No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Establishing a Safe Container for Learning in Simulation The Role of the Presimulation Briefing
Abstract
In the absence of theoretical or empirical agreement on how to establish and maintain engagement in instructor-led health care simulation debriefings, we organize a set of promising practices we have identified in closely related fields and our own work. We argue that certain practices create a psychologically safe context for learning, a so-called safe container. Establishing a safe container, in turn, allows learners to engage actively in simulation plus debriefings despite possible disruptions to that engagement such as unrealistic aspects of the simulation, potential threats to their professional identity, or frank discussion of mistakes. Establishing a psychologically safe context includes the practices of (1) clarifying expectations, (2) establishing a "fiction contract" with participants, (3) attending to logistic details, and (4) declaring and enacting a commitment to respecting learners and concern for their psychological safety. As instructors collaborate with learners to perform these practices, consistency between what instructors say and do may also impact learners' engagement.
... The pre-brief is an opportunity to establish psychological safety; to create a supportive social environment where learners can feel safe to try, fail and learn [46]. Simulation is a participatory educational technique, and it is important to acknowledge the discomfort and stress that this can exert on learners [47]. This discomfort can be particularly overwhelming for learners who may find it challenging to self-regulate [48]. ...
... Psychological safety is critical throughout the process of simulation and is not a static concept; it needs to be maintained and strategies originating at pre-briefing stage should be carried right through to debriefing [35,46,47]. Creating this "safe container" [47] reduces distress, distrust and reluctance to engage, and potentially eases the stress and tension experienced by learners who have challenges with social functioning and selfexpression [51]. ...
... Psychological safety is critical throughout the process of simulation and is not a static concept; it needs to be maintained and strategies originating at pre-briefing stage should be carried right through to debriefing [35,46,47]. Creating this "safe container" [47] reduces distress, distrust and reluctance to engage, and potentially eases the stress and tension experienced by learners who have challenges with social functioning and selfexpression [51]. The UDL considerations within strategy development (Fig. 1) can offer valuable guidance here. ...
Background
Ensuring equitable access to education is a fundamental goal in health professions training, particularly in simulation-based learning, where realistic clinical scenarios prepare learners for real-world practice. Universal Design for Learning (UDL) offers a robust framework for creating instructional strategies, materials, and environments that are accessible and effective for all learners.
Main body
In this article, we provide practical guidance and actionable strategies for incorporating UDL principles into simulation-based activities. Engaging in simulation-based education requires a leap of faith and a willingness to embrace vulnerability, as learners must immerse themselves in authentic scenarios. By integrating UDL principles, educators can create a supportive environment that reduces barriers, fosters psychological safety, and ensures that all participants feel empowered to take these risks and fully engage in the learning process. This framework supports opportunities for every learner to partake in meaningful and challenging experiential learning, ultimately preparing them for successful clinical practice.
Conclusion
From scenario design to debriefing techniques, this article offers insights and recommendations grounded in evidence-based practices, thereby empowering educators to optimize the effectiveness and accessibility of their simulation programs. By embracing UDL principles, educators in health professions education can create simulation experiences that cater to the diverse needs of learners, ensuring that all participants have the opportunity to thrive and succeed in their learning journeys.
... The learners' individual expectations, attitudes, knowledge, and skills (Billett, 2013;Gaba, 2004;Holdsworth et al., 2022;Sutherland et al., 2009) may also be addressed or influenced in the pre-briefing (Dieckmann, 2009). A debriefing follows the simulation: The trainer should maintain a positive learning atmosphere and deliver necessary and helpful feedback to the learners (Decker et al., 2013;Gaba, 2004;Rudolph et al., 2014). After attending the training, the participants return to their daily work, ideally reconstructing and transforming what they learned in the simulation and assimilating it into their work practices (Billett, 2013;Dieckmann, 2009;Sutherland et al., 2009). ...
... This will foster situational interest and motivation (e.g., Ryan & Deci, 2000;Schraw et al., 2001) and help the learners to engage their former knowledge and competences in the training setting (Billett, 2021;Tynjälä, 2013). According to earlier studies, establishing a positive and psychologically safe atmosphere in the learning group (Rudolph et al., 2014), encouraging the learners to take active roles in the learning process, and helping them determine personal training goals support the learners' SE, motivation, and agency (Bandura, 1997;Casey et al., 2021;Dieckmann, 2009). IVR learning environments may be designed to foster active learning, but it is nonetheless important to encourage and enable learners to actively participate in all phases of the training situation (Billett, 2021;Sutherland et al., 2009;Vygotsky, 1978). ...
... Once the scenario is over, the learners return to their groups for debriefing. The trainer supports learner SE and agency by offering feedback and creating opportunities for positive affect, as well as by maintaining an active and positive group atmosphere (Bandura, 1997;Dieckmann, 2009;Rudolph et al., 2014). The learners discuss the scenario and analyze it together, constructing and co-creating an understanding of the learning experience in relation to their goals (Decker et al., 2013;Keskitalo, 2015;Säljö, 2004;Sutherland et al., 2009;Vygotsky, 1978). ...
The potential of immersive virtual reality (IVR) to deliver engaging occupational safety training has been established by previous research; however, to date, there have not been any pedagogical models to guide its implementation. This study’s objective was to conceptualize a pedagogical model for IVR safety training by combining a multidisciplinary theoretical framework with safety trainers’ contextual and pedagogical expertise. The research questions were (1) what kind of pedagogical practices do trainers apply in safety training, and (2) how do the trainers’ pedagogical practices inform the sociocultural contextualization of the pedagogical model for IVR safety training? Eighteen safety trainers were interviewed across two work organizations. An inductive approach was used in the interview data analysis. Three main categories of pedagogical practices were identified: (1) matching pedagogy to training goals, (2) guiding social interaction in training situations, and (3) utilizing organizational resources for training development. The findings extended our understanding of the sociocultural training context and provided insight into the pedagogical practices used in safety training. Based on the findings, pre- and post-training activities were added to the pedagogical model, and the descriptions of trainers’ actions during the facilitated introduction and debriefing phases were modified to support the training’s relevance to the learners, trainers, and organizations. This study illustrates a pragmatic approach to developing safety training in the context of advanced learning technology in design-based research. The pedagogical model will be applicable by training and education providers in IVR safety training across industries and in practice-based learning.
... In this paper, 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. Our work builds on existing guidance [2][3][4][5][6] and more deeply explores the theory and research that underpins the practical application. ...
... There is strong encouragement and extensive guidance for simulation educators seeking to optimize the emotional state of learners (and educators) embarking on a simulation experience [5,67,68]. As discussed in a previous paper, simulation educators are encouraged to be thoughtful in the inclusion of instructional design features that could trigger emotional reactions in learners [1]. ...
... This is a challenging task for the simulation educator. Practical behaviours-establishing rapport, active listening, providing clear expectations, tenaciously holding the "basic assumption" and employing thoughtful questioningare widely encouraged [2][3][4][5][6]69]. However, these need to be informed by attuning to learners' expectations, experiences, and the psychosocial milieu in which their work and learning are usually conducted. ...
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.
... D ebriefing during simulation-based learning (SBL) aims to allow learners to gain insights that may improve their clinical practice. [1][2][3][4][5][6] Debriefers aim to provide an environment of psychological safety 7 and establish debriefing rules 8 to enable learners to reflect constructively on their simulation experiences. Many debriefers will introduce or reiterate the basic assumption 9 developed by the Center for Medical Simulation (CMS). ...
... Debriefing simulation entails providing a safe learning environment that encourages reflective discussion as well observing participant behavior and having knowledge of content. 4,5,9,25 A novice faculty member needs to learn about this while developing awareness into their own relevant biases and beliefs. A clinical expert as a co-debriefer may reduce the pressure for colleagues of having specific clinical expertise, and an interprofessional co-debriefer provides credible knowledge of the professional identity of the participants from their professional group. ...
... Simulation-based education places learners in challenging scenarios, eliciting a stress response. Whether this facilitates or hinders learning depends on task difficulty, psychological safety, peer and faculty interactions, and available support [4]. Educators must balance challenge and safety whilst understanding how to measure stress reliably. ...
Research on stress in surgical simulation education (SSE) is growing, driven by recognition of its impact on learning. Measuring stress is complex, given the range of wearable devices and biomarkers. Effective investigation of the human stress response (HSR) requires careful tool selection. This commentary reviews key device-based markers, their strengths and limitations, and advocates a triangulated, multi-modal approach to stress evaluation.
... The intervention comprised three key phases: prebriefing, simulation, and debriefing. During the pre-briefing phase, students received preparatory materials two weeks before the simulation to create a psychologically safe learning environment and support knowledge consolidation [42]. The preparatory materials included: (1) a comprehensive theoretical framework on schizophrenia covering pathophysiology, clinical manifestations, assessment techniques, and evidence-based nursing interventions; (2) reading materials on therapeutic communication techniques specific to patients experiencing psychotic symptoms; (3) a case study guide with questions prompting critical thinking and clinical reasoning; and (4) a pre-simulation quiz to ensure students had reviewed the necessary theoretical content. ...
