Background Game-based simulation education is becoming an integral component in healthcare programs. It is defined as any educational activity implying simulation procedures to recreate clinical scenarios. Previous studies have shown that simulation can improve patient safety by enhancing healthcare providers' competencies. However, few studies have investigated students' perceptions of simulation within osteopathic programs. Aim This study aimed to measure and compare Year three osteopathy students’ perceptions of a game-based simulation versus traditional clinical training. Methods Year three students at the end of their 12 weeks clinical training were asked to participate in this research project. This included filling out a Likert-based survey and semi-structured interviews. Three clinical training modalities were implemented and evaluated: a demonstration clinic, a video-streamed demonstration clinic, and a game-based simulation, the clinical battle. Results Sixty-seven Year three osteopathy students completed the surveys, and eight students were interviewed. The clinical battle was significantly felt as the most engaging, most useful to gain feedback, and least stressful of the three training proposed (p<0.05). The clinical battle was also perceived as similar to a demonstration clinic to formulate a diagnosis and for reflective practice (p>0.05). The semi-structured interviews offered deep structured explanatory narratives depicted from thematic analyses. Five themes were identified: engagement, clinical reasoning improvement, stress, ideas for improving clinical training, and reflective practice and self-assessment. Conclusion The simulation-based training implemented in this study was positively perceived by students for their clinical education. Future research could focus on the effectiveness of game-based simulation versus traditional training on clinical competencies acquisition.

Objective: To compare changes in pressure pain threshold (PPT) following spinal high-velocity low-amplitude thrust manipulation (HVLAT) and spinal mobilisation.Design: Fifty asymptomatic subjects (mean age 27 (6) years; 29 males and 21 females) volunteered to participate in a randomised controlled, singled blinded design study. Subjects were screened for suitability and were randomly allocated into one of three intervention groups where they received either a unilateral spinal HVLAT or a spinal mobilisation of the lumbar spine, or a sham 'laser' procedure (control). PPT measurements were made immediately pre- and post-intervention, using a hand-held algometer which was positioned directly over the lumbar spinous process. A two-way ANOVA with repeated measures was conducted to determine PPT changes between the groups. Statistical significance was set at the 0.05 level.Results: There were no significant differences in PPT across time for each of the groups (P = 0.584). The mobilisation group displayed a small increase, though not a significant change in the mean pressure pain threshold (0.434(0.55) kg/cm(2)), although effect size was considered to be large (ES = 0.78). The HVLAT group demonstrated a decrease in the mean PPT (-0.173(0.48)) (ES = 0.36, small), and a smaller decrease was noted for the control group (0.105(0.425) kg/cm(2)) (ES = 0.25, small).Conclusion: Neither spinal HVLAT nor mobilisation had a significant effect on PPT of the lumbar spine in asymptomatic subjects. Only spinal mobilisation appeared to have a greater mean increase in PPT and effect size than the control group. Further investigation into the hypoalgesic effects of these techniques on symptomatic subjects is suggested. (C) 2008 Elsevier Ltd. All rights reserved.