Emotions in simulation-based education: friends or foes of learning?

Threshold-anxiety in medical students performing a prehospital high-fidelity clinical simulation: Randomized clinical trial

BACKGROUND

The aim of this study was to determine the delta anxiety index (pre- and post-simulation) of medical students performing prehospital critical care high-fidelity clinical simulations (sepsis, myocardial infarction, polytrauma and anaphylactic shock) case-by-case. The secondary outcome was to identify clinical scenarios resulting in extreme anxiety levels (> 25 % post-simulation vs. pre-simulation delta anxiety).

METHODS

A randomized (four prehospital critical care cases), blind, simulation-based clinical trial was performed at the Advanced Clinical Simulation Center of the Medical School of Valladolid University (Spain) with the participation of volunteer last-year medical students (6th year) from September 20, 2022, to April 15, 2024. The STAI questionnaire, epidemiological data and lifestyle habits were assessed. The principal outcome was the delta anxiety level (pre- and post-simulation) on the state subscale of the STAI.

RESULTS

A total of 342 participants met the inclusion criteria. The median age was 23 years (IQR: 23-24; range: 22-41), and 67.8 % were female (213 cases). Scenario-by-scenario analysis revealed no significant differences by sex, age, prior simulation training, or role in the simulated scenario (leader or assistant). The polytrauma scenario yielded the worst post-simulation evaluation on the state subscale of the STAI, with a median of 54 points (IQR: 46-66) (p < 0.001).

CONCLUSION

Polytrauma and anaphylactic shock scenarios are more likely to induce extreme anxiety levels in final-year medical students during high-fidelity clinical simulations. Educators must be aware of these potential anxiety levels and carefully design the scenarios, providing adequate preparation and facilitating effective debriefing to optimize learning and mitigate the negative effects of excessive anxiety.

Stirring the Sleeping Giant? an Evaluation of a Planetary Health Political Action Sequential Simulation for Nursing Students

The need for nurses to be political is as great as ever, however, nursing has a complicated relationship with politics and political action. This paper examines the impact of a sequential simulation learning activity that sought to transform students' values and attitudes towards political action in addressing Planetary Health issues. Adult and adult mental health nursing students from two British universities participated in the Political Action Sequential Simulation which had three scenarios related to either water or air pollution. Scenario one was clinical, while scenarios two and three were community- and policy-based, respectively. We used a pre-post design to gauge attitudes and values both before and after the intervention. Outcomes measures included Nurse Professional Value Scale-3, Political Efficacy - Short Scale, Perceived Political Self-Efficacy Scale - Short Form, Social Justice Scale and Internal Environmental Locus of Control scale. Of the 256 students who undertook the activity, 75 completed both pre and post-measures. Significant shifts across all scales except the social justice scale were found, meaning that students' attitudes towards political action, their beliefs in their ability to take political action, and in particular, action related to the environment shifted significantly after the sequential simulation. We discuss these results in the context of the broader literature, reflect on some of the reasons why these shifts occurred and consider the implications for nursing education and practice.

Bridging the gap: Leveraging simulation expertise to improve active learning environments

Introduction

Active learning engages learners in constructing knowledge through interactive strategies such as simulation, small-group discussion, and peer instruction. Although recognized as a superior approach to traditional passive learning, its adoption has been inconsistent. Barriers include reliance on traditional lectures, lack of training, and limited time to develop materials. Simulation educators have a unique skill set that may inform and support active learning initiatives.

Methods

Fifteen emergency medicine simulation experts convened to define the unique skill set of simulation educators and identify transferable simulation-based medical education (SBME) skills and concepts to promote effective active learning beyond the simulation lab. Workgroup members are simulation education directors who have undergone specialized training in SBME. During biweekly meetings over 6 months, workgroup members reviewed primary literature in SBME and active learning, along with relevant simulation educator training materials. Objectives were achieved through iterative review, group conceptualization, and expert consensus.

