Debra Nestel

• PhD FSSH
• Professor at Monash University (Australia)

Introduction: There is growing evidence that instruction and guidance during simulation engagement can enhance explicit and subtle procedural knowledge and skills, medical knowledge, situation awareness and organization, and observation and reflection. However, instruction and guidance to scaffold learners during simulation engagement receive limit...

While the focus of this book is on older adults as simulated participants (SPs), in this chapter, we step back and share important considerations for supporting learning through conversations. The phrase learning conversation implies some sort of exchange between participants—as learners, SPs, and other faculty. However, this chapter is largely des...

Programme evaluation (PE) refers to the systematic use of social research methods to investigate the effects of a programme to provide evidence about the ‘value’ of a programme while also identifying recommendations for change and continuous improvement. PE takes place for many reasons, including examining the need for a programme, examining a prog...

In this chapter, we orient readers to key concepts in scenario design, the most common format for older SP participation in healthcare simulations. We view scenario design as spanning every phase of simulation practice, including planning considerations, the scenario itself (the story line), briefing all those involved, implementation, feedback/deb...

This chapter describes the work of older adult simulated participants (SPs) reported in literature. Older adult SPs are those who are 60 years of age or older. Working with older adult SPs in healthcare students’ and providers’ education can promote authenticity and learner engagement. The chapter builds on findings from a scoping review undertaken...

While Chap. 5 addresses faculty considerations during learning conversations, this chapter explores ways in which those who work with SPs can best support them in feedback practices. While the focus in this chapter targets the SP and their provision of feedback, we recognise that it usually occurs as part of a dynamic exchange between older adult S...

This book focuses on the role of older adult simulated participants (SPs) in simulations, especially but not exclusively in the care of older adults. This chapter introduces essential concepts related to working with older adult SPs, including key terms. It summarizes key considerations in working with older adult SPs, shares the origins of the boo...

This book was designed as a resource for anyone working with older adult SPs and/or simulation related to the care of older adults. We purposefully focused on integration of evidence-informed SP methodology practices, relevant clinical evidence of aging, and evidence-based care related to the care of older adults. In this chapter we focus on challe...

Background: Providing feedback is a key aspect of simulated participants' (SPs) educational work. In teaching contexts, the ability to provide feedback to learners is central to their role. Suboptimal feedback practices may deny learners the valuable feedback they need to learn and improve. This scoping review systematically maps the evidence rela...

Adult simulated patients (SPs) are now embedded in health professions education, prompting the development of practice standards. The comparatively sparse involvement of children and young people as simulated participants in education may account for the absence of standards to underpin their safe practice. Research suggests that children and young...

Introduction Health professional students may commonly encounter cognitive dissonance when they leave university and enter clinical placement. The primary aim was to understand if education and placement impact health professional student's knowledge of falls prevention evidence base. Theoretical Framework The research design was a repeated-measur...

Background Real patients in clinical placements are important for learning and may well be the ‘gold standard’. However, simulated patients (SPs) are a viable alternative in the absence of this opportunity. While adult SPs contribute to health professions education, child and adolescent simulated patients (CASPs) are less common. This research aims...

Background Simulation-based education (SBE) has many benefits for learners, but costs can limit embedding SBE in health professional curricula. Peer simulation involves students portraying patient roles, and may reduce costs while still providing the benefits of other SBE experiences. However, the quality of the SBE may be impacted if students cann...

Introduction Simulation-based education (SBE) benefits learners, but multiple barriers limit curriculum integration. Peer simulation, where students are formally educated to portray patient roles in simulated interactions with their peers, might maintain the educational benefits of SBE, be cost-effective, and enable additional learning. Our researc...

Background Simulation is reported as an appropriate replacement for a significant number of clinical hours in pregraduate programmes. To increase access for learners, educators have looked to understanding and improving learning in observer roles. Studies report equivalent learning outcomes and less stress in observer roles. However, reports on the...

Adolescent simulated patients (SPs) work in an environment where complex and dynamic power relationships are at play. These relationships differ to those encountered in clinical practice. Instead of health professionals exerting their power from a foundation resting on knowledge, to a patient consumed with worry, SPs in simulation scenarios often h...

Background Learners should be exposed to the core principles of adolescent specific communication and assessment frameworks as part of health professional curricula. How this is done can vary considerably, but the inclusion of adolescents seems an ideal and realistic option. However, securing their participation can be challenging. A viable option...

Background: Urological surgical trainees who underperform are difficult to identify, manage and require significant resources in an already stretched system relying on pro bono supervisors that often have no formal training. While there are commentaries on how to manage underperforming surgical trainees, there is a lack of data detailing the compl...

