Publication Date


Date of Final Oral Examination (Defense)


Type of Culminating Activity


Degree Title

Doctor of Education in Educational Technology


Educational Technology

Major Advisor

Brett E. Shelton, Ph.D.


Lida Uribe-Flórez, Ph.D.


Patrick Lowenthal, Ph.D.


Radiography education programs are designed to prepare students to perform radiographic examinations and acquire diagnostic medical images of real patients in the clinical setting. Radiographic Science (RS) education, like all healthcare education, is uniquely different from education in other professional fields. Students must not only acquire the technical, cognitive learning required, but they must also master the psychomotor skills necessary to apply didactic knowledge to patients in a clinical setting. In medical imaging, when students are hesitant or lack knowledge and skills they are prone to produce images with decreased quality or expose patients to unnecessarily high amounts of radiation. RS educational programs should establish a way to improve students’ competence in terms of radiographic examinations as part of preparing students (i.e. self-efficacy and positioning skills) to enter a clinical setting.

Research suggests simulation helps develop competence in RS students prior to demonstrating that competence on real patients in the clinical setting. Simulations, aka real life simulated learning scenarios, use mannequins, phantoms, and/or people to practice radiographic positioning. Virtual simulation is a new educational tool which has the potential to help supplement deficiencies in traditional simulation. Virtual simulation uses technology enhanced simulation through the medium of a computer software program. Leveraging all the benefits of traditional simulation, virtual simulation decreases the demands for time, space, and equipment as compared to traditional simulation and has the added benefits of “anytime, anywhere” flexibility, scalability, scaffolding, and presenting unique or unusual scenarios to students. Many studies evaluating the use of virtual simulation have been performed in various medical education disciplines; however, little empirical research has been performed in the field of RS education.

The purpose of this study was to investigate first year radiography students’ perceptions of their own self-efficacy and clinical skills after using a virtual radiography simulation in an undergraduate radiography course. A mixed-methods research design was used following an explanatory sequential research model to investigate students’ perceptions of their own self-efficacy and positioning skills after using the virtual radiographic positioning simulation software program MedspaceXR. Students’ self-efficacy and clinical skills were based on the perceptions of students evaluated through a survey instrument and follow-up interviews built on the tenets of Activity Theory (AT). Students were given access to the virtual simulation program to use on their own in addition to their normal didactic coursework. Participants included first year radiography students in one cohort of a RS education program in the intermountain West; 13 students responded to the survey, and 8 students were selected for interviews.

The findings for this study have many implications for both radiographic science educators and for radiographic science students. While no simulation or education can fully replace actual experience, the results of this study showed students benefit from practice in a safe and risk free environment before performing exams on real patients. When implementing a virtual simulation program educators should help mitigate the negative effects of using a new technology program by providing adequate direction and instruction to students. Educators should also find ways to help students “buy in” to using a virtual simulation program, as research results showed students self-efficacy and positioning skills increased the more they used the simulation program. This study indicates students felt the virtual simulation was a good addition to, but should not be a replacement for, traditional laboratory positioning practice. The conclusions drawn from this research can help provide educators a base of information on how students perceive their own clinical readiness after using a virtual simulation program and can guide further research studies of virtual simulation in health care education.