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E alua ing he e ec o hospi al in o ma ion sys em simula ion-
based aining on nu sing s uden s' in o ma ics skills be o e
in e nship: A quasi-expe imen al s udy
Reza Abbasi1, Faezeh Gha a i2, Razieh Fa ahi3* , Malihe Ram4, Ma yam
Mokh a i Seghaleh5
1Depa men o Heal h In o ma ion Technology, School o Pa amedical Sciences, To ba Heyda iyeh Uni e si y o Medical Sciences,
To ba Heyda iyeh, I an
2Depa men o Heal h In o ma ion Managemen , School o Heal h Managemen and In o ma ion Sciences, I an Uni e si y o Medical
Sciences, Teh an, I an
3Depa men o Heal h In o ma ion Technology, Fe dows Facul y o Medical Sciences, Bi jand Uni e si y o Medical Sciences, Bi jand, I an
4Facul y o Medical Sciences, Bi jand Uni e si y o Medical Sciences, Bi jand, I an
5Rasul-e-Ak am Hospi al, Fe dows, Bi jand Uni e si y o Medical Sciences, Bi jand, I an
A icle in o Abs ac
In oduc ion
O e he pas wo decades, heal hca e In o ma ion
Technology (IT) has de eloped signi ican ly. Heal h
in o ma ion echnology (HIT) includes a b oad spec um
o in o ma ion sys ems and ools ha enable elec onic
s o age, e ie al, sha ing, and use o heal hca e da a,
in o ma ion, and knowledge o communica ion and
decision-making [1]. These echnologies include a
a ie y o sys ems such as Elec onic Heal h Reco ds
(EHR), disease egis y sys ems, elec onic p esc ibing,
Hospi al In o ma ion Sys ems (HIS), Clinical Decision
Suppo Sys ems (CDSS), and mo e [2].
HISs play an impo an ole in planning, implemen ing,
o ganizing, and con olling he ope a ions o hospi al
depa men s, such as labo a o y, adiology, admission
and discha ge, inpa ien , and ope a ing oom [3].
Success ully implemen ing HIS in heal hca e se ings
A icle his o y:
Recei ed 4 No . 2024
Accep ed 12 May. 2025
Published 13 Jul. 2025
Abbasi e al. J Med Edu De . 2025; 18(2): 46-54 Jou nal o Medical Educa ion De elopmen
Backg ound & Objec i e: Educa ional simula o s ha e been p oposed as e ec i e ools o
enhancing lea ning and imp o ing s uden s' skills when p epa ing o he wo kplace. This s udy
aimed o de e mine he e ec o simula ion-based aining in a hospi al in o ma ion sys em on
nu sing s uden s' in o ma ics skills be o e hei in e nship.
Ma e ials & Me hods: This quasi-expe imen al s udy was conduc ed in he i s semes e o
he academic yea (2023-2024) wi h 26 hi d-semes e unde g adua e nu sing s uden s a he
Fe dows Facul y o Medical Sciences. The s uden s we e andomly di ided in o con ol and
in e en ion g oups. The educa ional con en ea u ed a simula ion o he inpa ien module o a
hospi al in o ma ion sys em. S uden s in he in e en ion g oup we e gi en access o his
module's de eloped aining and p ac ice sec ions o e wo weeks. A e one mon h, he es
sec ion o his module was made a ailable o bo h he in e en ion and con ol g oups. Da a
analysis was conduc ed using SPSS e sion 26, whe e desc ip i e s a is ics we e calcula ed, and
he Mann-Whi ney es was u ilized.
Resul s: A e he es , he mean sco es o s uden s in he in e en ion and con ol g oups we e
35.69 ± 3.9 and 29.85 ± 5.01 (ou o 41), espec i ely. The di e ence be ween he mean sco es
o he wo g oups was signi ican (p = 0.003, E ec size = 0.59). Fu he mo e, he e was no
signi ican co ela ion be ween sex, age, o g ade poin a e age and he mean es sco es in
ei he g oup (P > 0.05).