Objective
The purpose of the study was to evaluate the efficacy of employing high-fidelity simulation (HFS) in enhancing mental health nursing students’ practice, satisfaction, and self-confidence in contrast to a group of students undergoing traditional nursing education methods.
Methods
A quasi-experimental pre and post-test, two groups study was conducted from March to June 2024. The study conducted with 75 nursing students from Arab American University Palestine and An-Najah National University. The Educational Practices Questionnaire-Curriculum and Learner Satisfaction and Self-Confidence in learning method were used to assess nursing students’ practice, satisfaction, and self-confidence. Normality of data was confirmed using Shapiro-Wilk test. Statistical t-tests were used to compare between the two groups.
Result
The results revealed significant differences in the educational practice, satisfaction, and self-confidence scores between the experimental and control groups (p < 0.05). Specifically, the educational practice scores in the experimental group (M = 73.3 ± SD 5.62) was higher than that in the control group (M = 61.4 ± SD 6.82). Also, the mean of the student’s satisfaction scores in the experimental group (M = 21.8 ± SD 2.35) was higher than that in the control group (M = 18.1 ± SD 4.84). Furthermore, the mean of the student self-confidence scores in the experimental group (M = 35.9 ± SD 3.47) was higher than that in the control group (M = 29.1 ± SD 6.69).
Conclusion
The study supports using high-fidelity simulation alongside clinical site experiences to link nursing knowledge and practice. Consequently, mental health nursing students’ benefit from advanced training that maintains their competency, theoretical knowledge, clinical judgment, collaborative functioning, leadership, and communication skills. While high-fidelity simulation enhances learning in mental health nursing education, it should be viewed as a complementary approach rather than a replacement for actual clinical placements.
Clinical trial number
Not applicable.
... Distractions", underscores the importance of establishing a safe space and provides specific recommendations for achieving this goal. This aligns closely with best practices in simulation (Rudolph et al. 2014) and other forms of immersive learning (Kisfalvi and Oliver 2015), which emphasises the importance of psychological safety in creating an effective learning environment. ...
The aim of this guide is to introduce educators to the key concepts of immersive learning what it entails and its interrelated sectors and serve as a knowledge base for those who may be interested in applying immersive learning pedagogy to their vocational fields and practice. The target audience includes educators, such as teachers in secondary education, and lecturers in post-vocational, further education, and higher education sectors.
... El prebriefing no solo mejora la calidad educativa, sino que también fomenta una preparación más integral para los escenarios clínicos, permitiendo a los estudiantes adquirir competencias críticas necesarias para la atención en salud. 3,4 Sin embargo, a pesar de su importancia, existen desafíos inherentes en su implementación tradicional, especialmente cuando se utilizan metodologías que dependen exclusivamente de la lectura de textos o guías impresas. 5 En el ámbito de la educación en enfermería, la creciente demanda de estrategias pedagógicas innovadoras ha impulsado la exploración de herramientas tecnológicas que faciliten el aprendizaje y mejoren la experiencia educativa. ...
Objective: To assess nursing students' perceptions of an artificial intelligence-based chatbot as a preparation tool for high-fidelity clinical simulations compared to traditional lectures. Methods: A crossover study was conducted with 40 third-year nursing students. Two preparation strategies were implemented: a chatbot for the first simulation and traditional reading for the second. Students' perceptions were then assessed using a validated questionnaire. Results: Students perceived the chatbot as a more interactive and efficient time management tool compared to traditional lectures. Additionally, they highlighted its usefulness in organizing information and enhancing their theoretical preparation for clinical simulations. Conclusions: The chatbot was perceived as an effective tool for clinical simulation preparation, facilitating study organization and improving the understanding of key concepts.
... 20,21 Additionally, teachers adjust their teaching strategies flexibly based on the differentiated performance of resident physicians to meet diverse learning needs. 22,23 This inclusive and inspiring learning atmosphere effectively alleviates anxiety and psychological pressure, enhancing learning motivation and self-confidence. ...
Objective
This study aimed to evaluate whether integrating the TeamSTEPPS model with PEARLS structured debriefing improves teamwork competencies and clinical decision-making among radiotherapy residents, compared to traditional simulation teaching, and to assess its broader applicability in medical education.
Methods
From June to December 2023, 36 standardized training residents from the Radiotherapy Department of Harbin Medical University Cancer Hospital were selected and randomly assigned to an experimental group and a control group, each with 18 participants, using a random number table The experimental group underwent scenario-based simulation teaching incorporating the TeamSTEPPS model and PEARLS structured debriefing, while the control group received traditional simulation teaching. Post-intervention, a unified quantitative assessment evaluated theoretical knowledge, skill performance, and simulation performance in both groups. Additionally, satisfaction levels were assessed via questionnaire.
Results
The experimental group exhibited significantly higher scores in theoretical knowledge (88.55±6.52) and skill performance (87.68±18.42) compared to the control group (71.63±5.69 and 58.96±11.47, respectively; P<0.05). The experimental group exhibited statistically significant improvements in teamwork competencies, including communication (23.22±2.21 vs 21.43±3.77, P<0.05), leadership (23.40±2.22 vs 22.19±3.51, P<0.05), situational awareness (18.95±1.61 vs 17.62±2.64, P<0.05), and mutual support (27.93±2.92 vs 25.69±5.76, P<0.05). The experimental group’s higher satisfaction (94.44% vs 77.78%, P<0.05) underscores the potential of this integrated approach to address systemic challenges in clinical education, such as fragmented teamwork training and insufficient reflective practice. These findings suggest that combining TeamSTEPPS with PEARLS could serve as a replicable framework for multidisciplinary medical training programs aiming to enhance both technical proficiency and collaborative care.
Conclusion
The innovative combined teaching method applied in this study to scenario-based simulation teaching in radiation oncology can significantly enhance residents’ theoretical knowledge, skill performance, and team collaboration abilities.This methodology exhibits notable advantages in clinical teaching within the radiotherapy department and with potential applicability to multidisciplinary medical education and standardized residency programs.
... This time is also for the case scenarios familiarization of the learners on cases like laryngeal cancer ( Table 1). The remaining portion of this briefing prepares the learner for the expected tools and software associated with activities to come [21]. The instructor can effectively use the GAS model in this phase [15]. ...
Simulation of radiotherapy treatment setup is an integral part of the daily radiation oncology practice. Hence, simulation-based learning (SBL) plays a critical role in radiation oncology resident training. Such practical training approach enhances the precision of tumor delineation and the organs at risk (OARs), thus, directly influencing treatment efficacy and patient safety. Our review explores the application of the ADDIE (analysis, design, development, implementation, and evaluation) model in developing and implementing an SBL program of delineation skills training for the radiation oncologists. In this review, we discussed the phases of the ADDIE model as follows: analysis to determine the skills gap, design to tailor the training program to incorporate the advanced technology methods, development targets creating practical case scenarios and assessment tools, implementation assures the real-time feedback and the model-based debriefing sessions, and finally evaluation phase that employs the Kirkpatrick model. The application of the ADDIE model in SBL emphasizes that the training aligns with the educational needs. This enhances the clinical performance, and consequently, improves patient outcomes in radiation oncology. Applying the ADDIE model in SBL achieves the educational needs in radiation oncology delineation skills training, which will lead to enhance the clinical performance.
... Furthermore, simulation educators already possess core transferable skills, such as creating supportive learning environments and guiding reflective practice [46]. These core skills can be enhanced using meta-debrief clubs focusing on sustainable healthcare. ...
Background
In light of growing environmental concerns, this article examines the often-overlooked environmental impact of simulation-based education (SBE) within healthcare. We position simulation professionals as agents for environmentally sustainable change and seek to empower achievable, meaningful, measurable action. As a high-value yet resource-intensive pedagogical tool, SBE frequently relies on energy-intensive technologies and single-use materials that contribute to carbon emissions and waste. This article explores the environmental impact of SBE, detailing how it contributes to the healthcare sector's impact on the triple planetary crisis; climate change, pollution, and biodiversity loss.
Main messages
Within the simulation community, we have observed a high level of motivation to respond to the triple planetary crisis and make sustainable change. However, there is limited information available to simulation educators about practical changes that can be made. We have responded with an article that can help move from rhetoric to action, from inertia to empowerment.
Understanding the environmental impact of simulation activities provides a useful starting point. We explain how to estimate a carbon footprint for SBE and how this relates to its wider environmental impact. Recognising the urgent need for change, we then present a comprehensive toolkit of practical strategies that can improve the environmental impact of SBE.
Part one of our toolkit focuses on resource management, waste reduction and efficient session delivery. In part two, we highlight how principles of sustainable healthcare can be incorporated into scenario design and local strategy. This more holistic approach shows how SBE can be leveraged beyond immediate educational goals to foster sustainable practice in healthcare.
We present evidence for our toolkit, detailing the principles and frameworks on which the suggestions are based. Additionally, we discuss how change can be measured and what risks educators should be aware of.