Unique treatment

The increasing prevalence of SBME in medical education, along with the growth of simulation fellowships, has produced a group of education experts with shared competencies. Simulation educators acquire expertise in psychological safety, facilitation, communication, and debriefing, through specialized training and extensive experience. These skills are critical for active learning environments where learners benefit from structured, engaging, and psychologically safe experiences.

Implications for educators

Key transferable SBME topics were identified for use in active learning environments outside of the simulation lab: (1) psychological safety, (2) facilitation strategies, and (3) communication techniques. Transferable tools and concepts were identified to promote efficacy and learner engagement during active learning in diverse environments. Simulation educators' expertise is an underutilized resource for faculty development initiatives aimed at advancing active learning. This work advocates for leveraging simulation educators' skills to close the active learning implementation gap, enhance learner outcomes, and meet the evolving needs of contemporary medical education.

The Physiologic Effect of Augmented Reality Simulation Versus Traditional Simulation: A Noninferiority, Randomized Controlled Trial

Background

Traditional medical simulations leverage stressful scenarios to potentiate memory. Augmented reality (AR) simulations provide cost-effective experiences using holograms instead of mannequins. This study investigated the physiologic response to AR simulations.

Methods

This was a noninferiority, controlled trial at an academic, pediatric hospital in Northern California among health care workers randomized to AR or traditional, in situ medical simulations. The primary outcome investigated parasympathetic tone. Biometric sensors assessed parasympathetic tone as respiratory sinus arrhythmia (RSA). A difference in RSA of less than 10% between groups was considered noninferior. Secondary outcomes explored usability, ergonomics, satisfaction, and recall with the System Usability Scale (SUS), ISO 9241-400, Simulation Design Scale (SDS), and an electronic questionnaire 5 months after the intervention, respectively.

Results

A total of 111 participants were enrolled and 106 analyzed. Both groups experienced a decrease in mean RSA from baseline to during the simulation (P < .001 for both groups). Subsequently, there was an increase in RSA from the simulation period to the recovery period (P < .001 for the AR group and P = .035 for the traditional group). Regarding secondary outcomes, the mean SUS score of 70.5 suggested good usability, 65.38% of AR participants reported feeling comfortable using the headset, and satisfaction in both groups was similar except for differences in use of real-life factors. The recall assessment was completed by 12 AR and 15 traditional participants, with similar scores between the 2 groups (P = .4).

Conclusions

AR simulations produced a noninferior change in parasympathetic tone compared with traditional simulations. Future investigations may explore the effectiveness of AR simulations for developing nontechnical skills during remote training. (Registration: Clinical Trials Registry NCT05674188.).

More than a feeling: emotional regulation strategies for simulation-based education

Simulation-based education often involves learners or teams attempting to manage situations at the limits of their abilities. As a result, it can elicit emotional reactions in participants. These emotions are not good or bad, they simply are. Their value at any given moment is determined by their utility in meeting the goals of a particular situation. When emotions are particularly intense, or a given emotion is not aligned with the situation, they can impede learners' ability to engage in a simulation activity or debriefing session, as well as their ability to retain knowledge and skills learned during the session. Building on existing guidance for simulation educators seeking to optimize the learning state/readiness in learners, this paper explores the theory and research that underpins the practical application of how to recognize and support learners' emotions during simulation sessions. Specifically, we describe the impact of various emotions on the cognitive processes involved in learning and performance, to inform practical guidance for simulation practitioners: (1) how to recognize and identify emotions experienced by others, (2) how to determine whether those emotional reactions are problematic or helpful for a given situation, and (3) how to mitigate unhelpful emotional reactions and leverage those that are beneficial in achieving the goals of a simulation session.

Peer Emotion in Collaborative Simulation Among Nursing Students

BACKGROUND

The emotional experiences of nursing students are linked to learning outcomes. Peer learning is a key component of nursing education and simulation. However, little is known about the emotions of students in the context of peer learning. This study sought to provide an in-depth description of nursing students' emotional experiences when participating with another peer in a simulation activity.