Conclusion: Simula ion-based aining can po en ially enhance nu sing s uden s' skills in
u ilizing hospi al in o ma ion sys ems. Conside ing he emphasis on he ole o heal h
in o ma ion sys ems in he managemen o heal hca e se ings, i is ecommended ha simula ed
HIS aining be included in he educa ional cu iculum o nu sing s uden s.
Keywo ds: e-lea ning, simula o sys em, hospi al in o ma ion sys em, skill, nu sing s uden s
*Co esponding au ho :
Razieh Fa ahi, Depa men o Heal h
In o ma ion Technology, Fe dows
Facul y o Medical Sciences, Bi jand
Uni e si y o Medical Sciences,
Bi jand, I an.
Email: Fa ahi [email protected]
O iginal A icle
How o ci e his a icle:
Abbasi R, Gha a i F, Fa ahi R, Ram
M, Mokh a i Seghaleh M. E alua ing
he e ec o hospi al in o ma ion
sys em simula ion-based aining on
nu sing s uden s' in o ma ics skills
be o e in e nship: A quasi-
expe imen al s udy. J Med Edu De .
2025; 18(2): 46-54.
[ DOI: 10.61882/edcj.18.2.46 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
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Abbasi e al
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depends on use s who ely on hese sys ems o pe o m
hei du ies [4, 5]. The e o e, comp ehensi e use
aining is a c ucial elemen in sys em de elopmen , as i
os e s accep ance and enhances use s' speed and
accu acy in comple ing asks and u ilizing he sys em
e ec i ely [6].
In I an, ollowing he implemen a ion o he Heal h
Sys em T ans o ma ion Plan in 2013, HIS ha e ecei ed
g ea e a en ion han o he echnological ad ancemen s
in in o ma ion echnology [5]. These sys ems play a
pi o al ole in heal hca e se ice deli e y and a e
ecognized as key ools o eco ding and managing
pa ien da a and heal hca e se ices [7]. Nu ses, as he
la ges use g oup o hese sys ems, play a key ole in
ensu ing accu a e and comp ehensi e documen a ion o
clinical da a [8]. Despi e his i al ole, nu sing s uden s
do no ecei e he necessa y p ac ical aining o use HIS
e ec i ely du ing hei s udies. As a esul , new
p o essionals o en lack amilia i y wi h hese sys ems
upon en e ing he wo k o ce, e en hough hey mus
documen medical in e en ions. This lack o expe ience
can lead o challenges such as spending excessi e ime
on da a en y and an inc eased likelihood o
documen a ion e o s.
Due o conce ns o e pa ien in o ma ion con iden iali y,
high wo k p essu e, and he s ess ul en i onmen o
hospi als, clinical in e nships usually lack hands-on
p ac ice wi h HIS. In mos cases, s uden s p ima ily
obse e how heal hca e s a ope a e hese sys ems,
missing he oppo uni y o engage di ec ly wi h he ac ual
HIS en i onmen .
This lack o p ac ical expe ience can lead o dec eased
sel -con idence, low p oduc i i y, and e o s in da a
en y [9].
Simula ion has eme ged as an inno a i e and e ec i e
educa ional app oach in his con ex . Using HIS
simula o s, especially o s uden s wi h limi ed
expe ience wo king wi h in o ma ion sys ems, o e s an
oppo uni y o p ac ice in a sa e en i onmen wi hou
nega i e pa ien consequences. This me hod has
nume ous ad an ages o e adi ional educa ional
me hods by allowing epe i ion, ial and e o , ac i e
lea ning, and immedia e eedback [10].
While simula ion is commonly employed in aining o
clinical ac i i ies such as ca diopulmona y esusci a ion
and wound ca e using mannequins and skill labo a o ies,
and some s udies [11-15] ha e u ilized EHR simula ion
o nu sing educa ion, he e has been less emphasis on
comp ehensi e HIS aining ha mi o s eal hospi al
wo k lows.
A esea ch li e a u e e iew e eals signi ican gaps in
in eg a ing HIS educa ion in o he nu sing cu iculum,
pa icula ly in simula ed en i onmen s. Fo example,
s udies by Zhang e al. [16] and Whi e al. [11] ha e
iden i ied signi ican limi a ions. In esponse o his
educa ional need, a p ac ical aining module o he
Ti aje HIS nu sing sys em (inpa ien module)—used in
o e 300 hospi als na ionwide—was de eloped using a
compu e simula o . This s udy aims o e alua e he
e ec i eness o a simula ion-based educa ional app oach
in enhancing nu sing s uden s' skills and eadiness o
using HIS.
