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Is simulation training effective in increasing podiatrists' confidence in foot ulcer management?

Peter A Lazzarini123*, Elizabeth L Mackenroth26, Patricia M Régo45, Frances M Boyle6, Scott Jen7, Ewan M Kinnear2, Graham M PerryHaines5 and Maarten Kamp48

Author Affiliations

1 Allied Health Research Collaborative, Metro North Health Service District, Queensland Health, Australia

2 Department of Podiatry, Metro North Health Service District, Queensland Health, Australia

3 School of Public Health, Queensland University of Technology, Australia

4 School of Medicine, The University of Queensland, Australia

5 Clinical Skills Development Service, Centre for Healthcare Improvement, Queensland Health, Australia

6 School of Population Health, The University of Queensland, Australia

7 Department of Podiatry, Darling Downs-West Moreton Health Service District, Queensland Health, Australia

8 Department of Endocrinology, Metro North Health Service District, Queensland Health, Australia

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Journal of Foot and Ankle Research 2011, 4:16  doi:10.1186/1757-1146-4-16

Published: 5 June 2011



Foot ulcers are a frequent reason for diabetes-related hospitalisation. Clinical training is known to have a beneficial impact on foot ulcer outcomes. Clinical training using simulation techniques has rarely been used in the management of diabetes-related foot complications or chronic wounds. Simulation can be defined as a device or environment that attempts to replicate the real world. The few non-web-based foot-related simulation courses have focused solely on training for a single skill or "part task" (for example, practicing ingrown toenail procedures on models). This pilot study aimed to primarily investigate the effect of a training program using multiple methods of simulation on participants' clinical confidence in the management of foot ulcers.


Sixteen podiatrists participated in a two-day Foot Ulcer Simulation Training (FUST) course. The course included pre-requisite web-based learning modules, practicing individual foot ulcer management part tasks (for example, debriding a model foot ulcer), and participating in replicated clinical consultation scenarios (for example, treating a standardised patient (actor) with a model foot ulcer). The primary outcome measure of the course was participants' pre- and post completion of confidence surveys, using a five-point Likert scale (1 = Unacceptable-5 = Proficient). Participants' knowledge, satisfaction and their perception of the relevance and fidelity (realism) of a range of course elements were also investigated. Parametric statistics were used to analyse the data. Pearson's r was used for correlation, ANOVA for testing the differences between groups, and a paired-sample t-test to determine the significance between pre- and post-workshop scores. A minimum significance level of p < 0.05 was used.


An overall 42% improvement in clinical confidence was observed following completion of FUST (mean scores 3.10 compared to 4.40, p < 0.05). The lack of an overall significant change in knowledge scores reflected the participant populations' high baseline knowledge and pre-requisite completion of web-based modules. Satisfaction, relevance and fidelity of all course elements were rated highly.


This pilot study suggests simulation training programs can improve participants' clinical confidence in the management of foot ulcers. The approach has the potential to enhance clinical training in diabetes-related foot complications and chronic wounds in general.