METHOD

Data were obtained from a study of peer collaborative clinical decision making in simulation. All data related to emotions were extracted, summarized, and interpreted using thematic analytic techniques.

RESULTS

Six themes were identified: (1) experiencing a multitude of emotions; (2) hiding emotions; (3) suppressing emotions; (4) revealing emotions; (5) perceiving peers' emotions; and (6) absorbing peers' emotions.

CONCLUSION

This study highlights the importance of peer emotion in collaborative simulation and renders important implications for nursing education. [J Nurs Educ. 2024;63(11):746-754.].

Assessing satisfaction in simulation among nursing students: psychometric properties of the Satisfaction with Simulation Experience - Italian Version scale

BACKGROUND

The Satisfaction with Simulation Experience scale is a 5-point Likert scale that measures students' satisfaction in medium and high-fidelity simulation scenarios. This study aims at investigating the psychometric properties of the Satisfaction with Simulation Experience - Italian Version scale.

METHODS

A multi-centre cross-sectional study was conducted. The scale was administered to a sample of 266 undergraduate nursing students from two Italian universities after attending a medium- and high-fidelity simulation session in November 2022 and March 2023. Cronbach's alpha coefficient and item-total correlation were sorted out to assess internal consistency and reliability. The test-retest method was used as a measure of scale stability over time as well as the confirmatory factor analysis to verify construct validity.

RESULTS

The Cronbach's alpha value was 0.94 for the overall scale, indicating excellent reliability, and it was 0.84 or higher for each subscales, indicating good reliability. A large correlation coefficient of 0.60 or higher was found between each item and its subscale and between each item and the overall scale score. A medium test-retest correlation coefficient was found for most items (r > 0.30). The confirmatory factor analysis confirmed the factorial structure found in the original study.

CONCLUSIONS

Satisfaction is an important teaching and learning quality indicator along with the achievement of learning outcomes in simulation. The Satisfaction with Simulation Experience - Italian Version scale showed good reliability and validity; therefore, it could be a useful tool to assess simulation impact in Italian nursing students. The extensive utilization of the Satisfaction with Simulation Experience scale, along with its various validated versions, could facilitate assessing satisfaction in simulation across diverse contexts and enable comparisons of findings across studies in different countries.

Emergency airway management in the prone position: an observational mannequin-based simulation study

INTRODUCTION

Accidental extubation during prone position can be a life-threatening emergency requiring rapid establishment of the airway. However, there is limited evidence of the best airway rescue method for this potentially catastrophic emergency. The aim of this study was to determine the most effective method to recover the airway in case of accidental extubation during prone positioning by comparing three techniques (supraglottic airway, video laryngoscopy, and fiber-optic bronchoscopy) in a simulated environment.

METHODS

Eleven anesthesiologists and 12 anesthesia fellows performed the simulated airway management using 3 different techniques on a mannequin positioned prone in head pins. Time required for definitive airway management and the success rates were measured.

RESULTS

The success rates of airway rescue were 100% with the supraglottic airway device (SAD), 69.6% with the video laryngoscope (CMAC), and 91.3% with the FOB. The mean (SD) time to insertion was 18.1 (4.8) s for the supraglottic airway, 78.3 (32.0) s for the CMAC, and 57.3 (24.6) s for the FOB. There were significant differences in the time required for definitive airway management between the SAD and FOB (t = 5.79, p < 0.001, 95% CI = 25.92-52.38), the SAD and CMAC (t = 8.90, p < 0.001, 95% CI = 46.93-73.40), and the FOB and CMAC (t = 3.11, p = 0.003, 95% CI = 7.78-34.25).

CONCLUSION

The results of this simulation-based study suggest that the SAD I-gel is the best technique to manage accidental extubation during prone position by establishing a temporary airway with excellent success rate and shorter procedure time. When comparing techniques for securing a definitive airway, the FOB was more successful than the CMAC.