Introduction: Simulated patients (SPs) are individuals who have learned to realistically portray patient roles in health professional education. Program recommendations are increasing for simulation programs, and as key stakeholders, SPs' perspectives seem underrepresented. The aim of the study was to explore the experiences, perspectives, and pra...

More than explanatory frameworks, Brown and Nestel argue that myths and theories create shared narratives that sustain particular values and political agendas. Understanding this, helps us know what values we prioritise.

This book compiles the state of the art and science of health professions education into one truly international resource with expertise in many and varied topics. It aligns profession specific contributions with inter-professional offerings, and prompts readers to think deeply about their educational practices. The book explores the contemporary c...

Background Virtual patients are a recent addition to the educational arsenal to develop non-technical skills in undergraduate health professionals. The Virtual Simulated Patient Resource (www.vspr.net.au) is a web-based resource that uses branching, narrative virtual patients to develop knowledge, attitude and practice of all categories of non-tech...

Introduction: Simulation in community care is a relatively understudied area. In this paper, we report a qualitative evaluation of the Simulated Client Interprofessional Education (SCIPE) program in a community clinic for undergraduate health and social care students in a rural setting. We sought to explore the stakeholders' perceptions and experi...

A main reason for writing a research proposal is to obtain funding or other non-monetary support. For this chapter, the purpose and predominant theme of writing a research proposal is for obtaining funds to support the research project. Many of our readers already know there is no one research proposal “formula” that can be applied to all funding a...

Research makes a critical contribution to healthcare simulation. Many simulation educators and practitioners wish to start researching but are not sure where to begin. This book has provided many approaches. In this chapter, we introduce practical strategies for individuals new to healthcare simulation research to help navigate the social dimension...

This chapter reviews the major developments and milestones in simulation research over the last 20 years. While we acknowledge that simulation has many applications outside education, our focus in this chapter is on documenting contemporary history with a strong education focus. We first outline major developments in medicine and nursing. We consid...

In this chapter, we offer guidance on the processes of peer review for scholarly publications. We explore the purpose of peer review and summarise approaches from healthcare simulation journals. We position the role of reviewer as one of privilege and responsibility. We illustrate reviewer reports and set expectations for approaches to author respo...

Having reviewed each chapter in this book, thinking about the future of surgical education is a truly exciting prospect. Across the four parts, authors have made offerings on various topics from the past and the present. In this final part, the previous chapter considered the state of surgical education in 2030 while here we shift our focus to the...

The surgeon as educator faces the challenges of adequately preparing the next generation of surgeons while maintaining a busy practice and keeping up with the latest developments and innovations of the field through familiarity with best evidence in literature. This book helps with keeping up with the latest best evidence in education research and...

Building on ideas from Chaps. 30 to 36, we offer worked examples of high-standard qualitative research in surgical education to illustrate key concepts underpinning their design, execution and presentation but also essentially how they achieve coherence through these activities. A key goal is to forward the idea that a significant proportion of sur...

In this chapter, we share the theoretical notion of Community of Practice. We apply the theory to surgical training and use examples from Australia and the United Kingdom (UK). We summarize surgical training approaches then outline the theory and provide illustrations of how Community of Practice theory informs surgical training. By applying the th...

This chapter explores a constructivist theory that can inform the design of surgical education and training programs, especially to address areas of particular challenge. Threshold concepts, troublesome knowledge and threshold capability are introduced and illustrated in paediatric surgical training and transition to cardiothoracic surgical practic...

In this chapter, we define program evaluation, address its role in evaluating surgical education programs, describe important early steps surgical program evaluators can take to improve the usefulness of program evaluation, discuss common challenges, and offer solutions evaluators can use to overcome these challenges. The chapter is intended for th...

In this chapter, we focus our attention on qualitative research related to healthcare simulation. This chapter explores two related approaches to analysing qualitative data – thematic analysis and qualitative content analysis. Both of these methods are commonly used in qualitative research, and are considered relatively accessible forms of analysis...

Supervision is an important facet of research. Highly relational in nature, it has the potential to provide rich experiences for all involved. The supervisory relationship has an important role in stewarding standards of research practice and achieving shared goals. In this chapter, we focus on formal supervisory relationships between higher degree...

This book is the product of an international community of scholars in healthcare simulation research. Although the book has a strong focus on simulation as an educational method, the contents reflect wider applications of simulation. The book covers a broad range of approaches to research design. It is written for anyone embarking on research in he...

In this chapter, we introduce and illustrate features of qualitative research through published healthcare simulation literature. We also outline key concepts in qualitative research and offer definitions of commonly used terms. Qualitative research is largely concerned with social phenomena, and hence studies people either directly or indirectly....