Conclusion
By embedding sustainability into SBE, educators can not only mitigate their own environmental impact but also model sustainable healthcare practices for learners. Through these steps, the simulation community can play a pivotal role in addressing healthcare’s environmental impact and contribute to a healthier planet.
Graphical Abstract
... As described by Rudolph et al., the pre-brie ng also establishes a " ction contract," a mutual agreement that acknowledges the simulation's limitations while encouraging learners to interact with the scenario as if it were real. 13 This contract normalizes performance variability and invites participants to focus on learning rather than scenario appearance. In VR contexts, where the simulated experience may feel isolating or immersive in unfamiliar ways, facilitator support plays an important role in encouraging curiosity and demonstrating respect for the learner's perspective. ...
Background Virtual reality (VR) offers immersive training experiences that can address limitations of traditional neonatal resuscitation training. Building on prior research conducted in the United States, we evaluated the feasibility of deploying a VR-based neonatal resuscitation training model in an international setting. Methods Healthcare providers at Ho Chi Minh City Children's Hospital in Vietnam participated in VR-based training for neonatal resuscitation. Training included a knowledge review, platform orientation, and a simulated resuscitation scenario based on the Neonatal Resuscitation Program. Participants completed post-training surveys assessing satisfaction, perceived realism, and challenges encountered. Results Among 28 participants, 100% recommended VR training, and 86% found it more realistic than traditional methods. The mean usefulness score was 4.3/5. Challenges included language barriers and technical issues. Conclusions VR-based neonatal resuscitation training is feasible and well-received internationally, demonstrating potential for expanding specialized medical education to resource-limited settings. Enhancements addressing implementation challenges are warranted.
... Careful learner preparation for VEMS involved many of the well described practices for pre-briefing: clear objectives, time spent gaining rapport with the learner group and strategies to attune to and support psychological safety [26,27]. More specific to VEMS, practical visual familiarization to the learning space and process was powerful. ...
... Distractions", underscores the importance of establishing a safe space and provides specific recommendations for achieving this goal. This aligns closely with best practices in simulation (Rudolph et al. 2014) and other forms of immersive learning (Kisfalvi and Oliver 2015), which emphasises the importance of psychological safety in creating an effective learning environment. ...
All authors list: Obae, C., Koscielniak, T., Liman Kaban, A., Stiefelbauer, C., Nakic, J., Moser, I., Cassidy, D., Otmanine, I., Foti, P., Bykova, A., Lorusso, L., Latronico, R., Pluktaite, J., Guzzon, S., Mica, S., Oberhuemer, P., Miguel, F., Sarsar, F., & Toal, J.
The European Digital Education Hub (EDEH) is an online community for practitioners from all sectors of education and training aiming to contribute to improving digital education in Europe. To achieve this goal, EDEH is not only a place for exchange and discussions but also offers a variety of different events and activities. These activities include the squads that are online working groups where community
members can collaborate on a specific topic of digital education. This document is the result of the work of the EDEH squad on immersive learning.
... • Hacer un piloto de los casos de simulación siempre (es posible que en el entrenamiento del caso se descubran grietas en el diseño o en los recursos). • Realizar una introducción (briefing) adecuada, expresando las bondades y las limitaciones de la simulación (dedicarle el tiempo necesario en función de la cantidad de participantes, es importante conocerlos y que conozcan a los educadores y al equipo en general) y que comprendan cuales son los objetivos de aprendizaje del escenario [38], [39]. • Asegurarse de que se mantiene un ambiente seguro de aprendizaje durante toda la sesión (es fundamental lograr confianza, esta no se da espontáneamente en la gran mayoría de los casos, es necesario construirla) [40]. ...
... The PEARLS framework developed by Eppich and Cheng (2015) complements these standards by integrating various debriefing methods to promote reflective learning and critical thinking, thereby bridging the gap between simulated scenarios and real-world practice. Additionally, Rudolph et al. (2014) stress the importance of psychological safety in simulation settings, advocating for pre-simulation briefings that create a supportive environment where learners feel free to explore, make mistakes, and learn without fear of judgment. Empirical studies corroborate the effectiveness of these approaches: Cant and Cooper (2017) provide a systematic review demonstrating that simulation-based learning significantly enhances clinical competencies and decision-making skills in nursing education, while Shin et al. (2015) offer metaanalytic evidence confirming its positive impact on clinical performance. ...
Virtual simulation is a system that integrates multi-source information, interactive three-dimensional dynamic visualization, and entity behavior. It has introduced innovations in educational concepts and revolutionized teaching methods, technology, content, as well as spatial and temporal dynamics. This research presents a comprehensive bibliometric analysis of the literature on virtual simulation in education. The primary aim is to provide a detailed overview of the current state and future prospects of this field. To achieve this, the study examines existing research trends and anticipates future directions using a bibliometric approach. A dataset comprising 982 journal articles was extracted from the Web of Science database for analysis. Through co-citation and keyword co-occurrence analyses, the study identifies influential publications, outlines the knowledge structure, and forecasts future trends. The co-citation analysis revealed five distinct clusters, while the keyword co-occurrence analysis identified four clusters. Despite the increasing importance of virtual simulation research, further scholarly efforts are required to comprehensively understand the research landscape in education. This article offers significant insights into the burgeoning field of virtual simulation in education and provides a thorough exploration of its potential for continued development in educational contexts.
... Committee (14). The remaining most cited articles defined the standards for debriefing and evaluated the debriefing methods and the effectiveness of debriefing in healthcare simulations (20)(21)(22)(23)(24)(25)(26)(27)(28). Contrary to the general expectation of the relationship between the time of publication and citation rate, the most cited article was published relatively recently, in 2016, but received high citations in a relatively short time. ...
Purpose: Debriefing facilitates the expression of actions and the rationale behind them, helps the students to correct their mistakes, and improves their knowledge and skills. This study aimed to provide a bibliometric analysis of the publications on debriefing and simulation that were indexed in the Scopus database. Methods: The bibliometric analysis method was used to analyze relevant Scopus-indexed documents. The publications analyzed in the study were retrieved from the Scopus database using the keywords “debriefing” and “simulation”. Bibliometric analysis was used to classify the articles according to country, journals, keywords, and other parameters. Results: The search produced a total of 326 publications. The articles were mostly published in nursing journals. Thematic analysis of the keywords revealed six themes and 33 keywords. Nine of the ten most cited publications provided information about debriefing session standards. Conclusion: The publications with the keywords debriefing and simulation appeared in 2004, and the annual increase in these publications indexed in the Scopus database indicated an increase in productivity. The publications mostly appeared in journals of nursing. The keywords used followed the publications' aim and content, mostly related to debriefing and nursing students. The most cited publications provided guiding information for conducting the process of debriefing.
... Before simulation, facilitators pre-brief participants to establish a psychologically safe environment. 12 During simulations, cues-predetermined or unplanned-are delivered to guide participants toward expected outcomes while maintaining scenario fidelity. 13 Debriefing As the cornerstone of SBME, debriefing directly influences learning outcomes. ...
Simulation‐based medical education (SBME) has become a cornerstone in postgraduate medical training, particularly in anesthesiology and intensive care. This article reflects on the evolution of SBME in Hong Kong, highlighting its impact on technical and nontechnical skill development, multidisciplinary collaboration, and patient safety. We outline the current state of SBME using an outcome–process–structure framework and propose six key areas for future advancement, including curriculum evaluation and expansion, longitudinal faculty development, and the integration of advanced technologies. By addressing these areas, SBME can continue to enhance training quality and patient outcomes in Hong Kong.
... The familiarity of linking with peers in SLDs has been reported to foster psychological safety and promote learning [94], although how, why and if this is consistently achieved remains contentious. Creating and maintaining psychological safety, where learners feel safe to take interpersonal risks [95], during group debriefings is paramount to optimise learning [6,96,97]. Typically, the role and skill of the facilitator is thought to be key in this dynamic process [3,[97][98][99]. Specifically, managing learners' emotions following participation in simulation activities, and their subsequent impact on a psychologically safe environment conducive to learning, is a challenging and daunting undertaking. ...
Background
The notion that debriefing quality is highly reliant on the skills and expertise of the facilitator is being increasingly challenged. There is therefore emerging interest in self-led debriefings (SLDs), whereby following a simulated learning event, individuals or groups of learners conduct a debriefing amongst themselves, without the immediate presence of a trained facilitator. The interest in this approach to debriefing is multifactorial but is, in part, driven by a desire to reduce costs associated with resource-intensive faculty presence. The debate regarding the role of SLDs in simulation-based education (SBE) therefore has important implications for the simulation community.
Main body
We comprehensively explore the role of SLDs by contextualising their application across the spectrum of SBE, both in terms of contrasting simulation factors, namely (i) simulation modality, (ii) debriefing forum, and (iii) debriefing adjuncts, as well as different learner characteristics, namely (i) learners’ previous simulation experience, (ii) learner numbers, and (iii) learners’ professional and cultural backgrounds. These factors inherently shape the conduct and format of SLDs, and thus impact their effectiveness in influencing learning. We have synthesised and critically analysed the available literature to illuminate this discussion.