Ma e ials & Me hods
Design and se ing(s)
This quasi-expe imen al s udy was conduc ed a Fe dows
Facul y o Medical Sciences du ing he i s semes e o
he 2023–2024 academic yea .
Pa icipan s and sampling
The s udy popula ion comp ised 26 hi d-semes e
unde g adua e nu sing s uden s om he Fe dows
Facul y o Medical Sciences. A e ob aining e hical
app o al (code IR.BUMS.REC.1402.445) om Bi jand
Uni e si y o Medical Sciences and ecei ing implici
consen om he s uden s in he class oom o pa icipa e
in he esea ch, a b ie ing session was conduc ed o all
pa icipan s. Du ing his session, he esea che s—who
hold PhDs in heal h in o ma ion managemen wi h a
backg ound in sys em design and applica ion and a
mas e 's in nu sing wi h expe ience wo king wi h HIS—
in oduced he scena io-based compu e simula o . They
clea ly explained he s udy objec i es, i s signi icance,
and how o use he aining, p ac ice, and es ing sec ions
in he simula o . Adequa e ime was p o ided o add ess
any ques ions o conce ns om s uden s ega ding he
p ocess.
A e he b ie ing session, a census sampling app oach
was employed, including all s uden s in he class.
Subsequen ly, 26 sealed en elopes we e p epa ed, wi h
13 labelled 'In e en ion' and 13 labelled 'Con ol.' To
ensu e andom alloca ion, each s uden blindly selec ed
an en elope, de e mining hei assignmen o one o he
s udy g oups. Finally, s uden s' demog aphic
cha ac e is ics, including sex, age, and G ade Poin
A e age (GPA), we e eco ded on a checklis (Figu e 1).
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Figu e 1. CONSORT Flow diag am o he quasi-expe imen al s udy
Tools/Ins umen s
The web-based simula o sys em o eaching HIS
includes se e al key unc ional capabili ies, such as
in e ac i e aining cou ses, mul imedia con en ,
p ac ical exe cises, and assessmen s. Addi ionally, i
p o ides help and eedback o use s o add ess hei
po en ial e o s. This sys em's adminis a ion,
communica ion, and con en managemen capabili ies
can ex end he lea ning p ocess beyond o he educa ional
simula o s. Addi ional ea u es, including in o ma ion
dashboa ds, epo ing capabili ies, ques ion bank design,
and messaging, ha e also been inco po a ed o c ea e a
ully in eg a ed educa ional sys em.
Da a collec ion me hods
One o his sys em's simula ed educa ional con en s is he
inpa ien module aining in he HIS. This module, one
o he mos widely used modules by nu sing s a , was
in oduced o nu sing s uden s in he in e en ion g oup.
In his module, s uden s we e augh how o log in o he
hospi al in o ma ion sys em, assign beds om di e en
hospi al depa men s o pa ien s, egis e eques s o
a ious se ices such as labo a o y es s, medica ions,
and pa ien imaging, cancel o dele e o de s, and iew
es esul s and medica ions assigned o he pa ien .
S uden s we e g an ed access o he aining and,
subsequen ly, he p ac ice con en o his module,
allowing hem o ain and p ac ice any ime, anywhe e,
and on any de ice—a mobile phone, able , lap op, o
pe sonal compu e —o e wo weeks. To comple e he
p ocess, s uden s needed o selec he "End o T aining"
op ion a e inishing he aining and he "End o
P ac ice" op ion a e comple ing he p ac ice o inalize
hei p og ess. One mon h la e , bo h he in e en ion and
con ol g oups comple ed he es sec ion o he module
o e alua e he aining's impac on hei skills in using
he Ti aje Hospi al In o ma ion Sys em. S uden s we e
asked o comple e he es , which was designed in a
scena io-based o ma aligned wi h he educa ional
con en , and comple ed exe cises. The alidi y and
eliabili y o he es (Supplemen a y 1), c ea ed by
nu ses using his module based on eal pa ien s, we e
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e iewed and app o ed by expe s in Heal h In o ma ion
Managemen (HIM) and Medical In o ma ics (MI), who
a e amilia wi h he design and use o his sys em. A
scena io consis ing o 16 s eps was p epa ed, wi h each
s ep sco ed acco ding o weigh ed impo ance analysis.