Feedback is often unidirectional and focused on learners receiving feedback. Learning relationships are viewed as influential to promoting feedback dialogue. The aim of this study was to explore factors that facilitate or impede feedback between general practice supervisors and registrars. An in-depth qualitative study was conducted. Data collectio...

“Debriefings” are the developmental conversations that take place after real or simulated work. A specialized form of feedback, debriefing has a substantial evidence-base, particularly in healthcare simulation. This chapter explores how the healthcare simulation debriefing can inform feedback in higher education. The impact of debriefing may stem f...

Aims and objectives: To describe the design, delivery and evaluation outcomes of a simulation-based educational workshop to teach a patient-centred falls prevention strategy to health professional students tasked with implementing the strategy during clinical placement. Background: Falls are among the most common and costly threat to patient saf...

Background and objectives: Supervisors have an integral and demanding role in general practice vocational training. Becoming a supervisor involves expanding a ‘clinician’ professional identity to include ‘supervisor’. Little is known about what contributes to the development of supervisor identity; knowing this could inform effective training and s...

Obstetric Decision-Making and Simulation - edited by Kirsty MacLennan March 2019

Background Women are under-represented in surgery and leave training in higher proportions than men. Studies in this area are without a feminist lens and predominantly use quantitative methods not well suited to the complexity of the problem.

Objectives The use of theory in research is reflected in its presence in research writing. Theory is often an ineffective presence in medical education research papers. To progress the effective use of theory in medical education, we need to understand how theory is presented in research papers. This study aims to elicit how theory is being written...

Background: Women are under-represented in surgery and leave training in higher proportions than men. Studies in this area are without a feminist lens and predominantly use quantitative methods not well suited to the complexity of the problem. Methods: In this qualitative study, a researcher interviewed women who had chosen to leave surgical tra...

This book provides readers with a detailed orientation to healthcare simulation research, aiming to provide descriptive and illustrative accounts of healthcare simulation research (HSR). Written by leaders in the field, chapter discussions draw on the experiences of the editors and their international network of research colleagues. This seven-sect...

Introduction: Non-technical skills (NTS) are fundamental requirements for health professional graduates for safe and competent practice. Technology enhanced simulation, including virtual patients (VPs), is suggested to be effective in developing NTS. Purpose: The purpose of this paper is to explore what participants learnt about NTS following inter...

Context Simulation‐based education (SBE) includes a broad spectrum of simulation activities, which are individually well researched. An extensive literature reports on SBE methods, topics and modalities, but there are limited studies investigating how simulation as a holistic phenomenon promotes learning. This study seeks to identify the ways in wh...

Simulation‐based learning (SBL) is regularly integrated into the undergraduate curriculum of diverse health professions education programmes where students learn diverse clinical skills, such as patient assessment, procedural skills, and teamwork. Establishing well‐defined goals is central to the simulation instructional design process and should b...

Simulated Patients in Interprofessional Education

Problem: Interprofessional training programs for obstetric emergencies have been introduced for up-skilling birth unit staff in hospitals but not frequently used in training midwives and paramedicine staff for home birth emergency. Background: Practical Obstetric Multiprofessional Training (PROMPT) has previously been described in the home birth...

Collaboration between teams is an essential component of patient safety in the complex ever-changing environment of healthcare. Collaborative practice requires training, which needs to start prior to registration for it to be established in the clinical workforce by graduation. Despite the perceived value and motivation of course coordinators, inte...

Objectives At minimum, safe patient outcomes are recognised as resulting from a combination of technical and non-technical skills. Flin and colleagues provide a practical framework of non-technical skills, cognitive, social and interpersonal, that complement technical skills, with categories identified as situational awareness, communication, team...

[Extract] Although simulation-based education (SBE) has a very long history, it has surfaced as in important learning method in contemporary health professions education. In this chapter, we orientate readers to definitions, key concepts and theoretical underpinnings of SBE and introduce two frameworks to enhance SBE practice. Given that this book...

The transition from trainee to consultant cardiothoracic surgeon may be challenging. Curricula for cardiothoracic surgical training and for the professional development of cardiothoracic surgeons need to address the issues in transition that are the most difficult. This research used threshold concepts to identify the areas within this transition t...

This article has been written for the 40th year of the publication of Medical Teacher. While we celebrate the contribution of simulated participants (SPs) to health professions education through values and value-based learning, we also offer critical reflection on elements of our practice, commencing with language. We argue for the use of the term...

Clinicians who teach are essential for the health workforce but require faculty development to improve their educational skills. Curricula for faculty development programs are often based on expert frameworks without consideration of the learning priorities as defined by clinical supervisors themselves. We sought to inform these curricula by highli...

Objectives: The aim of this study was to evaluate the implementation of the Practical Obstetric Multi-Professional Training (PROMPT) simulation using the Kirkpatrick's framework. We explored participants' acquisition of knowledge and skills, its impact on clinical outcomes and organisational change to integrate the PROMPT programme as a credential...