Relinquishing control? Supervisor co-regulation may disrupt students' self-regulated learning during simulation-based training

When uncertain, medical trainees often seek to co-regulate their learning with supervisors and peers. Evidence suggests they may enact self-regulated learning (SRL) strategies differently when engaged in self- versus co-regulated learning (Co-RL). We compared the impacts of SRL and Co-RL on trainees' acquisition, retention, and preparation for future learning (PFL) of cardiac auscultation skills during simulation-based training. In our two-arm, prospective, non-inferiority trial, we randomly assigned first- and second-year medical students to the SRL (N = 16) or Co-RL conditions (N = 16). Across two learning sessions separated by two-weeks, participants practiced and were assessed in diagnosing simulated cardiac murmurs. We examined diagnostic accuracy and learning trace data across sessions, and conducted semi-structured interviews to explore participants' understandings of their underlying choices and learning strategies. SRL participants' outcomes were non-inferior to Co-RL participants on the immediate post-test and retention test, but not on the PFL assessment (i.e., inconclusive). Analyzing interview transcripts (N = 31) generated three themes: perceived utility of initial learning supports for future learning; SRL strategies and sequencing of murmurs; and perceived control over learning across sessions. Co-RL participants regularly described relinquishing control of learning to supervisors and regaining it when on their own. For some trainees, Co-RL seemed to interfere with their situated and future SRL. We posit that transient clinical training sessions, typical in simulation-based and workplace-based settings, may not allow the ideal processes of Co-RL to unfold between supervisor and trainee. Future research must examine how supervisors and trainees can share accountability to develop the shared mental models that underlie effective Co-RL.

"It´s like walking in a bubble", nursing students´ perspectives on age suit simulation in a home environment - group interviews from reflection seminars

BACKGROUND

Older persons with age-related and complex health problems will increasingly depend on care provision from nurses in their own homes. However, a barrier to quality care is ageism and nursing students´ disinterest in geriatrics. In addition, nurse education often falls short in preparing students for the complexity of geriatric care. Welfare technology (WT) is progressively implemented in home care to help older persons live at home despite their health problems. However, this process is intricate and requires acceptance and digital literacy among caregivers and older persons. Despite these challenges, nurse education can address and change negative attitudes through innovative teaching methods such as age suit simulation. Therefore, the study aims to describe nursing students´ experiences of age suit simulation in a home-like environment with WT and technical aids, and will reveal their perspective on ageing and providing care to older adults.

METHODS

A qualitative explorative design using semi-structured group interviews (n=39) among nursing students. Data was analysed through reflexive thematic analysis.

RESULTS

The analysis generated three main themes; "It's like walking in a bubble", "An eye opener" and "Concerns about ageing and the current structure of geriatric care". The main themes included eight subthemes. Adapting to the sensory and physical limitations of the age suit was an immersive experience and caused feelings of frustration, loneliness and disconnection. A prominent result was a raised awareness of cognitive loss, especially impaired vision, and students felt the simulations had made them aware of the everyday challenges older persons faced. Students highlighted the importance of patience and giving enough time in care situations by being present and having a critical perspective of WT. The students were mostly negative towards their own ageing and could better relate to older persons´ vulnerability.

CONCLUSIONS

Age suit simulation was described as an embodied and eye-opening experience, raising nursing students´ awareness of older persons´ functional limitations and the consequences for dignity and independence. Coping with cognitive loss was especially difficult. Students were motivated to apply their new knowledge to clinical practice. Age suit simulation can complement geriatric education, preparing students for the complex care needs of older persons.

Nursing students experienced academic emotions during education - a longitudinal descriptive study from a nursing bachelor's program in Sweden

AIM

To explore nursing students' academic emotions during ongoing learning activities focusing on perceived challenge and competence.

BACKGROUND

Emotions plays an important part in learning. Positive emotions can be beneficial while negative emotions can be detrimental to educational outcomes. Optimal experiences are situations when learners simultaneously experience sufficient challenge and competence. Since various learning activities are performed in different learning environments during the nursing program, it is of interest to investigate students' ongoing emotions in the occurring contexts.

DESIGN

A longitudinal descriptive study.