The impo ance o each scena io s ep was de e mined
based on expe opinion, and each s ep was sco ed based
on i s impo ance. The s uden s eco ded hei sco es on
he sys em a e comple ing he es . The simula o
calcula ed he module-speci ic es sco e wi h a
maximum sco e o 41, and he sco es ob ained by bo h
g oups we e compa ed.
Da a analysis
A e ecei ing demog aphic in o ma ion and s uden s'
es sco es h ough he simula o sys em, hese da a we e
en e ed in o he SPSS so wa e e .26 o analysis. Fi s ,
he da a we e desc ibed using desc ip i e s a is ics
( equency, pe cen age, mean, and SD). Because he
dependen a iable ( es sco e) did no ha e a no mal
dis ibu ion, he Mann-Whi ney U es was used o
compa e he sco es o he in e en ion and con ol
g oups. Fu he mo e, Spea man's co ela ion coe icien
es examined he associa ion be ween he demog aphic
and dependen a iables.
Resul s
O he 26 pa icipan s, 13 (50%) we e male. A e sample
alloca ion, se en emales (54%) and six males (46%)
we e placed in he in e en ion g oup, and se en males
(54%) and six emales (46%) we e placed in he con ol
g oup. The dis ibu ion o he pa icipan s was no g oup.
The dis ibu ion o he pa icipan s was no s a is ically
signi ican (p = 0.695). The GPA o s uden s in he
in e en ion g oup was 15.80 ± 1.18, and in con ol, i
was 16.02 ± 0.61, wi h no signi ican di e ence be ween
he wo g oups (p = 0.700). Also, he mean age o
s uden s in he in e en ion g oup was 20.38 ± 1.26
yea s, and in con ol, i was 21.69 ± 2.95 yea s, and he e
was no s a is ically signi ican di e ence be ween he
wo s udy g oups (p = 0.370) (Table 1).
Table 1. Demog aphic cha ac e is ics o in e en ion and
con ol g oups
Gende
n (%)
Sig.
In e en ion
Male Female
6 (46.2)
7 (53.8)
0.154 (0.695)
Con ol
Male Female
7 (53.8)
6 (46.2)
GAP
Mean ± SD
U (Sig.)
In e en ion
Con ol
15.8 ± 1.18
77 (0.700)
16.02 ± 0.61
Age
Mean ± SD
U (Sig.)
In e en ion
20.38 ± 1.26
65.5 (0.370)
Con ol
21.69 ± 2.95
Abb e ia ions: n, numbe o pa icipan s; SD, s anda d de ia ion; U, Mann-
Whi ney es ; Sig, signi icance le el.
The mean es sco es o s uden s in he in e en ion and
con ol g oups we e 35.69 ± 3.9 and 29.85 ± 5.01 (ou o
41), espec i ely. A s a is ically signi ican di e ence
was obse ed be ween he g oups unde in es iga ion (U
= 27, p = 0.003, E ec size = 0.59). This indica es ha
simula ion-based educa ion o he Inpa ien module
signi ican ly impac s nu sing s uden s' skills (Figu e 2).
Figu e 2. Compa ison o s uden s’ es sco es be ween in e en ion and con ol g oups
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To assess he impac o demog aphic a iables on
s uden s' es sco es, analyses we e conduc ed based on
gende , age, and GPA wi hin bo h he in e en ion and
con ol g oups. The Mann–Whi ney U es esul s
showed ha he di e ence in mean sco es be ween
emale and male s uden s was no s a is ically signi ican
in ei he g oup. In he in e en ion g oup, he es s a is ic
was 15 wi h a p- alue o 0.350; in he con ol g oup, he
es s a is ic was 16.5 wi h a p- alue o 0.518. These
esul s indica e ha gende did no signi ican ly a ec
es sco es (Table 2). Addi ionally, Spea man's
co ela ion es was used o examine he ela ionship
be ween age and GPA wi h es sco es. The indings
showed no signi ican co ela ion be ween GPA and es
sco es in he in e en ion g oup ( = 0.122, p = 0.693)
and he con ol g oup ( = -0.343, p = 0.252). Simila ly,
no s a is ically signi ican co ela ion was ound be ween
age and es sco es in he in e en ion g oup ( = -0.019,
p = 0.952) o he con ol g oup ( = -0.177, p = 0.563)
(Table 3).
