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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.
... Discourse related to psychological safety within the simulation community has centred on how facilitators can create a "safe container" for participants, but this narrow emphasis limits the potential power of a critical teamwork concept [1]. The next step to inform our approach, as we seek to improve the performance of healthcare teams, is to understand how psychological safety leaks into, and out of, the container of simulation. ...
... Psychological safety-"a shared belief held by members of a team that the team is safe for interpersonal risk taking"-informs simulation facilitators' current approaches and also has real-world implications for teams [1,2]. Simulation facilitators have diligently focused on fostering psychologically safe learning environments. ...
... Simulation facilitators have diligently focused on fostering psychologically safe learning environments. Many employ pre-briefings, rapport building, fiction-contracts, and a variety of other tools in hopes of creating and maintaining space for interpersonal vulnerability and collective learning, with variable success [1,[3][4][5]. But the concept of psychological safety originates and extends well beyond the walls of the simulation space. ...
Background
Simulation facilitators strive to ensure the psychological safety of participants during simulation events; however, we have limited understanding of how antecedent levels of psychological safety impact the simulation experience or how the simulation experience impacts real-world psychological safety.
Methods
We explored the experience of participants in an embedded, interprofessional simulation program at a large tertiary emergency department (ED) in Australia. We engaged in theoretical thematic analysis of sequential narrative surveys and semi-structured interviews using a previously derived framework of enablers of psychological safety in healthcare. We sought to understand (1) how real-world psychological safety impacts the simulation experience and (2) how the simulation experience influences real-world psychological safety.
Results
We received 74 narrative responses and conducted 19 interviews. Simulation experience was both influenced by and impacted psychological safety experienced at the individual, team, and organizational levels of ED practice. Most strikingly, simulation seemed to be an incubator of team familiarity with direct impact on real-world practice. We present a model of the bidirectional impact of psychological safety and simulation within healthcare environments.
Conclusion
Our model represents both opportunity and risk for facilitators and organizations engaging in simulation. It should inform objectives, design, delivery, debriefing, and faculty development and firmly support the situation of simulation programs within the broader cultural ethos and goals of the departments and organizations.
... Much of the research on effective teaching in simulation has centered around debriefing, feedback, and prebriefing. [5][6][7][8][9][10] Research has shown the importance of creating learning environments conducive to constructive debriefing, involving the learners in the codebriefing dialog, [10][11][12] and using specific data to compare objectives and outcomes. 5,9,10,[12][13][14][15] Research has also shown the importance of prebriefing to create an effective learning environment and set up learning goals to be addressed in the debriefing. ...
... [5][6][7][8][9][10] Research has shown the importance of creating learning environments conducive to constructive debriefing, involving the learners in the codebriefing dialog, [10][11][12] and using specific data to compare objectives and outcomes. 5,9,10,[12][13][14][15] Research has also shown the importance of prebriefing to create an effective learning environment and set up learning goals to be addressed in the debriefing. 5,9 Few researchers have investigated student perceptions about the instructor attributes, skills, and knowledge they believe that are needed to create an effective learning experience. ...
... 5,9,10,[12][13][14][15] Research has also shown the importance of prebriefing to create an effective learning environment and set up learning goals to be addressed in the debriefing. 5,9 Few researchers have investigated student perceptions about the instructor attributes, skills, and knowledge they believe that are needed to create an effective learning experience. ...
Summary statement:
Twenty-three focus groups were held with 183 first-year medical students to assess student perceptions of effective simulation instructors during preclinical training in a medical school. Qualitative descriptive analysis guided the interpretation of focus group data. Students identified 6 areas of knowledge (schedule, student learning goals, session scenario, tasks and checklists, technique, and session purpose); 5 effective instructor skill categories (setting up the learning environment, teaching at the appropriate level, teaching technique, providing deeper context, and giving effective feedback); and 8 positive instructor attributes (enthusiasm, engaged, prepared, knowledgeable, patient, relational, transparent, and calm) instructors should have. Each category of instructor attributes, skills, and knowledge was also described in detail providing illustrative examples of what effective instruction would look like in practice from the students' perspective. Recommendations for instructor faculty development methods and topics/goals are given.
... Two scenarios were conducted during each simulationbased training activity each preceded by a briefing and immediately followed by a debriefing [20]. The briefing provided an introduction to the simulation room, the available (technical) equipment and the patient simulator SimMan ÂŽ by Laerdal Medical [21], as well as a reminder about confidentiality and an introduction to the scenario [22]. During the simulation, facilitators acted as the patient's voice and answered the questions directed towards the patient. ...
