGs) are innovative yet accessible and effective tools in healthcare education. The objectives of our study were to develop VSGs to increase HCP confidence and self-efficacy in vaccine communication, advocacy, and promotion, and evaluate the VSGs\u2019 effectiveness using a pre-post self-assessment pilot study.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A multidisciplinary team of experts in medicine, nursing, pharmacy, and simulation development created three VSGs for HCP learners focused on addressing conversations with vaccine hesitant individuals. We evaluated the VSGs with 24 nursing students, 30 pharmacy students, and 18 medical residents who completed surveys and 6-point Likert scale pre-post self-assessments to measure changes in their confidence and self-efficacy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>There were no significant differences in baseline confidence and self-efficacy across the three HCP disciplines, despite varied levels of education. Post-VSG confidence and self-efficacy (median: 5) were significantly higher than pre-VSG (median: 4\u20135) for all three HCP disciplines (<jats:italic>P<\/jats:italic>\u2009\u2264\u20090.0005), highlighting the effectiveness of the VSGs. Medical residents reported significantly lower post-VSG confidence and self-efficacy than nursing and pharmacy learners despite completing the most significant amount of education.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Following the completion of the VSGs, learners in medicine, nursing, and pharmacy showed significant improvement in their self-assessed confidence and self-efficacy in holding vaccine conversations. The VSGs as an educational tool, in combination with existing clinical immunization training, can be used to increase HCP confidence and engagement in vaccine discussions with patients, which may ultimately lead to increased vaccine confidence among patients.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12909-024-05169-9","type":"journal-article","created":{"date-parts":[[2024,2,25]],"date-time":"2024-02-25T20:02:04Z","timestamp":1708891324000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Development and evaluation of virtual simulation games to increase the confidence and self-efficacy of healthcare learners in vaccine communication, advocacy, and promotion"],"prefix":"10.1186","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0540-1826","authenticated-orcid":false,"given":"Emily J.","family":"Doucette","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison M.","family":"Fullerton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Pateman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa","family":"Lip","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherilyn K. D.","family":"Houle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9083-2980","authenticated-orcid":false,"given":"James D.","family":"Kellner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenine","family":"Leal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon E.","family":"MacDonald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"McNeil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Tyerman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian","family":"Luctkar-Flude","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Davidson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cora","family":"Constantinescu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,25]]},"reference":[{"issue":"34","key":"5169_CR1","doi-asserted-by":"publisher","first-page":"4161","DOI":"10.1016\/j.vaccine.2015.04.036","volume":"33","author":"NE MacDonald","year":"2015","unstructured":"MacDonald NE, Hesitancy SWGV. Vaccine hesitancy: definition, scope and determinants. Vaccine. 2015;33(34):4161\u20134.","journal-title":"Vaccine"},{"key":"5169_CR2","unstructured":"Organization WH. Ten threats to global health in 2019 2019 [Available from: who.int\/news-room\/spotlight\/ten-threats-to-global-health-in-2019]."},{"issue":"8","key":"5169_CR3","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1007\/s10654-020-00671-y","volume":"35","author":"AA Dror","year":"2020","unstructured":"Dror AA, Eisenbach N, Taiber S, Morozov NG, Mizrachi M, Zigron A, et al. Vaccine hesitancy: the next challenge in the fight against COVID-19. Eur J Epidemiol. 2020;35(8):775\u20139.","journal-title":"Eur J Epidemiol"},{"key":"5169_CR4","unstructured":"United Nations Children\u2019s Fund. The state of the World\u2019s children 2023: for every child, vaccination. UNICEF Innocenti\u2013 Global Office of Research and Foresight. Florence; April 2023."},{"key":"5169_CR5","unstructured":"Government of Canada. COVID-19 vaccination in Canada. 2022."},{"issue":"1","key":"5169_CR6","doi-asserted-by":"publisher","first-page":"e055968","DOI":"10.1136\/bmjopen-2021-055968","volume":"12","author":"SE MacDonald","year":"2022","unstructured":"MacDonald SE, Paudel YR, Kiely M, Rafferty E, Sadarangani M, Robinson JL, et al. Impact of the COVID-19 pandemic on vaccine coverage for early childhood vaccines in Alberta, Canada: a population-based retrospective cohort study. BMJ Open. 2022;12(1):e055968.","journal-title":"BMJ Open"},{"key":"5169_CR7","unstructured":"COVID-19 pandemic. Fuels largest continued backslide in vaccinations in three decades [press release]. Word Health Organization. Geneva\/New York, 15 JUL 2022 2022."