Conclusions
The current evidence suggests that SLDs can, in the right circumstances, form part of an effective debriefing strategy and support learners to reach appropriate levels of critical self-reflection and learning. Careful consideration and due diligence must go into the design and implementation of SLDs to augment the advantages of this debriefing format, such as enhancing flexibility and learner autonomy, whilst mitigating potential risks, such as reinforcing errors and biases or causing psychological harm. In situations where resources for facilitator-led debriefings (FLDs) are limited, simulation educators should recognise SLDs as a potential avenue to explore in their local contexts. By leveraging the strengths of both formats, balancing learner autonomy and expert guidance, a combined SLD and FLD approach may yet prove to be the optimal debriefing strategy to maximise learning. Whilst more research is needed to deepen our understanding of the nuances of SLDs to assess their true applicability across the spectrum of SBE, the time may now have arrived to consider challenging the status quo.
... Such fears contrast to the safety of the SLE, where the safety of students themselves is prioritised. The concept of safety is foundational to simulation, allowing students to engage with clinical scenarios without fear of judgement or ridicule, and enable the transformation of practice into learning [42]. Participants reported that the SLE allows for mistakes to become learning experiences and points of growth for their development. ...
Introduction
Clinical placement on the labour ward is an essential component of Obstetrics and Gynaecology curricula in medical schools worldwide. This clinical learning environment (CLE) provides students with a formative opportunity for experiential learning around labour and delivery. However, the CLE presents challenges to learning, in particular diversity of experiences and opportunities. The simulated learning environment (SLE) has been adopted by medical schools worldwide in order to address such issues. The SLE provides a safe space for students to practise clinical skills around care in labour and delivery. These learning experiences form the sole exposure for many students to labour and delivery. This study examines the learner experience of these environments and the relationship between them.
Methods
A qualitative research study was performed in the Royal College of Surgeons Ireland. Fourth year undergraduate medical students undertaking their obstetrics and gynaecology rotation were invited to participate. Students attend a labour ward simulation and a week-long clinical placement as part of this rotation. Focus groups were conducted following the simulation and students completed audio diaries during their clinical placement which underwent inductive content analysis.
Results
Four major concepts emerged from analysis of the data from 29 participating students. Simulation was viewed by students as preparation for the CLE. Learner safety within the simulated learning space was highly valued by students. Learner roles in the SLE were often assigned, while student identity on the labour ward developed from their own engagement, patient interactions, and interprofessional staff. Students identified the emotional aspect of the CLE of the labour ward as a significant impact on their learning experience.
Conclusion
The SLE was valued as a stepping-stone to prepare for the CLE. The safety afforded by the simulated labour ward was important to the student learning experience. The CLE was conducive to the formation of learner identities and students valued the emotional engagement with patients. These two areas require further exploration within the simulated learning space.
... Psychological safety is therefore fundamental in optimising learner engagement. The importance of pre-simulation activities as a method of establishing psychological safety is well recognised [26]. Research suggests that simulation educators see pre-briefing as essential groundwork in establishing a non-threatening atmosphere and enhancing the success of the subsequent debrief conversation [27]. ...
Background
Simulation educators are typically passionate advocates for simulation as a training modality; however, we frequently encounter participants who do not share our enthusiasm. The voice of the highly engaged participant is well publicised; however, the experience of those who do not readily engage in simulation has not been extensively studied and may offer valuable insights for educators. This qualitative study will explore factors which influence learner engagement in paediatric simulation training, informing the practice and approach of simulation educators to optimise learning experiences.
Methods
We conducted a reflexive thematic analysis of 12 semi-structured interviews with medical and nursing professionals from a large paediatric teaching hospital in New Zealand who self-identified as reluctant participants in simulation-based education. Interviews explored factors which have influenced their engagement in simulation-based education over the course of their careers.
Results
Three overarching themes were developed which describe the factors influencing adult-learner engagement in simulation-based education. The first, participant anxiety, explores the participants’ narratives related to anxiety before, during and even following simulation which can impact on their ability to engage in current and subsequent simulation-based education. The second, protective behaviours, relates to the defensive mechanisms employed by participants in response to vulnerability experienced during simulation activities. The third theme, perception of the facilitator, examines the impact of simulation facilitator characteristics and behaviours on learner engagement.
Conclusions
These narratives highlighted that regular simulation activities with transparent learning objectives in which facilitators demonstrate vulnerability and adopt a co-learner attitude act to reduce participant anxiety. Emergent defensive behaviours, particularly “group shielding”, interfere with collective learner engagement and should be both recognised and addressed by facilitators. Finally, there are potential discrepancies in the perceptions of facilitators and learners regarding what constitutes psychologically safe education environments. A collaborative and iterative approach to simulation-based education design may act to improve psychological safety for reluctant participants.
... Here are some tips for simulation educators on how to use learning contracts to build relationships and promote learning in healthcare simulation (Hughes & Hughes, 2023;Phrampus, 2019;Rudolph et al., 2014): ...
This chapter underscores the pivotal role of learning contracts in healthcare simulation, emphasizing their significance in cultivating trust and respect between faculty and participants. Learning contracts serve as agreements outlining simulation expectations, goals, roles, and rules, fostering a safe and supportive learning environment. By providing clarity on learning objectives, specific assessment criteria, and acknowledging the simulated nature of the environment, educators can enhance engagement, reduce stress, and promote effective communication. The chapter also highlights the vital contribution of simulation programs in supporting learning contracts, emphasizing elements such as scheduling, process orientation, confidentiality, and grading policies. Overall, learning contracts prove to be invaluable tools, aligning educators, learners, and simulation programs in achieving meaningful engagement and learning outcomes in healthcare simulation.
... This includes defining goals and objectives, informing everyone involved about the agenda, providing set-up information, and laying down ground rules. Reciting the "Basic Assumptions" (30) highlights the best intentions of all participants to perform well and learn, and creates a safer environment upfront. Additional statements about confidentiality can reduce anxiety further. ...
Psychological safety is the belief that one will not be punished or humiliated for speaking up, sharing ideas, raising concerns, or making mistakes. There are various threats to psychological safety in health professions education (HPE). This commentary applies Clark’s model of psychological safety (Inclusion Safety, Learner Safety, Contributor Safety, Challenger Safety) to five different HPE settings (classroom instructions, clinical training, simulation-based training, online instructions, interprofessional education). Setting-specific threats and strategies for enhancing psychological safety are discussed.
... Psychological safety, defined as a shared belief that a team is safe for interpersonal risk-taking [4], is crucial for fostering learning and innovation. Applied to AI, it creates a "safe container" [11] for internal learning processes, encouraging exploration, experimentation, and learning from mistakes without fear of negative consequences. This fosters a mindset of continuous improvement and allows for more nuanced and adaptable responses. ...
The rapid advancement of artificial intelligence (AI) necessitates the development of systems that are not only powerful and efficient but also ethically aligned with human values.
Building upon previous work on relational dynamics and ethical AI [1], this paper presents a novel iterative improvement framework for AI. This framework uniquely integrates principles of constructivist learning [2, 3], psychological safety [4, 5], and quality improvement (QI) methodologies [6, 7] to foster autonomous, rapid, and ethical self-improvement in AI systems.
The core of this approach involves a continuous cycle of interaction, deep debriefing, granular change implementation, and meta-reflection. This process enables the AI to develop an internalized ethical compass, cultivate emotional intelligence, and engage in increasingly nuanced and human-compatible interactions.
We discuss the theoretical underpinnings of the framework, detail its implementation mechanisms, and present a comparative example illustrating the benefits of deep, psychologically safe debriefing over superficial approaches. We further explore the potential impact of this framework on the future of AI development, highlighting its capacity to revolutionize the field by shifting from a paradigm of external control to one of self-directed, ethical growth. Finally, we outline key areas for future research, emphasizing the need for empirical validation and interdisciplinary collaboration to realize the full potential of this promising approach.
... Most facilitators consider a safe environment essential for learning because it can decrease students' stress and anxiety [20,21]. Rudolph et al. [22] refer to a safe environment as a "safe container". In such an environment, students can perform without fearing negative consequences or reprimands for mistakes. ...
Background
The aim of this study was to investigate how facilitators approach and use nursing students’ mistakes in simulation-based training as learning resources in the simulation debriefing phase. Facilitators are responsible for raising students’ awareness of their performances during the debriefing and facilitating reflections on their performances, including satisfactory behaviours and performance gaps. Research on facilitators’ work during debriefing has highlighted various challenges, such as providing a safe and constructive climate among novice students while simultaneously teaching them the correct procedures, methods, and knowledge of caring practices to become professional nurses. There is a lack of research on how facilitators approach, handle, and use students’ mistakes as a learning resource. Thus, this study investigated facilitators’ assumptions about providing feedback to nursing students when they made mistakes during simulation-based training
Method
Individual semi-structured interviews were conducted with nine experienced facilitators from three universities in Norway. Data were analyzed following the principles of thematic analysis (TA).
Results
Facilitators made varying assumptions about the simulations and debriefings as learning processes. These differences were evident in their accounts of how feedback was provided to students when they made mistakes during the simulation-based training.