METHODS

By using the Contextual Activity Sampling System, data was collected every third week on a three-year nursing program. From August 2015 to January 2020, a total of 2, 947 questionnaires were answered by 158 students. Experiences of positive and negative academic emotions were calculated for the entire program. Optimal experience was calculated for courses where high discrepancy between positive and negative experiences were identified.

RESULTS

Students self-reported academic emotions varied over time and in relation to learning activities. High ratings of negative emotions were reported during clinical practice in all semesters except the final. Students' positive academic emotions and optimal experience in clinical practice increased after having deepened their academic knowledge.

CONCLUSION

Nursing students had an increased positive experience when they themselves practice a learning activity and it appeared that they benefit from academic preparation prior to entering internship. Nursing students need an academic competence to develop their skills during training in the clinical reality. Increased collaboration between academia and clinic would be beneficial for students' clinical development.

The impact of brief mindfulness meditation on anxiety, cognitive load, and teamwork in emergency simulation training: A randomized controlled trial

BACKGROUND

Emergency simulation training may impose a heavy psychological burden on health professions students (HPS), evoking anxiety, and overwhelming their cognitive load. Mindfulness may have a positive impact on HPS' anxiety, cognitive load, and teamwork during simulation training. The effects of integration of a brief pre-briefing mindfulness meditation (MM) practice into emergency simulation training, on anxiety, cognitive load, and teamwork remain understudied.

METHODS

From November 2021 to June 2022, 70 undergraduate HPS participated in this pilot randomized controlled study. Participants were randomly assigned to the experimental group (EG, n = 24) that completed a brief in-person mindfulness meditation training program (MMTP) (2 h/week during 4 weeks) or a control group (CG, n = 46). Each group was comprised of teams (2 medical students and 1-2 nursing students). Measures of anxiety, mindfulness, cognitive load, and teamwork were collected at 4-time points: baseline, after the completion of the brief MMTP (for the EG only), at the first simulation assessment within one month later, and the second (6-month follow-up) simulation assessment. Student's t and Wilcoxon Mann-Whiney tests were used to compare the groups' measures and changes over time. A one-way repeated measures ANOVA was conducted to assess anxiety and mindfulness scores' changes over time among EG participants.

RESULTS

52 participants completed all time-point assessments. EG participants recorded better state-anxiety, cognitive load, and teamwork scores than the CG participants in both simulation assessments. However, no statistically significant differences were recorded between the EG and the CG in trait-anxiety and mindfulness at the 6-month follow-up assessment.

CONCLUSION

Brief pre-briefing MM practice mitigates HPS' state-anxiety, and promotes cognitive load, and teamwork during emergency simulation training. Simulation instructors should consider MM practice in the emergency healthcare simulation instructional design.

Evaluation of tracheostomy suctioning procedure among nursing and respiratory therapy students: wearable manikin vs. standard manikin

Introduction

This study aims to evaluate cognitive load (CL), emotional levels (EL), and stress levels (SL) of students when using a wearable manikin vs. a standard manikin for tracheostomy suctioning (TS).

Methods

This study was approved by the Institutional Review Board. Subjects were recruited by email. Subjects completed a baseline demographics questionnaire, then they were randomized into two groups: wearable manikin group (WMG) or standard manikin group (SMG). For the WMG, an actor simulated a patient by wearing the device. In phase I, both groups were educated on how to perform TS by video and offered hands-on practice. Then I put through a tracheostomy suctioning clinical simulation and completed a post sim-survey. In phase II, the same survey was repeated after encountering a real patient as part of their clinical rotation.

Results

A total of 30 subjects with a mean age 26.0 ± 5.5 years participated. 20 (66.7%) were respiratory care students and 10 (33.3%) were nursing students. In the WMG, the median stress level dropped significantly post phase II compared to post phase I [2(1,4) vs.3(1,5), p = 0.04]. There were no significant changes in median CL, confidence, and satisfaction levels between post phase II and post phase I (p > 0.05). In the SMG, the satisfaction level increased significantly post phase II compared to post phase I [5(4,5) vs.4(2,5), p = 0.004], but there were no significant changes in CL, SL, and confidence levels between post phase I and phase II. There was no significant difference in mean EL scores over time and these changes did not differ by group. Subjects in the WMG showed a higher mean competency score than those in the SMG (85.5 ± 13.6 vs. 78.5 ± 20.8, p = 0.14, Cohen's d = 0.4), yet not significant.