Table 2. Compa ison o es sco es be ween males and emales
in each g oup using he Mann-Whi ney U es
G oup
Gende
Mean ± SD
U (p- alue)
In e en ion
Female
37.29 ± 1.11
15 (0.350)
Male
33.83 ± 5.23
Con ol
Female
31.17 ± 4.92
16.50 (0.518)
Male
28.71 ± 5.19
Table 3. Spea man's co ela ion es esul s o he e ec o age
and GPA on s uden s' es sco es
Va iable
G oup
Co ela ion
p- alue*
GPA
In e en ion
0.122
0.693
Con ol
-0.343
0.252
Age
In e en ion
-0.019
0.952
Con ol
-0.177
0.563
*Co ela ion is signi ican a he 0.05 le el (2- ailed).
Abb e ia ions: p- alue, p obabili y alue.
Discussion
This s udy e alua ed he e ec o simula ion-based
aining o he HIS inpa ien module on he in o ma ics
skills o nu sing s uden s be o e hei in e nship.
The esul s showed ha he HIS educa ion simula o
inc eased nu sing s uden s' skills wo king wi h he
hospi al in o ma ion sys em's inpa ien module. This
s udy ound ha a iables such as gende , age, and GPA
did no impac s uden s' in o ma ics skills.
In he p esen s udy, s uden s in he in e en ion g oup
acqui ed mo e skills in pe o ming asks in he inpa ien
module o he HIS han hose in he con ol g oup,
indica ing he use ulness o simula ion-based educa ion.
In his ega d, he esul s o a sys ema ic e iew s udy by
Nabo a i e al. [17] showed he posi i e impac o
simula o s on a ious ou comes, such as use s' skills in
using heal h in o ma ion sys ems. The esul s o a
p e ious s udy [14] showed ha aining using an EHR
simula o signi ican ly imp o ed he in o ma ics skills o
nu sing s uden s. A s udy by Repsha e al. [15] showed a
signi ican inc ease in sco es ela ed o nu sing s uden s'
in o ma ics compe ency a e using a simula ed EHR.
The esul s o ano he s udy also emphasized he
enhancemen o nu sing s uden s' in o ma ics
compe ency a e simula ion-based aining in EHR in
he i s yea [18].
In oday's wo ld, as HIS use becomes widesp ead o
enhance hospi al managemen , insu icien knowledge
and skills among use s—pa icula ly nu ses and
physicians—can lead o se e al nega i e consequences.
These include dec eased e iciency and was ed ime, an
inc eased likelihood o e o s (such as inco ec da a
en y) [19], educed mo i a ion and job sa is ac ion [20],
unde u iliza ion o he sys em's ull capabili ies [21, 22],
and challenges in iden i ying and esol ing echnical
issues [23]. These issues, in u n, lead o a decline in he
quali y o ca e [24, 25], inc eased cos s [23, 26], educed
in o ma ion secu i y [20], and epo ing p oblems wi hin
he o ganiza ion [26]. The e o e, using hese sys ems
wi hou su icien in o ma ics and compu e skills can
esul in se ious p oblems o bo h he use and he
o ganiza ion. The e o e, p ope aining o use s be o e
hey begin wo king wi h he sys em, especially hose
who a e mo e amilia wi h clinical p ocesses bu may
ha e less compu e knowledge, is c i ical [27]. T aining
in a sa e, low- isk en i onmen o pa ien s using
in e ac i e and ac i e lea ning me hods, such as di ec
sys em usage wi h immedia e eedback, is essen ial
compa ed o adi ional eaching me hods [28, 29]. This
app oach o e s lexibili y and accessibili y [30],
pa icula ly o nu ses wo king in di e en shi s o hose
wi h limi ed in-pe son aining esou ces. Fu he mo e,
s anda diza ion o aining o ensu e uni o m lea ning,
easy and e ec i e pe o mance assessmen , p ecise and
objec i e e alua ion o nu ses, epea abili y o aining
sessions, and ul ima ely cos educ ion p o ides g ea e
con ol o e he lea ning p ocess [31]. This leads o
educed s ess and anxie y [32], be e p epa edness o
eal-li e si ua ions [33], and a mo e e ec i e
imp o emen in in o ma ics skills compa ed o o he
aining me hods [19]. Conside ing hese posi i e
ou comes, i is ecommended ha simula ion-based HIS
aining be in eg a ed in o he cu iculum o nu sing
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s uden s, who will be u u e use s o hese sys ems.