... The recognisable scenarios, together with information about the setting and available equipment, were important factors in getting students to engage in the simulation. Considering the simulation activity as a social practice where learning is constructed in interaction between the participants, environment and equipment, it highlights the importance of pre-briefing to create a safe and recognisable environment for the students to interact in [22,27,28]. Thus, they seemed to manage to utilise the resources available in the room and frame the simulated situations into something manageable. ...
... In our study, the students highlighted that the relaxed pace of the scenarios, combined with a reasonable amount of time to complete them, made it possible to focus on the interactions and communication within the team, to ask each other questions and discuss and reflect together without being overwhelmed. When students recognise the simulation-based activity as a safe environment, it can motivate them to perform at the edge of their expertise [22], which might enable them to expand on the learning activity and enhance their knowledge. In our scenarios, the students recognised the setting as a safe environment, which made them willing to ask questions, listen to reflections from others and contemplate on the best way forward together, although it might highlight skills deficiencies. ...
Background
Introducing interprofessional education (IPE) in healthcare curricula can prepare students for healthcare practices that have become increasingly complex. The use of simulation is promoted to support IPE. This study explores healthcare studentsâ experiences of participating in common, sub-acute patient scenarios that routinely occur in clinical practice in primary care. More specifically, it looks at how sub-acute patient scenarios from primary care can help develop interprofessional collaborative competence.
Methods
Medical students ( N = 10), masterâs students in advanced geriatric nursing ( N = 8) and bachelorâs students in nursing ( N = 9) participated in the simulations. The students were in their last or second-to-last year of education. We conducted five semi-structured focus group interviews with the participantsâ directly after the simulation training to elicit experiences related to the scenarios, the simulation and interprofessional collaboration. The transcripts were analysed using systematic text condensation. To supplement the focus group interviews, the students also completed the interprofessional collaborative competency attainment survey (ICCAS), which measures the studentsâ self-assessed interprofessional competence.
Results
Three main themes emerged from the analysis of the focus group interviews: realism , uncertainty and reflection . The students emphasised the importance of authentic and recognisable scenarios. They said the vague and unspecific patient symptoms created uncertainty in the situation, making it difficult to understand the patientâs diagnosis. Despite that uncertainty, they described the experience as positive. Further, the students expressed that the simulation increased their confidence in interprofessional collaboration and prepared them for future work. The results from the ICCAS questionnaire showed that the students reported a subjective positive change in their interprofessional competence after participating in the scenarios.
Conclusions
This study showed that simulation-based IPE with sub-acute primary care scenarios contributes to develop interprofessional collaborative competence in healthcare education. Sub-acute scenarios can supplement the more common approaches with acute care scenarios and aid in developing the collaborative competence required to work in healthcare teams.
... At present, educators and researchers are making major efforts to make the "safe environment" become a requirement for learning with healthcare simulation groups. [1][2][3][4] Trust, respect, and a motivating and welcoming atmosphere 5 provide a suitable environment for simulation learning. Simulation learning entails the public exposure of actions that are evaluated and discussed, and making mistakes and discussing them without inhibitions can be challenging. ...
... To recruit the most suitable informants for the study, an intentional, nonprobabilistic sampling method was used. The participants were undergraduate nursing students and emergency nursing graduate students who met the following inclusion criteria: (1) previous participation in at least 100 hours of simulation during their undergraduate/postgraduate studies and (2) enrollment in a learning with simulation program. The data were collected between the months of January to November 2019. ...
... 18,19 Nevertheless, a psychologically safe environment is fundamental for taking full advantage of the simulation. 1 Our study suggests that spontaneous applause contributes to creating this safe environment. ...
Introduction:
Applause is a common behavior during simulation case learning sessions. Some simulation facilitators believe that this should not be allowed, arguing that it can mislead students when they make mistakes during simulation. This study was conducted to explore the opinions of students about spontaneous applause (initiated by the participants), as a habitual behavior in the simulation sessions, in the undergraduate and postgraduate nursing degrees.
Methods:
A qualitative research study was conducted based on the content analysis of 7 focus groups composed of simulation students (N = 101, both undergraduate and graduate students). The participants were asked to conduct a debate about the following question: What is your opinion about the spontaneous applause given to participants by their peers at the completion of the scenario as they go to the debriefing, and why? An inductive method of content analysis was used to interpret the data.