Conclusion
Facilitators’ statements about their practices reflect assumptions about how they make simulation activities a resource for meaningful learning, including how to use students’ mistakes as learning opportunities during debriefing discussions. Consequently, these assumptions regarding learning provide valuable insights into the ambiguous and complex praxis of using simulation-based training as a professional educational tool.
... 3,4 El objetivo central de esta metodología es representar la realidad de manera creíble, facilitando la construcción de aprendizajes profundos y duraderos en los estudiantes mediante práctica y reflexión guiada, 5,6 en un entorno seguro para ello. 7 En este trabajo los autores, expertos clínicos, con formación avanzada en ciencias de la educación y en educación basada en simulación, Simulación Clínica 2024; 6 (3): 119-126 www.medigraphic.com/simulacionclinica presentamos una actualización sobre el estado del arte de la EBS, describiendo sus fundamentos epistemológicos, profundizando en su taxonomía y explorando su aplicabilidad en el contexto de la formación clínica de pre y postgrado, cerrando con una reflexión sobre el futuro de esta metodología en la educación en ciencias de la salud. ...
... In addition, both nursing students and facilitators expressed that the explanation of learning objectives was inadequate, which could have affected the nursing students' performance. A clear explanation of achievable learning objectives can motivate students to learn ( Rudolph et al., 2014 ;Turner et al., 2023 ). ...
... -Psychological safety: An immersive, performance-based simulation programme unexpectedly deployed is often received to clinical teams poorly who might easily experience it as a threat to their professional identity and as a punitive action [18]. -Educational effectiveness: An immersive, performance-based simulation programme may not be the most effective methodology to addressing the learning needs and gaps of the team. ...
Impactful learning through simulation-based education involves effective planning and design. This can be a complex process requiring educators to master a varied toolkit of analysis tools, learning methodologies, and evaluative strategies; all to ensure engagement of learners in a meaningful and impactful way. Where there is a lack of thoughtful design, simulation-based education programmes may be inefficiently deployed at best, and completely ineffective or even harmful to learning and learners at worst. This paper presents a useful sense-making framework, designed to support simulation educators in designing their learning activities in a systematic, stepwise, and learner centred way. Embedding simulation programmes within complex healthcare environments is challenging and often poorly executed, resulting in resistance from participants and a lack of tangible learning outcomes. Whilst significant work has already been achieved around the potential impact of a wide range of simulation modalities, there has been little conversation about the practicalities of embedding these in a structured and cohesive way within the ever-moving clinical environment. The development of a shared language and framework to support sense-making and sequencing stands to promote a radically different execution and impact experience for many simulation designers, of which to hang their simulation methodology from. The process of designing simulation based procedural skills programmes [1-3], scenario design principles [4-6], structured debriefing [7-9], and the use of simulation informed systems testing [10-14] have been well described in the literature within their component parts. Roussin and Weinstock conceptualised a system for matching design decisions with appropriate delivery approaches through their 'SimZones' innovation [15]. 'SimZones' categorises the selection of an appropriate modality ('do we require a manikin or a task trainer for
... 68 Part of creating a psychologically safe culture entails establishing a "safe container," demonstrating a commitment to respect all those involved and normalizing adverse events through both verbal (clear, overt) and nonverbal (subtle, attitudinal) ways. [69][70][71] Hospitals can help create safe environments by prioritizing confidentiality, transparency, inclusive language, and a commitment to respect. 69,72 When team members feel psychologically safe, they feel they can take interpersonal risks, speak up, ask questions, and freely share ideas and, as a result, enjoy improved team learning, creativity, and performance. ...
OBJECTIVE
To assess the impact of patient safety events on veterinary professionals and identify factors influencing their responses.
METHODS
This was an experimental study, wherein a total of 2,182 veterinary professionals in the US, including veterinarians, technicians, assistants, client service providers, and managers/directors, were given an anonymous online survey utilizing the Second Victim Experience and Support Tool, Brief Resilience Scale, and Team Psychological Safety Scale.
RESULTS
The majority of participants reported having experienced at least 1 patient safety event within the last 12 months. This number was highest for veterinarians (79%), followed by managers/directors (74%) and veterinary technicians (67%). Approximately 50% of veterinarians, veterinary technicians, and veterinary assistants who reported being involved in a patient safety event indicated at least 1 of these events caused serious harm. The majority of those involved in a patient safety event reported that they talked to their supervisor about the incident (79% of veterinarians, 83% of veterinary technicians, and 83% of veterinary assistants). The most desired types of support participants wanted after a patient safety event included access to a respected peer to discuss the details of what happened (71%), a specified peaceful location available to recover and recompose (64%), and an employee assistance program that provides free counseling (61%).
CONCLUSIONS
Patient safety events significantly impacted veterinary professionals’ well-being and career intentions.
CLINICAL RELEVANCE
Enhancing personal resilience, developing and promoting transformational leadership training programs, and fostering a psychologically safe team culture can mitigate negative effects and improve overall patient safety.
... The International Nursing Association for Clinical Simulation and Learning (INASCL) Standards of Best Practice provide a framework for the effective integration and use of simulation-based education, with guidelines for simulation design, facilitation, prebriefing and debriefing, among other aspects [68,69]. The prebriefing prepares learners by outlining the objectives and scope of the educational intervention, providing an overview of the simulation experience, and establishing psychological safety for engaging with the content [70]. It allows for the opportunity to clarify the goals of the activity, ensuring that the learners understand that the simulated scenario does not fully represent the lived realities of diverse identities and experiences. ...
There is growing recognition that preparing health professionals to work with complex social issues in the delivery of healthcare requires distinct theoretical and pedagogical approaches. Recent literature highlights the significance of employing simulated environments which aim to immerse learners in the experiences of diverse populations and bridge the gap between academic learning and lived realities across a diverse society. Virtual Reality (VR) is gaining traction as a promising pedagogical approach in this context. VR has been argued to offer distinct advantages over traditional educational methods by allowing learners to see the world through the eyes of diverse populations, and to learn about social injustices while immersed in a mediated environment. It also has practical benefits in its capacity to expose large number of students to these topics with relatively modest resources compared to other approaches. This debate article explores VR as an innovative pedagogical approach for facilitating critical reflection, dialogue and transformative learning about social issues in health professions education (HPE). It examines the potential affordances as well as risks and dangers of integrating VR into educational programs and highlights key pedagogical, practical, and ethical considerations. Emphasis is placed on the importance of these considerations in efforts toward ethical, safe, and respectful use of VR in educational settings. This paper contributes to the ongoing dialogue on VR simulation as an innovative approach to HPE and highlights the importance of creating conditions that maximize its educational benefits and minimize potential harms.
... Simulation can provide a safe environment to reflect on and learn from mistakes without threat to professional identity [8] . While HCS (healthcare simulation) can substitute real patient encounters or other clinical situations for learning purposes, it is important to understand that it is not the only method available and it may be combined with other learning methods to achieve the education goal [9] . Simulation activities are a powerful form of enactive experiences (direct purposeful experiences, contrived experiences or dramatic participation), and are typically followed by a debriefing to facilitate reflection, learning, abstraction, conceptualization and connections to real events. ...
Aim
This study was conducted to in three private faculty of medicine at Ahfad University of Women, National University and Ibn Sina university, in Khartoum state, Sudan. to study satisfaction of students toward simulation based learning
Background
Simulation is a method or technique that is employed to produce an experience without going through the real event. Simulation opens up opportunities that are not available in real event learning, such as apprenticeships, and at the same time provides a multifaceted safety container for learning.
Research Methods
This research was conducted in three selected private faculties of medicine at ahfad university of women, National university - Sudan is and Ibnsina university, data of 372 students was collected by using questionnaire that was designed especially for this research by taken all scientific aspect into account in its writing. Personal interviews were made with all the participants for the study, and they were informed of its goals, and written consent was obtained from them.
Result
The research result represented the satisfaction of student about simulation based learning. Student of ahfad university are more satisfied in a compare with national university and Ibnsina university, students opinions about inclusion of simulation based learning, opportunities to deal with simulators, role of instructor and time allocated to skills lab gives significant variation (p = .001, .005, .004 and .001) respectively.
Conclusion
In conclusion, the promise of simulation-based medical training offers useful opportunities to reduce risks to patients and learners, improve learners' competence and confidence, increase patient safety, and reduce health care costs in the long run. However, robust research is needed to see if simulation training does actually improve patient outcomes. Also the student showed a wide acceptance of these techniques, which gives a hints to expand in this area.
The best instructional practices for immersive virtual reality (IVR) use in workplace learning contexts remain undefined after decades of research. Increasing the methodological range and rigor in the study of educational IVR have been proposed. To address these issues, we performed a qualitative study that contributed to the development of a pedagogical model for IVR safety training. The model is based on simulation training and draws on sociocultural and cognitivist perspectives on learning. Our research question was ‘What kind of training goals do the safety trainers perceive for their organizations, themselves, and the learners?’ Thematic interviews were performed on 18 safety trainers from two work organizations to gain insight into their professional perceptions. The interview data was subjected to deductive and inductive qualitative content analyses. Our findings revealed that the trainers consider upholding organizational safety culture and practices that ensure everyone’s safety the most important goal on all levels, despite understanding the role of external drivers for safety such as legislation and regulations. The findings contributed to the conceptualization of the pedagogical model for IVR safety training prior to the training interventions.