},{"issue":"9","key":"5169_CR8","doi-asserted-by":"publisher","first-page":"e009062","DOI":"10.1136\/bmjopen-2015-009062","volume":"5","author":"DM MacDougall","year":"2015","unstructured":"MacDougall DM, Halperin BA, MacKinnon-Cameron D, Li L, McNeil SA, Langley JM, et al. The challenge of vaccinating adults: attitudes and beliefs of the Canadian public and healthcare providers. BMJ Open. 2015;5(9):e009062.","journal-title":"BMJ Open"},{"issue":"52","key":"5169_CR9","doi-asserted-by":"publisher","first-page":"6700","DOI":"10.1016\/j.vaccine.2016.10.042","volume":"34","author":"P Paterson","year":"2016","unstructured":"Paterson P, Meurice F, Stanberry LR, Glismann S, Rosenthal SL, Larson HJ. Vaccine hesitancy and healthcare providers. Vaccine. 2016;34(52):6700\u20136.","journal-title":"Vaccine"},{"issue":"12","key":"5169_CR10","doi-asserted-by":"publisher","first-page":"e30424","DOI":"10.2196\/30424","volume":"7","author":"JL Benham","year":"2021","unstructured":"Benham JL, Atabati O, Oxoby RJ, Mourali M, Shaffer B, Sheikh H, et al. COVID-19 vaccine-related attitudes and beliefs in Canada: National cross-sectional survey and cluster analysis. JMIR Public Health Surveill. 2021;7(12):e30424.","journal-title":"JMIR Public Health Surveill"},{"issue":"11","key":"5169_CR11","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1046\/j.1365-2923.2000.00728.x","volume":"34","author":"J Stewart","year":"2000","unstructured":"Stewart J, O\u2019Halloran C, Barton JR, Singleton SJ, Harrigan P, Spencer J. Clarifying the concepts of confidence and competence to produce appropriate self-evaluation measurement scales. Med Educ. 2000;34(11):903\u20139.","journal-title":"Med Educ"},{"key":"5169_CR12","volume-title":"Self-efficacy: the Exercise of Control","author":"A Bandura","year":"1997","unstructured":"Bandura A. Self-efficacy: the Exercise of Control. New York: W.H. Freeman and Company; 1997."},{"issue":"2","key":"5169_CR13","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1007\/S40037-018-0411-3","volume":"7","author":"RM Klassen","year":"2018","unstructured":"Klassen RM, Klassen JRL. Self-efficacy beliefs of medical students: a critical review. Perspect Med Educ. 2018;7(2):76\u201382.","journal-title":"Perspect Med Educ"},{"key":"5169_CR14","doi-asserted-by":"crossref","unstructured":"Lip A, Pateman M, Fullerton MM, Chen HM, Bailey L, Houle S et al. Vaccine hesitancy educational tools for healthcare providers and trainees: a scoping review. Vaccine. 2022.","DOI":"10.1016\/j.vaccine.2022.09.093"},{"issue":"1","key":"5169_CR15","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1097\/SIH.0000000000000411","volume":"15","author":"CL Foronda","year":"2020","unstructured":"Foronda CL, Fernandez-Burgos M, Nadeau C, Kelley CN, Henry MN. Virtual Simulation in nursing education: a systematic review spanning 1996 to 2018. Simul Healthc. 2020;15(1):46\u201354.","journal-title":"Simul Healthc"},{"key":"5169_CR16","doi-asserted-by":"crossref","unstructured":"Luctkar-Flude M, Tyerman J. The Rise of Virtual Simulation: Pandemic Response or Enduring Pedagogy? Clin. Sim. Nurs., Tyerman J, Luctkar-Flude M, Chumbley L, Lalonde M, Peachey L, McParland T et al. Developing virtual simulation games for presimulation preparation: A user-friendly approach for nurse educators. J Nurs Educ Pract. 2021;11.","DOI":"10.5430\/jnep.v11n7p10"},{"issue":"4","key":"5169_CR17","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/S2155-8256(23)00028-5","volume":"13","author":"MT El Hussein","year":"2023","unstructured":"El Hussein MT, Hirst SP. High-Fidelity Simulation\u2019s impact on clinical reasoning and patient safety: a scoping review. J Nurs Regul. 2023;13(4):54\u201365.","journal-title":"J Nurs Regul"},{"key":"5169_CR18","doi-asserted-by":"crossref","unstructured":"Ross JG, Carney H. The Effect of Formative Capstone Simulation Scenarios on Novice Nursing Students\u2019 Anxiety and Self-Confidence Related to Initial Clinical Practicum. Clinical simulation in nursing., Opel DJ, Heritage J, Taylor JA, Mangione-Smith R, Salas HS, Devere V et al. The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics. 2013;132(6):1037-46.","DOI":"10.1542\/peds.2013-2037"},{"key":"5169_CR19","unstructured":"Centre for Effective Practice. In: Constantinescu C, Ivers N, editors. Grindrod. K. PrOTCT Framework. Ontario. Toronto: Centre for Effective Practice; December 2020."},{"key":"5169_CR20","unstructured":"CAN-Sim. Vaccine Conversations [Available from: https:\/\/can-sim.ca\/vaccine-hesitancy\/]."},{"issue":"4","key":"5169_CR21","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.3758\/BRM.41.4.1149","volume":"41","author":"F Faul","year":"2009","unstructured":"Faul F, Erdfelder E, Buchner A, Lang A-G. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149\u201360.","journal-title":"Behav Res Methods"},{"key":"5169_CR22","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1186\/1472-6920-10-86","volume":"10","author":"LP Pelly","year":"2010","unstructured":"Pelly LP, Pierrynowski Macdougall DM, Halperin BA, Strang RA, Bowles SK, Baxendale DM, et al. THE VAXED PROJECT: an assessment of immunization education in Canadian health professional programs. BMC Med Educ. 2010;10:86.","journal-title":"BMC Med Educ"},{"issue":"6","key":"5169_CR23","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1037\/0022-3514.77.6.1121","volume":"77","author":"J Kruger","year":"1999","unstructured":"Kruger J, Dunning D. Unskilled and unaware of it: how difficulties in recognizing one\u2019s own incompetence lead to inflated self-assessments. J Pers Soc Psychol. 1999;77(6):1121\u201334.","journal-title":"J Pers Soc Psychol"},{"issue":"5","key":"5169_CR24","doi-asserted-by":"publisher","first-page":"532","DOI":"10.4300\/JGME-D-20-00134.1","volume":"12","author":"M Rahmani","year":"2020","unstructured":"Rahmani M. Medical trainees and the Dunning-Kruger Effect: when they don\u2019t know what they don\u2019t know. J Grad Med Educ. 2020;12(5):532\u20134.","journal-title":"J Grad Med Educ"},{"issue":"6","key":"5169_CR25","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1007\/S40037-017-0389-2","volume":"6","author":"DS Cowley","year":"2017","unstructured":"Cowley DS, Markman JD, Best JA, Greenberg EL, Grodesky MJ, Murray SB, et al. Understanding ownership of patient care: a dual-site qualitative study of faculty and residents from medicine and psychiatry. Perspect Med Educ. 2017;6(6):405\u201312.","journal-title":"Perspect Med Educ"},{"issue":"1","key":"5169_CR26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/clc.22348","volume":"38","author":"CR Conti","year":"2015","unstructured":"Conti CR. Some thoughts about patient ownership. Clin Cardiol. 2015;38(1):1.","journal-title":"Clin Cardiol"},{"issue":"1","key":"5169_CR27","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1186\/s12909-022-03730-y","volume":"22","author":"H Fujikawa","year":"2022","unstructured":"Fujikawa H, Son D, Aoki T, Eto M. Association between patient care ownership and personal or environmental factors among medical trainees: a multicenter cross-sectional study. BMC Med Educ. 2022;22(1):666.","journal-title":"BMC Med Educ"},{"issue":"4","key":"5169_CR28","doi-asserted-by":"publisher","first-page":"2025","DOI":"10.1007\/s11135-011-9640-9","volume":"47","author":"I Krumpal","year":"2013","unstructured":"Krumpal I. Determinants of social desirability bias in sensitive surveys: a literature review. Qual Quant. 2013;47(4):2025\u201347.","journal-title":"Qual Quant"}],"container-title":["BMC Medical Education"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12909-024-05169-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12909-024-05169-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12909-024-05169-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,25]],"date-time":"2024-02-25T20:02:39Z","timestamp":1708891359000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmededuc.biomedcentral.com\/articles\/10.1186\/s12909-024-05169-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,25]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["5169"],"URL":"https:\/\/doi.org\/10.1186\/s12909-024-05169-9","relation":{},"ISSN":["1472-6920"],"issn-type":[{"value":"1472-6920","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,25]]},"assertion":[{"value":"9 August 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 February 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 February 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study received approval from the University of Calgary Conjoint Health Research Ethics Board (REB22-0012) and a University of Waterloo Research Ethics Board (REB 44487). Informed consent was obtained from all participants prior to participation in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"SKDH has received unrestricted research funding from Sanofi and Valneva, a medical education grant from GSK, a research consulting honorarium from Seqirus, and has been an advisory committee member for AstraZeneca, GSK, Novavax, Pfizer, Sanofi, Seqirus, and Valneva. JDK has been an investigator on projects funded by GlaxoSmithKline, Merck, Moderna, and Pfizer, outside the submitted work. All funds have been paid to his institution, and he has not received any personal payments. He has been an unpaid Data Safety Monitoring Board Member for a COVID-19 vaccine clinical trial. He has been an unpaid member of the Canadian COVID-19 Immunity Task Force (Leadership Group member, Field Studies Working Party Co-Chair and Pediatric Network Lead), and of the Alberta Advisory Committee on Immunizations. JT and ML-F are affiliated with the non-profit organization CAN-Sim, and are paid instructors in the CASN Certified Canadian Simulation Nurse Educator (CCSNE) program. CC has been an investigator on projects funded by GlaxoSmithKline, Merck and Pfizer. She has also contributed to continuing medical education initiatives (by producing and delivering vaccine related education materials) supported by pharmaceutical companies such as bioMerieux, Moderna, and Pfizer. All funds, including any honoraria have been paid to her institution (University of Calgary), and she has not received any personal payments. She has held an unpaid executive position for the organization 19 to Zero.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"190"}}