Results:
The majority considered applause as a sign of support; one student disapproved of the practice. For most participants, receiving spontaneous applause from their peers after finishing the simulation represented a spontaneous example of moral support that reduced the participants' stress.
Conclusions:
Applause within the context of clinical simulation is a motivational act, which should not be repressed by the facilitator, as long as it is a spontaneous and genuine act by the participants once the simulation experience ends.
... S'agissant des modalitÊs de participation, les rôles de chacun et les règles de communication sont prÊcisÊs pour l'ensemble des participants prÊsents (Page-Cutrara, 2014). Les modalitÊs d'analyse ou d'Êvaluation et leurs modes de restitution doivent Êgalement être discutÊes lors de ce moment (Rudolph et al., 2014). Le briefing est considÊrÊ comme un moment oÚ l'on peut revenir sur les connaissances qui seront mobilisÊes lors du scÊnario, ce qui permettrait aux apprenants de clarifier les objectifs (Bruce et al., 2009 ;Husebø et al., 2012) ou encore de donner l'opportunitÊ de poser les questions nÊcessaires dans le but de lever leurs doutes. ...
... Durant cette ĂŠtape, le formateur peut susciter la motivation ainsi que la mise en confiance de l'apprenant (Rudolph et al., 2014). Il s'agit de crĂŠer un cadre oĂš les apprenants se sentent suffisamment en sĂŠcuritĂŠ pour exposer leurs pratiques quotidiennes sans craindre de se sentir humiliĂŠs ou pour expĂŠrimenter de nouvelles pratiques (Rudolph et al., 2014). ...
... Durant cette ĂŠtape, le formateur peut susciter la motivation ainsi que la mise en confiance de l'apprenant (Rudolph et al., 2014). Il s'agit de crĂŠer un cadre oĂš les apprenants se sentent suffisamment en sĂŠcuritĂŠ pour exposer leurs pratiques quotidiennes sans craindre de se sentir humiliĂŠs ou pour expĂŠrimenter de nouvelles pratiques (Rudolph et al., 2014). Afin de favoriser le sentiment de sĂŠcuritĂŠ et de confiance, il est question de veiller Ă la sĂŠcuritĂŠ ĂŠmotionnelle. ...
La formation par simulation interprofessionnelle sâest imposĂŠe ces dernières annĂŠes avec pour perspective le dĂŠveloppement des compĂŠtences relatives Ă la sĂŠcuritĂŠ des patients. NĂŠanmoins, lâincidence des ĂŠvĂŠnements indĂŠsirables liĂŠs aux soins concerne encore un patient hospitalisĂŠ sur dix. Cette thèse contribue Ă ĂŠclairer le rapport travail- formation, plus prĂŠcisĂŠment le rapport entre la configuration didactico-pĂŠdagogique et le potentiel dâapprentissage organisationnel. Elle sâappuie sur une mĂŠthode mixte intĂŠgrĂŠe, combinant un ensemble dâanalyses qui traite des composantes de lâacte ĂŠducatif, de la pluralitĂŠ des situations professionnelles qui en constitue la rĂŠfĂŠrence, de lâĂŠvolution des compĂŠtences perçues qui en dĂŠcoulent. Le dispositif ĂŠtudiĂŠ est caractĂŠrisĂŠ par un mode transmissif davantage quâinteractif, par un faible partage de la rĂŠflexivitĂŠ de la part des apprenants, et par des dĂŠbats centrĂŠs très largement sur des ĂŠlĂŠments favorables Ă un apprentissage simple boucle plutĂ´t que double boucle. Le suivi en quatre temps de lâĂŠvolution des compĂŠtences perçues montre un dĂŠveloppement limitĂŠ dans le temps de la plupart des domaines de compĂŠtences relatives Ă la sĂŠcuritĂŠ des patients. Exploiter le potentiel dâapprentissage organisationnel en simulation interprofessionnelle et renforcer les compĂŠtences relatives Ă la sĂŠcuritĂŠ des patients par leur ampleur et leur durĂŠe, impliquent une consolidation de lâarticulation entre le travail et la formation, dâune part en soutenant le positionnement des apprenants Ă partir de leurs richesses dâexpĂŠrience, dâautre part en abordant lâenvironnement de simulation comme un lieu de rĂŠflexivitĂŠ sur lâactivitĂŠ, propice Ă la transformation des pratiques.