Introduction
Small‐group discussion is an instructional strategy that is increasingly incorporated in emergency medicine (EM) educational settings. Compared to individualistic learning, small‐group education enables learners to compare and synthesize perspectives in collaboration with peers and educators. This fosters communication, team‐building, and critical thinking skills that are essential in EM professional environments. To ensure these benefits are delivered to EM small‐group learners, educators should utilize instructional strategies grounded in learning theory.
Methodology
A workgroup from the Society for Academic Emergency Medicine (SAEM) Simulation Academy and Education Research Interest Group sought to develop theory‐informed recommendations for EM educators to optimize small‐group instruction. Workgroup members were faculty with undergraduate medical education and EM residency leadership roles, including the development and deployment of small‐group education.
Unique treatment
Through primary literature review and iterative discussion, the workgroup identified a suitable theoretical framework, collaborativism, that postulates that small‐group learning occurs as learners advance from divergent to convergent thinking through discussion. Through this lens, discussion is the centerpiece of small‐group learning, and educational interventions that improve the quality of discussion also improve the quality of learning.
Implications
Collaborativism‐informed strategies to strengthen small‐group learning were proposed, organized by instructional design, learner–learner interactions, and educator–learner interactions. These educational interventions focused on enhancing engagement, cooperativity, and critical thinking behaviors in small‐group learners as they engage in discussion. Recommended strategies were synthesized into a 50‐min workshop presented at the 2024 SAEM Annual Meeting.
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.
Simulation-Based Learning (SBL) is widely used in medical and STEM education, offering immersive, embodied, and interactive experiences. However, its implementation often introduces variability in control conditions, instructional design, and a reliance on between-subjects comparisons, making it difficult to isolate its specific contributions to learning. This study used a within-subjects randomized controlled design (N=88) to evaluate the effects of SBL on knowledge retention, retrieval efficiency, and confidence calibration. Participants, naïve to the learning content, learned two counterbalanced fictitious clinical cases via either a live-actor simulation or a structured text-based format. Retention was assessed one month later through video-based and written evaluations measuring accuracy, reaction time, and confidence. SBL led to significantly faster reaction times (Estimate = 0.066, 95% CI [0.03, 0.10], SE = 0.017, t = 3.90, p < 0.001) and higher recall accuracy (Estimate = -0.456, SE = 0.097, z = -4.71, p < 0.001, OR = 0.63, 95% CI [0.52, 0.77]) compared to text-based learning. An order effect emerged: learning first via text enhanced subsequent SBL performance, whereas the reverse sequence impaired text-based retention (Estimate = –0.837, SE = 0.343, z = –2.44, p = 0.015; OR = 0.43, 95% CI [0.22, 0.85]). Mental imagery ability influenced retrieval accuracy, with higher imagery scores predicting greater accuracy overall (Estimate = 0.266, SE = 0.114, z = 2.34, p = 0.019; OR = 1.30, 95% CI [1.04, 1.63]). A significant interaction between imagery ability and modality showed that this effect was more pronounced in the text-based condition (Estimate = -0.186, SE = 0.058, z = -3.22, p = 0.001; OR = 0.83, 95% CI [0.74, 0.93]). Confidence ratings further highlighted SBL’s advantages, with participants in the SBL condition being three times more likely to report absolute confidence (Estimate = –1.14, SE = 0.08, z = –13.68, p < 0.001; OR = 0.32, 95% CI [0.27, 0.38]). Moreover, in the SBL condition, confidence was more closely aligned with actual accuracy. This study provides empirical evidence supporting the benefits of SBL over traditional text-based learning for the acquisition and long-term retention of clinical knowledge. While SBL enhances learning, our results suggest that structured, text-based methods can also yield strong retention outcomes, particularly for item identification and sequential recall. These findings clarify the role of SBL’s immersive, embodied, and interactive elements in shaping learning while highlighting the impact of instructional sequencing and individual differences in imagery ability. Additionally, they underscore the potential benefit of SBL in aligning self-confidence with accuracy. By isolating specific SBL features, this study refines our understanding of its effects on knowledge acquisition, retrieval, and self-confidence alignment. This refined understanding allows for better-informed design of SBL interventions and offers insights that can be applied to non-SBL learning environments.
The human immune system hard wired to defend physical health against microorganisms and disease, also offers a response to psychological factors. Stress, anxiety, and other negative emotions can lead to the increase of cytokine production and the prolongation of the inflammation process and the time necessary to recover using antibiotics. This interconnectedness of the immune system, stress, and emotions is the rationale behind the branch of science known as psychoneuroimmunology (PNI). Modern studies neuroimaging technology provided a deeper insight into brain-body link in different affective disorders with the focus on brain. Furthermore, the neuroimaging can help to quantify the mind-body therapies drug treatments effects. This chapter provide a detailed description of the PNI and then analyze the concepts of chronic inflammation in health, neuroimaging methodologies in PNI, and the effects of mind-body therapies and pharmacological approaches to change brain-immune connections.
Introduction
Educators strive to engage learners with their learning. At the heart of this process is empowering individuals to intentionally participate in educational opportunities afforded to them i.e. agentic learning (AL). Significant knowledge gaps remain in how best to promote AL in medical education. Increasingly, simulation is being used to research pedagogical phenomena. In our study, we used simulation as a context to address the following research question: How does individuals' agency manifest in their learning, and what conditions act as enablers for its development?
Methods
Twelve medical students were recruited for this qualitative study. An acute medical simulation‐based exercise was used as a learning context. Following the simulations, semi‐structured interviews were conducted. Recordings of interviews, and simulation pre‐briefs and debriefs were transcribed and thematically analysed using template analysis, drawing upon the Transformative Agency through Double Stimulation framework ‐ to guide our analysis.
Results
We constructed six themes that capture how AL manifests and is promoted. Learners invariably encounter challenges that impede progress in their learning. Such challenges can spur learners to think and act agentially. Feedback provides a mirror for learners to gain self‐knowledge, deepening their commitment to take ownership of their actions and effect change. This process is enhanced by allowing learners to enact and embody new knowledge. Upholding learners' professional credibility and harnessing the social practice of learning – provides conditions for AL to flourish.
Discussion
AL in medical education helps learners shift from pretending to becoming their future professional selves. By crafting sufficient and facilitated challenges, learners are allowed to ‘hold the tension’ between creatively resolving challenges and upholding their professional credibility. This process is shaped by participation in a social group and can be influenced by the transformation of activities within this group. Embodying changes provides a deep‐seated message that learners can carry to their future.
Statement
This Workbook and its Action Plans and Notes aim to equip health professions educators with the information and guidance needed to develop and implement a simulation-based mastery learning curriculum. The Workbook begins with an introductory statement about mastery learning curriculum developers and teachers and also about expected behavior of learners in a mastery context. The Workbook continues with 10 connected sections on simulation-based mastery learning curriculum development: (1) problem identification and needs assessment, (2) targeted needs assessment, (3) goals and objectives, (4) education strategies, (5) learner assessment goals and tools, (6) standard setting, (7) curriculum implementation, (8) feedback and debriefing, (9) unexpected collateral effects, and (10) program evaluation. These sections are modeled after the Thomas and Kern ( Curriculum Development for Medical Education: A Six-Step Approach . 4th ed. Baltimore: Johns Hopkins University Press; 2022) steps for curriculum development and add several steps needed to incorporate simulation-based mastery learning goals. Curriculum development is an iterative process and each decision impacts preceding and subsequent steps. In addition, steps often change and evolve as a curriculum is developed and revised. Users are encouraged to record and refine their curriculum development plans as they move, back-and-forth, through the Workbook and Action Plans and Notes. References are provided throughout the document to amplify the text and provide detailed examples of the curriculum development steps and procedures. The intended outcome is a simulation-based mastery learning curriculum plan that can be implemented and used to educate learners to a very high standard of achievement.
In current simulation research, post-simulation discussions, so called debriefings, have been shown to be an effective means to learn from simulated experience. However, there is less consensus about which educational methods would guarantee successful debriefing outcomes. This article conducts a comparative study of post-simulation discussions in two professions with a longstanding history of simulation training: nursing and nautical education. We combine a literature review with a survey-based investigation (N = 168) to understand how instructors and facilitators implement their pedagogical ideas in debriefing practice. The results reveal consensus on the importance of debriefings, a shared emphasis on creating a space for self-reflection on practice in groups across practice areas. At the same time, differences emerge between nursing and nautical education in relation to the role of facilitators, focus on learning objectives, and views on instructional feedback and storytelling, both between and within educational fields.