We investigated the variation of drilled regions of expert and trainee surgeons performing virtual temporal bone surgery to identify their compliance with standard drilling procedures. To this end, we recruited seven expert and six trainee ENT surgeons, who were asked to perform the surgical preparations for cochlear implantation on a virtual tempo...

This file contains the data and Matlab code used in the discussed study. Extract the zip file and run the file ‘main.m’. The folder ‘Data’ holds the anonymized expert and trainee data. (ZIP)

CONTEXT The use of simulation is gaining prevalence in a number of educational fields, including engineering education in the area of work-integrated-learning (WIL). Despite the utilisation of simulation as an educational strategy, the uptake of simulation in engineering education is incomparable to how it has been undertaken in health professional...

Objective: Help-seeking supervisory encounters provide important learning experiences for trainees preparing for independent practice. Although there is a body of expert opinion and theories on how supervisor encounters should happen, supporting empirical data are limited. This is particularly true for the senior general practice (GP) trainee. Wit...

The suggested title for this session does not really tackle the key issues facing the healthcare simulation education community. Simulation (“sim”) is already embedded in many healthcare curricula. It is here to stay (Donaldson, 2009). Perhaps more helpful questions address the who, what, how, when, and where re sim. I’ll address some of the fundam...

This presentation will explore contemporary approaches to teaching psychomotor skills. Although I focus on the present, I’ll invite participants to reflect on recent history before sharing best evidence that supports the development of psychomotor skills. The origins of contemporary models will be considered briefly such as the 5-level Dave taxonom...

Pre-conference workshop at SimCongress 2017

Introduction: The inclusion of simulated patients (SPs) in health professional education is growing internationally. However, there is limited evidence for best practice in SP methodology. This study investigated how experienced SP educators support SPs in providing SP-based education for health professional students. Methods: Experienced SP edu...

Workshop at Holmesglen, Moorabbin

Context: Effective communication skills are at the core of good health care. Simulated patients (SPs) are increasingly engaged as an interactive means of teaching, applying and practising communication skills with immediate feedback. There is a large body of research into the use of manikin-based simulation but a gap exists in the body of research...

The landscape of surgical training is changing. The anticipated increase in the numbers of surgical trainees and the shift to competency-based surgical training places pressures on an already stretched health service. With these pressures in mind, we explored trainers’ and trainees’ experiences of surgical training in a less traditional rotation, a...

Background: Simulation-based programs are increasingly being used to teach obstetrics and gynaecology examinations, but it is difficult to establish student learning acquired through them. Assessment may test student learning but its role in learning itself is rarely recognised. We undertook this study to assess medical and midwifery student learn...

Background Simulation-based interprofessional education programs can have variable objectives for different participating professional teams. Methods In this study, through a qualitative research design, we report the medical and midwifery students' approach to their learning and attitude towards each other's team, assessed through thematic analysi...

Objective: The aim of this study was to identify and analyse communication skills learning outcomes via a systematic review and present results in a synthesised list. Summarised results inform educators and researchers in communication skills teaching and learning across health professions. Design: Systematic review and qualitative synthesis. M...

Statement: In this commentary, I review 38 articles published as editorials in Simulation in Healthcare from inception to April 2016. Of the 27 authors, there was a predominance of medical doctors (63%), male authors (67%), and work originating in the United States (86%). The founding Editor-in-Chief Dr David Gaba contributed to half of the editor...

This chapter explores the contested notion of realism and considers its application in simulation-based education. First, it explores a range of terms used to describe realism and then reflects on realism in other spheres. Then, the chapter explores key elements of realism in healthcare simulation, especially for supporting learning. It introduces...

This chapter discusses the key issues of the role of simulation in patient safety and to the vision of Sir Liam Donaldson in 2007 with a view to forecasting educational practices in healthcare simulation. New and flexible funding models will emerge, especially as simulation becomes embedded in curricula and certification in simulation for specific...

This chapter explores the roles of simulated patients and confederates in simulation-based education. It uses the collective term simulated participant (SP) for both and identifies points of intersection in their work. There are two main types of live simulators. First, simulated (standardized) patients are individuals trained to portray a patient...

Theories can be considered coherent frameworks of ideas, which inform learning and other simulation practices. This chapter provides a brief overview of different types of theories, illustrated by selected theorists and examples of application to practice. It first provides a short overview of behaviourism and some of the key debates, as well as ex...

This chapter describes a programme using immersive simulation to support the development of safe practices in transport of the critically ill patient. The programme, which was successful in obtaining a curriculum development grant from Monash University, addresses intrahospital transport and is offered to final-year medical students in Malaysia. Th...