... Les Êtudes les plus rÊcentes ont cherchÊ à caractÊriser les effets de techniques de respiration, de rÊtrocontrôle cardiaque, ou encore de la stimulation cÊrÊbrale transcrânienne à courant continu . Dans un contexte de stress inhÊrent à la pratique professionnelle oÚ un haut niveau de performance est attendu, les techniques d'optimisation du potentiel ont Êgalement ÊtÊ explorÊes Sigwalt et al., 2020) 21 . ...
... Simulations were always structured as follows: briefing (one to five min), scenario (10 to 20 min), and debriefing (30 to 45 min). [21][22][23] The scenarios dealt with crisis situations in the intensive care unit, operating room, and delivery room (TAMPONADE, NEONATAL, AMNIOTIC FLUID, PACEMAKER), no residents performed these scenarios beforehand (App. A). ...
... Ne passez pas trop de temps sur l'une ou l'autre de ces propositions et indiquez la rĂŠponse qui dĂŠcrit le mieux vos sentiments habituels. 21. Je me sens de bonne humeur, aimable. ...
Le stress survient lorsque les exigences dâune situation dĂŠpassent la capacitĂŠ d'adaptation individuelle. Le stress est une cause majeure dâinvaliditĂŠ due Ă ses effets nĂŠfastes sur les fonctions exĂŠcutives et ses complications sur la santĂŠ psychique et physique. Notre approche pluridisciplinaire sâancre dans la continuitĂŠ des rĂŠcents travaux questionnant ses impacts, les outils de remĂŠdiation, et les sensibilitĂŠs individuelles au stress. Le 1er objectif de cette thèse ĂŠtait de dĂŠterminer lâimpact dâun stress aigu sur les capacitĂŠs dâimagerie motrice (ĂŠtudes 1, 2). Nos rĂŠsultats montrent un maintien des capacitĂŠs explicites et une dĂŠtĂŠrioration des capacitĂŠs implicites pendant et suite Ă un ĂŠvènement stressant. Le 2nd objectif ĂŠtait de caractĂŠriser la pĂŠriode dâanticipation dâun ĂŠvènement stressant, pour cela nous avons crĂŠĂŠ et testĂŠ un nouveau protocole le Trier Social Anticipatory Stress Test (ĂŠtude 3). Alors que peu de moyens dâaction sont envisagĂŠs pour faire face au stress aigu, le traitement habituel dâun stress chronique repose principalement sur une prise en charge mĂŠdicamenteuse et des thĂŠrapies comportementales. Ces traitements peuvent entraĂŽner des effets secondaires, des rĂŠsistances et souffrir dâune faible adhĂŠsion. Il est donc nĂŠcessaire de trouver de nouvelles approches non-invasives. Le 3ème objectif ĂŠtait dâexplorer des techniques de remĂŠdiation du stress (ĂŠtudes 3, 4, 5, 6). Nous avons comparĂŠ lâefficacitĂŠ de 4 techniques de gestion ĂŠmotionnelles administrĂŠes pendant un stress dâanticipation : respiration relaxante (RESPIRATION), rĂŠtrocontrĂ´le biologique cardiaque (VFC-RETRO), stimulation cĂŠrĂŠbrale du cortex prĂŠfrontal dorsolatĂŠral (STCC), VFC-RETRO couplĂŠ Ă la STCC (VFC-RETRO + STCC). Ces techniques ont ĂŠtĂŠ explorĂŠes au laboratoire et durant un stress professionnel mĂŠdical (simulation de soins critiques). Nos rĂŠsultats indiquent que les interventions ont des effets psychophysiologiques et comportementaux spĂŠcifiques. Hormis la STCC, elles sont toutes efficaces pour rĂŠduire le stress. Comparativement Ă une condition contrĂ´le, 5 min de RESPIRATION permettent dâaugmenter la relaxation subjective et objective durant lâanticipation. Lorsque la respiration est couplĂŠe Ă un VFC-RETRO, on observe une augmentation significativement plus importante de ces marqueurs. Comparativement Ă une condition contrĂ´le, 15 min de VFC-RETRO augmentent la variabilitĂŠ de la frĂŠquence cardiaque et rĂŠduit le ressenti global de stress (ĂŠtudes 3, 4). Un couplage VFC-RETRO + STCC permet de potentialiser ces effets, dâinduire une relaxation immĂŠdiate et une rĂŠduction du stress global plus importante. Concernant les performances, la RESPIRATION et le VFC-RETRO permettent dâamĂŠliorer les ressentis subjectifs de performances (ĂŠtudes 3, 4, 5, 6). Lâimpact positif objectif du VFC-RETRO sur les fonctions exĂŠcutives