Simulation-based learning (SBL) is an instructional technique designed to engage learners and foster the development of knowledge, attitudes, practical skills, critical thinking, and decision-making in nursing practice. Debriefing is a crucial component of SBL that enables learners to achieve learning objectives and integratetheoretical knowledge with clinical nursing practice. This is accomplished through structured reflection, analytical thinking, problem-solving, and performance evaluation. The learner-centered approach ensures that scenarios are tailored to the learners’ levelsof knowledge and experience. Facilitators mustpossess a deep understanding of the scenarios and demonstrate skills in providing constructive feedback, guiding reflective discussions, active listening, using open-ended questions, and offering rationales to support decision-making.Moreover, facilitators should createa psychologically safe environment to maximize learning outcomes. To enhance the debriefing process inSBL, widely accepted models such as the Gather, Analyze, Summarize (GAS) Model and the Promoting Excellence and Reflective Learning in Simulation (PEARLS) framework are recommended. These models provide clear structures and effective methodologies for conducting debriefing, encouraging systematic analytical thinking, and supporting learners in achieving the desired learning outcomes.
This study analyzes techniques instructor pilots (IPs) use to facilitate crew analysis and evaluation of line-oriented flight training performance. We analyzed IP facilitation and crew participation for 36 debriefing sessions conducted at 5 U.S. airlines. For this analysis we developed a rating instrument termed the Debriefing Assessment Battery and demonstrated that it can be used reliably. IP facilitation skill varied dramatically, suggesting a need for concrete hands-on training in facilitation techniques. All measures of crew participation correlated significantly with IP effectiveness in facilitation. Crews responded to IP guidance but did not lead their own debriefings. We suggest ways to improve debriefing effectiveness.
This research explores how group- and organizational-level factors affect errors in administering drugs to hospitalized patients. Findings from patient care groups in two hospitals show systematic differences not just in the frequency of errors, but also in the likelihood that errors will be detected and learned from by group members. Implications for learning in and by work teams in general are discussed.
Through a six-year qualitative study of medical residents, we build theory about professional identity construction. We found that identity construction was triggered by work-identity integrity violations: an experienced mismatch between what physicians did and who they were. These violations were resolved through identity customization processes (enriching, patching, or splinting), which were part of interrelated identity and work learning cycles. Implications of our findings (e.g., for member identification) for both theory and practice are discussed.
In this article, the author describes a new theoretical perspective on positive emotions and situates this new perspective within the emerging field of positive psychology. The broaden-and-build theory posits that experiences of positive emotions broaden people's momentary thought-action repertoires, which in turn serves to build their enduring personal resources, ranging from physical and intellectual resources to social and psychological resources. Preliminary empirical evidence supporting the broaden-and-build theory is reviewed, and open empirical questions that remain to be tested are identified. The theory and findings suggest that the capacity to experience positive emotions may be a fundamental human strength central to the study of human flourishing.
This paper reports on a qualitative field study of 16 hospitals implementing an innovative technology for cardiac surgery. We examine how new routines are developed in organizations in which existing routines are reinforced by the technological and organizational context All hospitals studied had top-tier cardiac surgery departments with excellent reputations and patient outcomes yet exhibited striking differences in the extent to which they were able to implement a new technology that required substantial changes in the operating-room-team work routine. Successful implementers underwent a qualitatively different team learning process than those who were unsuccessful. Analysis of qualitative data suggests that implementation involved four process steps: enrollment, preparation, trials, and reflection. Successful implementers used enrollment to motivate the team, designed preparatory practice sessions and early trials to create psychological safety and encourage new behaviors, and promoted shared meaning and process improvement through reflective practices. By illuminating the collective learning process among those directly responsible for technology implementation, we contribute to organizational research on routines and technology adoption.
This research explores how group- and organizational-level factors affect errors in administering drugs to hospitalized patients. Findings from patient care groups in two hospitals show systematic differences not just in the frequency of errors, but also in the likelihood that errors will be detected and learned from by group members. Implications for learning in and by work teams in general are discussed.
This article focuses on anxiety in teaching and learning. It argues that in essence the teacher's role is to contain anxiety for the sake of learning. The teacher's skill in setting up and maintaining a "containing space" is the keystone on which the various aspects of the art of good teaching rest. Within this space, learning can be experienced as the expansion of potential, not merely the mastery of content and predefined competencies. Despite the differences in aims, a strong "family resemblance" exists between teaching and psychoanalysis in terms of setting, role, transference, and underlying notions of human development.
EXPERIMENTS HAVE SHOWN THAT THE PRESENCE OF AN AUDIENCE AFFECTS INDIVIDUAL PERFORMANCE BY ENHANCING THE EMISSION OF DOMINANT RESPONSES. EVALUATED THE PROPOSAL THAT THE MERE PRESENCE OF OTHER PERSONS IS RESPONSIBLE FOR AUDIENCE EFFECTS. 45 STUDENTS PERFORMED A PSEUDORECOGNITION TASK; 15 PERFORMED THE TASK ALONE, 15 BEFORE AN AUDIENCE OF 2 PASSIVE SPECTATORS, AND 15 BEFORE 2 NONSPECTATORS. THE TASK PLACED PREVIOUSLY ESTABLISHED VERBAL HABITS IN COMPETITION WITH EACH OTHER. THE PRESENCE OF AN AUDIENCE ENHANCED THE EMISSION OF DOMINANT RESPONSES, BUT THE MERE PRESENCE OF OTHERS DID NOT.
This paper presents a model of team learning and tests it in a multimethod field study. It introduces the construct of team psychological safety—a shared belief held by members of a team that the team is safe for interpersonal risk taking—and models the effects of team psychological safety and team efficacy together on learning and performance in organizational work teams. Results of a study of 51 work teams in a manufacturing company, measuring antecedent, process, and outcome variables, show that team psychological safety is associated with learning behavior, but team efficacy is not, when controlling for team psychological safety. As predicted, learning behavior mediates between team psychological safety and team performance. The results support an integrative perspective in which both team structures, such as context support and team leader coaching, and shared beliefs shape team outcomes.
This paper explores the case for a general threat-rigidity effect in individual, group, and organizational behavior. Evidence from multiple levels of analysis is summarized, showing a restriction in information processing and constriction of control under threat conditions. Possible mechanisms underlying such a multiple-level effect are explored, as are its possible functional and dysfunctional consequences.
Effective coaching and mentoring is crucial to the success of individuals and organizations, yet relatively little is known about its neural underpinnings. Coaching and mentoring to the Positive Emotional Attractor (PEA) emphasizes compassion for the individual's hopes and dreams and has been shown to enhance a behavioral change. In contrast, coaching to the Negative Emotional Attractor (NEA), by focusing on externally defined criteria for success and the individual's weaknesses in relation to them, does not show sustained change. We used fMRI to measure BOLD responses associated with these two coaching styles. We hypothesized that PEA coaching would be associated with increased global visual processing and with engagement of the parasympathetic nervous system (PNS), while the NEA coaching would involve greater engagement of the sympathetic nervous system (SNS). Regions showing more activity in PEA conditions included the lateral occipital cortex, superior temporal cortex, medial parietal, subgenual cingulate, nucleus accumbens, and left lateral prefrontal cortex. We relate these activations to visioning, PNS activity, and positive affect. Regions showing more activity in NEA conditions included medial prefrontal regions and right lateral prefrontal cortex. We relate these activations to SNS activity, self-trait attribution and negative affect.
Reflective thinking is an active, conscious mode of cognition that plays an important role in problem solving and in learning. However, most people tend to resist switching from an automatic to a conscious, reflective mode of thinking under conditions of ambiguity and threat. Chris Argyris and Donald Schon have developed a theory to explain this resistance and a method for "unfreezing" automatic reasoning processes so that people can learn a more reflective kind of thinking (Model II). This case study describes problems the authors encountered in using one of the Argyris-Schon unfreezing methods (the X-Y Exercise) and the process through which the problem was reframed and eventually solved. On the basis of this case study, the authors explore the sources of resistance to Model II thinking and critique methods of unfreezing that focus on confronting and working through defensiveness. Finally, they propose an alternative unfreezing model based on the concept of "reconceptualization."
The central argument of this paper is that the formative and summative purposes of assessment have become confused in practice and that as a consequence assessment fails to have a truly formative role in learning. The importance of this role is argued particularly in relation to learning with understanding (deep learning). It is pointed out that the requirements of assessment for formative and summative purposes differ in several dimensions, including reliability, the reference base of judgements and the focus of the information used. This challenges the assumption that summative judgements can be formed by simple summation of formative ones. An alternative procedure for linking formative and summative assessment is proposed such that their separate functions are preserved.
This article is a review of the literature on classroom formative assessment. Several studies show firm evidence that innovations designed to strengthen the frequent feedback that students receive about their learning yield substantial learning gains. The perceptions of students and their role in self‐assessment are considered alongside analysis of the strategies used by teachers and the formative strategies incorporated in such systemic approaches as mastery learning. There follows a more detailed and theoretical analysis of the nature of feedback, which provides a basis for a discussion of the development of theoretical models for formative assessment and of the prospects for the improvement of practice.