Conclusion

Our results showed that the WMG is beneficial in helping bridge the gap of learning TS from the sim setting to the real-world clinical setting. More studies with higher sample size and use of other CL scales that assesses the different types of CL are needed to validate our findings.

Unlocking the learning potential of simulation-based education

Simulation is ubiquitous in the training of hospital-based doctors worldwide, often focusing on an individual level in traditional 'skills and drills'-based training. However, there has been an expansion in the use of simulation in healthcare practice and training. Simulation is being adopted into many disciplines that traditionally have not used this form of experiential learning. Moreover, simulation is increasingly being harnessed to enhance team and organisational learning in hospital-based practice. This article shares some insights into simulation-based education and makes the 'familiar unfamiliar' about this important method of learning. The aim is to broaden readers' outlook about what simulation has to offer beyond the classic notion of skills and drills-based training.

Twelve tips for the pre-brief to promote psychological safety in simulation-based education

It is recognised that simulation-based education can be stressful, and this can impact negatively on learning. A fundamental aspect of facilitating simulation is creating a safe educational environment. Edmondson's seminal work on creating psychological safety among interpersonal teams has been embraced by the healthcare simulation community. Psychological safety is an underpinning philosophy for creating simulation experiences in which learners can develop within a stimulating and challenging yet supportive social atmosphere. Through careful design and thoughtful delivery, the introductory phase of simulation, the pre-briefing, can effectively prepare learners for simulation, reduce learner anxiety, and promote psychological safety, to enhance learning experiences. These twelve tips provide guidance for conducting a pre-brief and promoting a psychologically safe environment for simulation-based education.

A scoping review of emotions and related constructs in simulation-based education research articles

BACKGROUND

While acknowledgement of emotions' importance in simulation-based education is emerging, there are concerns regarding how education researchers understand the concept of emotions for them to deliberately incorporate emotionally charged scenarios into simulation-based education. This concern is highlighted especially in the context of medical education often lacking strong theoretical integration. To map out how current simulation-based education literature conceptualises emotion, we conducted a scoping review on how emotions and closely related constructs (e.g. stress, and emotional intelligence) are conceptualised in simulation-based education articles that feature medical students, residents, and fellows.

METHODS

The scoping review was based on articles published in the last decade identified through database searches (EMBASE and Medline) and hand-searched articles. Data extraction included the constructs featured in the articles, their definitions, instruments used, and the types of emotions captured. Only empirical articles were included (e.g. no review or opinion articles). Data were charted via descriptive analyses.

RESULTS

A total of 141 articles were reviewed. Stress was featured in 88 of the articles, while emotions and emotional intelligence were highlighted in 45 and 34 articles respectively. Conceptualisations of emotions lacked integration of theory. Measurements of emotions mostly relied on self-reports while stress was often measured via physiological and self-report measurements. Negative emotions such as anxiety were sometimes seen as interchangeable with the term stress. No inferences were made about specific emotions of participants from their emotional intelligence.

CONCLUSIONS

Our scoping review illustrates that learners in simulation-based education are most often anxious and fearful. However, this is partially due to medical education prioritising measuring negative emotions. Further theoretical integration when examining emotions and stress may help broaden the scope towards other kinds of emotions and better conceptualisations of their impact. We call for simulation education researchers to reflect on how they understand emotions, and whether their understanding may neglect any specific aspect of affective experiences their simulation participants may have.