Addi ionally, om he ou se o hei educa ion,
alongside p ac ical nu sing ca e skills, nu sing s uden s
should be in oduced o in o ma ics compe encies,
ecognizing he inc easing p ominence o new
echnologies in heal hca e in he in o ma ion age. To
maximize he e ec i eness o simula ion-based aining,
i is ad isable o complemen i wi h o he educa ional
me hods such as eal-wo ld exposu e and obse a ion o
sys em use in p ac ice.
To he bes o ou knowledge, his s udy is one o he i s
o explo e he impac o an HIS educa ion simula o on
nu sing s uden s' skills in using he inpa ien module o
documen nu sing se ices as u u e sys em use s.
Fu he mo e, he in e ac i e design o he sys em's use
in e ace enabled s uden s o eco d da a esembling a
eal sys em, guided by he de eloped scena ios, and
na iga e h ough o he ela ed p ocesses.
The limi a ions o his s udy include i s implemen a ion
a a single academic cen e , he sho du a ion o he
in e en ion, and he lack o an assessmen o nu sing
s uden s' baseline in o ma ics skills. Consequen ly, he
gene alizabili y and in e p e a ion o hese indings
should be app oached wi h cau ion.
Conclusion
The s udy demons a ed ha a hospi al in o ma ion
sys em aining simula o signi ican ly enhanced nu sing
s uden s' skills in u ilizing he HIS inpa ien module
be o e s a ing hei in e nship cou se.
P epa ing s uden s as u u e end-use s o hese sys ems
and inc easing hei skills and sel -con idence can
imp o e he quali y o heal hca e se ice deli e y and
pa ien heal h ou comes. The e o e, conside ing he
emphasis on he ole o sys ems in he managemen o
heal hca e se ings, i is ecommended ha simula ed
aining o he HIS be included in he educa ional
cu iculum o nu sing s uden s.
E hical conside a ions
This s udy was app o ed by he e hics commi ee o
Bi jand Uni e si y o Medical Sciences
(IR.BUMS.REC.1402.445).
The e is no pa ien in his s udy; all pa icipan s we e
s uden s. The s uden s' obse a ion o he aining and
comple ion o es s we e conside ed implici consen o
hei pa icipa ion in he s udy.
A i icial in elligence u iliza ion o a icle
w i ing
No.
Acknowledgmen
The au ho s hank all he s uden s who pa icipa ed in
he s udy.
Con lic o in e es s a emen
The au ho s decla e ha hey ha e no con lic o
in e es .
Au ho con ibu ions
RF, RA, and FGH concei ed and designed he s udy,
acqui ed and in e p e ed he da a, d a ed he manusc ip ,
and c i ically e ised i . RF and RA a anged he logis ics
o his s udy. RF, MM, and MR. we e esponsible o
collec ing and analyzing he da a. All i e au ho s ead
and app o ed he inal e sion o he submi ed
manusc ip .
Funding
The esea ch depu y a Bi jand Uni e si y o Medical
Sciences unded his s udy wi h g an numbe 6420.
Da a a ailabili y s a emen
The da ase s used and analyzed du ing he cu en s udy
a e a ailable in Pe sian om he co esponding au ho
upon easonable eques .
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Supplemn a y 1. A schema ic ep esen a ion o he simula ed use in e ace o he inpa ien module o a hospi al in o ma ion
sys em
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