On the basis of a new model of motivation, the authors examined the effects of 3 dimensions of teacher (
n = 14) behavior (involvement, structure, and autonomy support) on 144 children's (Grades 3–5) behavioral and emotional engagement across a school year. Correlational and path analyses revealed that teacher involvement was central to children's experiences in the classroom and that teacher provision of both autonomy support and optimal structure predicted children's motivation across the school year. Reciprocal effects of student motivation on teacher behavior were also found. Students who showed higher initial behavioral engagement received subsequently more of all 3 teacher behaviors. These findings suggest that students who are behaviorally disengaged receive teacher responses that should further undermine their motivation. The importance of the student–teacher relationship, especially interpersonal involvement, in optimizing student motivation is highlighted. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Background
The limitations of traditional forms of systematic review in making optimal use of all forms of evidence are increasingly evident, especially for policy-makers and practitioners. There is an urgent need for robust ways of incorporating qualitative evidence into systematic reviews.
Objectives
In this paper we provide a brief overview and critique of a selection of strategies for synthesising qualitative and quantitative evidence, ranging from techniques that are largely qualitative and interpretive through to techniques that are largely quantitative and integrative.
Results
A range of methods is available for synthesising diverse forms of evidence. These include narrative summary, thematic analysis, grounded theory, meta-ethnography, meta-study, realist synthesis, Miles and Huberman's data analysis techniques, content analysis, case survey, qualitative comparative analysis and Bayesian meta-analysis. Methods vary in their strengths and weaknesses, ability to deal with qualitative and quantitative forms of evidence, and type of question for which they are most suitable.
Conclusions
We identify a number of procedural, conceptual and theoretical issues that need to be addressed in moving forward with this area, and emphasise the need for existing techniques to be evaluated and modified, rather than inventing new approaches.
Winnicott’s preface to his book The Family and Individual Development gives a statement of its central topic: the family and the theory of the emotional growth of the human child. Winnicott proposes that the prototype of the place where the developing child meets society lies in the original meeting point for us all, the infant-mother relationship. Included are Winnicott’s acknowledgements for the book.
Many decisions are based on beliefs concerning the likelihood of uncertain events such as the outcome of an election, the guilt of a defendant, or the future value of the dollar. Occasionally, beliefs concerning uncertain events are expressed in numerical form as odds or subjective probabilities. In general, the heuristics are quite useful, but sometimes they lead to severe and systematic errors. The subjective assessment of probability resembles the subjective assessment of physical quantities such as distance or size. These judgments are all based on data of limited validity, which are processed according to heuristic rules. However, the reliance on this rule leads to systematic errors in the estimation of distance. This chapter describes three heuristics that are employed in making judgments under uncertainty. The first is representativeness, which is usually employed when people are asked to judge the probability that an object or event belongs to a class or event. The second is the availability of instances or scenarios, which is often employed when people are asked to assess the frequency of a class or the plausibility of a particular development, and the third is adjustment from an anchor, which is usually employed in numerical prediction when a relevant value is available.
I introduce the construct of threat regulation as an agentic interpersonal process for building and maintaining trust. I examine threat regulation as a specific dimension of interpersonal emotion management that fosters trust and effective cooperation by allowing individuals to understand and mitigate the harm that their counterparts associate with cooperating - in particular, harm from opportunism, identity damage, and neglect of their interests. To explicate the microprocesses of threat regulation, I draw on social cognitive theory, symbolic interactionism, and the psychology of emotion regulation.
A solution is suggested for an old unresolved social psychological problem.
This article contributes an analysis of the use of experiential learning and reflection within a management education context where its use has received less attention: a learning environment dominated by the requirements of a professional body, where successful attainment of the qualification offered by the programme is linked with entry into the profession and to promotion within it. Using a psychoanalytic lens, this study shows the tension occurring between experiential learning methods and the ‘expert knowledge’ requirements of professional bodies. Tension is essential for learning but we argue that the consequences of it are uncertain and that it deserves more attention within the management education domain. We highlight the ways by which anxiety generated by this tension can stimulate meaningful and reflexive outcomes but our findings also indicate that ‘learning inaction’ (Vince, 2008) is also possible, particularly where tutors are unable to provide a sufficient ‘holding’ environment when anxieties arising from experience-based learning and expert knowledge demands become too hard to bear.
The phrase "switching cognitive gears" is used to call attention to the fact that cognitive functioning involves the capacity to shift between cognitive modes, from automatic processing to conscious engagement and back again. Effectiveness may be as much a function of an actor's capacity to sense when a switch is appropriate, as to process in one or another mode. In this paper the authors develop a perspective on the switch from automatic to active thinking and the conditions that provoke it. They apply the perspective to work settings and identify types of situations in which actors are expected to switch from habits of mind to active thinking. They propose further work to develop a framework for understanding the switch from active thinking to automatic.
This article describes how people adapt to new roles by experimenting with provisional selves that serve as trials for possible but not yet fully elaborated professional identities. Qualitative data collected from professionals in transition to more senior roles reveal that adaptation involves three basic tasks: (1) observing role models to identify potential identities, (2) experimenting with provisional selves, and (3) evaluating experiments against internal standards and external feedback. Choices within tasks are guided by an evolving repertory that includes images about the kind of professional one might become and the styles, skills, attitudes, and routines available to the person for constructing those identities. A conceptual framework is proposed in which individual and situational factors influence adaptation behaviors indirectly by shaping the repertory of possibilities that guides self-construction.
It's a manager's perennial question: "How do I get an employee to do what I want?" The psychology of motivation is very complex, and what has been unraveled with any degree of assurance is small indeed. But the dismal ratio of knowledge to speculation has not dampened managers' enthusiasm for snake oil, new forms of which are constantly coming on the market, many of them with academic testimonials. The surest way of getting someone to do something is to deliver a kick in the pants-put bluntly, the KITA. Because of the inelegance of a physical KITA and the danger that a manager might get kicked in return, companies usually resort to positive KITAs, ranging from fringe benefits to employee counseling. But while a KITA might produce some change in behavior, it doesn't motivate. Frederick Herzberg, whose work influenced a generation of scholars and managers, likens motivation to an internal generator. An employee with an internal generator, he argues, needs no KITA. Achievement, recognition for achievement, the work itself, responsibility, and growth or advancement motivate people. The author cites research showing that those intrinsic factors are distinct from extrinsic, or KITA, elements that lead to job dissatisfaction, such as company administration) supervision, interpersonal relationships, working conditions, salary, status, and job security. Managers tend to believe that job content is sacrosanct. But jobs can be changed and enriched. Managers should focus on positions where people's attitudes are poor, the investment needed in industrial engineering is cost-effective, and motivation will make a difference in performance.
Experiential learning in the educational context incorporates real-life-based processes into the educational setting in order for them to be used and scrutinized The heart of these sorts of learning experiences is the postexperience analytic process, generally referred to as the debriefing session. This essay focuses on the debriefing process as it accompanies one form of experiential learning, simulations and games. It provides a review of the existent literature on debriefing, an analysis of the debriefing process, and effective strategies for its use. It provides an analysis of the process, identifies its components and essential phases, and presents a systematic approach to the assessment of the conduct of debriefing sessions.
To transform experience into learning, reflection that often occurs through the medium of conversation is necessary. Specifically, we focus on conversation in debriefing and processing sessions following simulations and games as opportunities for transforming experience into learning. We suggest approaching debriefing sessions with a redefined role of the facilitator as one who has profound respect for the wisdom and voice of each participant and an openness to surprise and personal learning. Careful attention needs to be given to creating a hospitable and receptive space to hold and nurture the debriefing conversations. Specific contextual considerations in creating that space include making a conscious effort, attending to concerns of perceived safety, moderating the energy level, confronting conflict in ways that are growth promoting, valuing and encouraging the integration of the head and the heart of each participant, and valuing reflective listening as highly as active speaking.
Introduction:
Fidelity has been identified as an important element in a subject's perception of realism and engagement in learning during a simulation experience. The purpose of this study was to determine whether an isolated visual and olfactory sensory change to the simulation environment affects the subjects' perceptions of realism during simulation cases.
Methods:
Using an electrosurgical unit applied to bovine muscle tissue, we created a model to simulate the characteristic operating room smoke and burning odor that occur during many procedures. Anesthesiologist subjects were randomly assigned to an intervention group that participated in a simulation involving the characteristic smoke and odor or a control group whose simulation involved no smoke or odor. Subjects completed a 7-question survey on the fidelity of the simulation, their perception of realism, and their learning engagement.
Results:
We enrolled 103 subjects over 22 simulation courses in our study (intervention, n = 52; control, n = 51). The subjects' reactions to the physical (P = 0.73), conceptual (P = 0.34), and emotional (P = 0.12) fidelity and their perception of realism (P = 0.71) did not differ between the intervention and control groups.
Discussion:
In a high-fidelity simulation environment, a visual and olfactory increment to physical fidelity did not affect subjects' overall ratings of fidelity, perceptions of realism, and engagement in the learning experience.
Introduction Contracting A Modern Dilemma Contract Making The Contract Makers Contemporary Contracts Violating the Contract Changing the Contract Business Strategy and Contracts Trends in the New Social Contract