Case study of virtual reality sepsis management- instructional design and ITEM outcomes

This case study focuses on the instructional design and outcomes of a virtual reality (VR) application for sepsis management in healthcare education. The instructional design of the VR sepsis application follows five principles adapted from Merrill's instructional design theory and Bloom's taxonomy. The VR simulation is structured to provide a coherent and realistic experience, with instructional materials and feedback incorporated to guide and support the learners. A pilot study was conducted with medical students on clinical placement. Participants experienced the VR sepsis simulation and completed a questionnaire using the Immersive Technology Evaluation Measure (ITEM) to assess their immersion, intrinsic motivation, cognitive load, system usability, and debrief feedback. Descriptive analysis of the data showed median scores indicating high immersion and presence, intrinsic motivation, and perceived learning. However, participants reported a moderately high cognitive load. Comparison with a neutral response to ITEM suggested that users had a significantly higher user experience (p <  0.05) in all domains. This case study highlights the potential of VR in healthcare education and its application in sepsis management. The findings suggest that the instructional design principles used in the VR application can effectively engage learners and provide a realistic learning experience. Further research and evaluation are necessary to assess the impact of VR on learning outcomes and its integration into healthcare education settings.

In situ simulation-based team training and its significance for transfer of learning to clinical practice-A qualitative focus group interview study of anaesthesia personnel

BACKGROUND

Anaesthesia personnel are an integral part of an interprofessional operating room-team; hence, team-based training in non-technical skills (NTS) are important in preventing adverse events. Quite a few studies have been done on interprofessional in situ simulation-based team training (SBTT). However, research on anaesthesia personnel's experiences and the significance for transfer of learning to clinical practice is limited. The aim of this study is to explore anaesthesia personnel's experience from interprofessional in situ SBTT in NTS and its significance for transfer of learning to clinical practice.

METHODS

Follow-up focus group interviews with anaesthesia personnel, who had taken part in interprofessional in situ SBTT were conducted. A qualitative inductive content analysis was performed.

RESULTS

Anaesthesia personnel experienced that interprofessional in situ SBTT motivated transfer of learning and provided the opportunity to be aware of own practice regarding NTS and teamwork. One main category, 'interprofessional in situ SBTT as a contributor to enhance anaesthesia practice' and three generic categories, 'interprofessional in situ SBTT motivates learning and improves NTS', 'realism in SBTT is important for learning outcome', and 'SBTT increases the awareness of teamwork' illustrated their experiences.

CONCLUSIONS

Participants in the interprofessional in situ SBTT gained experiences in coping with emotions and demanding situations, which could be significant for transfer of learning essential for clinical practice. Herein communication and decision-making were highlighted as important learning objectives. Furthermore, participants emphasized the importance of realism and fidelity and debriefing in the learning design.

Exploring participant experience to optimize the design and delivery of stress exposure simulations in emergency medicine

Objectives

Emergency department (ED) teams frequently perform under conditions of high stress. Stress exposure simulation (SES) is specifically designed to train recognition and management of stress responses under these conditions. Current approaches to design and delivery of SES in emergency medicine are based on principles derived from other contexts and from anecdotal experience. However, the optimal design and delivery of SES in emergency medicine are not known. We aimed to explore participant experience to inform our approach.

Methods

We performed an exploratory study in our Australian ED with doctors and nurses participating in SES sessions. We used a three-part framework-sources of stress, the impacts of that stress, and the strategies to mitigate-to inform our SES design and delivery and to guide our exploration of participant experience. Data were collected through a narrative survey and participant interviews and analyzed thematically.

Results

There were 23 total participants (doctors n = 12, nurses n = 11) across the three sessions. Sixteen survey responses and eight interview transcripts were analyzed, each with equal numbers of doctors and nurses. Five themes were identified in data analysis: (1) experience of stress, (2) managing stress, (3) design and delivery of SES, (4) learning conversations, and (5) transfer to practice.

Conclusions

We suggest that design and delivery of SES should follow health care simulation best practice, with stress adequately induced by authentic clinical scenarios and to avoid trickery or adding extraneous cognitive load. Facilitators leading learning conversations in SES sessions should develop a deep understanding of stress and emotional activation and focus on team-based strategies to mitigate harmful impacts of stress on performance.