est confirmĂŠ uniquement lorsque le niveau de base des individus est pris en compte (ĂŠtude 4). Ces rĂŠsultats permettent dâenvisager la mise en place de techniques de remĂŠdiation du stress Ă grande ĂŠchelle, mĂŞme si les rĂŠponses de stress font lâobjet de variabilitĂŠs interindividuelles qui doivent ĂŞtre considĂŠrĂŠes. Ainsi, le 4ème objectif ĂŠtait dâĂŠvaluer lâinfluence de la personnalitĂŠ sur la sensibilitĂŠ au stress et lâefficacitĂŠ des techniques de gestion ĂŠmotionnelle (ĂŠtude 7). Nos rĂŠsultats montrent que les traits de nĂŠvrosisme, dâextraversion et le caractère consciencieux sont importants Ă prendre en compte. Nos ĂŠtudes dĂŠmontrent pour la première fois lâintĂŠrĂŞt des interventions prĂŠventives de très courtes durĂŠes, pour prĂŠvenir les rĂŠponses psychophysiologiques (VFC-RETRO + STCC > VFC-RETRO > RESPIRATION) et les dĂŠtĂŠriorations cognitives frĂŠquemment observĂŠes lors dâun stress aigu. Ces travaux ouvrent de nombreuses perspectives dans le traitement prĂŠventif et individualisĂŠ des maladies associĂŠes au stress.
... Les Êtudes les plus rÊcentes ont cherchÊ à caractÊriser les effets de techniques de respiration, de rÊtrocontrôle cardiaque, ou encore de la stimulation cÊrÊbrale transcrânienne à courant continu . Dans un contexte de stress inhÊrent à la pratique professionnelle oÚ un haut niveau de performance est attendu, les techniques d'optimisation du potentiel ont Êgalement ÊtÊ explorÊes Sigwalt et al., 2020) 21 . ...
... Simulations were always structured as follows: briefing (one to five min), scenario (10 to 20 min), and debriefing (30 to 45 min). [21][22][23] The scenarios dealt with crisis situations in the intensive care unit, operating room, and delivery room (TAMPONADE, NEONATAL, AMNIOTIC FLUID, PACEMAKER), no residents performed these scenarios beforehand (App. A). ...
... Ne passez pas trop de temps sur l'une ou l'autre de ces propositions et indiquez la rĂŠponse qui dĂŠcrit le mieux vos sentiments habituels. 21. Je me sens de bonne humeur, aimable. ...
Stress occurs when situational demands exceed the individual's ability. Stress is a major cause of disability due to its detrimental effects on executive functions and its complications on psychological and physical health. Our multidisciplinary approach is in line with recent works seeking the impacts, remediation tools, and stress-related individual sensitivities. The first aim of this thesis was to determine the impact of acute stress on motor imagery ability (studies 1,2). Our results showed a deterioration of implicit motor imagery abilities following a stressful event and a maintenance of explicit abilities both during and following stress. The 2nd goal of our work was to characterize the stress anticipation period by developing a new tool: the Trier Social Anticipatory Stress test. While few interventions are designed to deal with acute stress, the usual treatment of chronic stress mainly relies on medication and behavioral therapies. These treatments can elicit side effects, resistance and poor adherence. It is therefore necessary to find non-invasive alternatives. The 3rd main was thus to explore several stress remediation techniques (studies 3,4,5,6). We compared the effectiveness of four coping techniques administered during an anticipatory stress period: relaxing breathing (BREATHING), cardiac biofeedback (BFB), dorsolateral prefrontal cortex cerebral stimulation (TDCS), cardiac biofeedback paired with tDCS (BFB + TDCS). These techniques were explored in the laboratory (studies 3,4) or during a medical occupational stress (critical care simulation) (studies 5,6,7). Our results indicate that the interventions have specific psychophysiological and behavioral effects. With the exception of tDCS, they are all effective for reducing stress. Compared to a control condition, 5 min of BREATHING increases subjective and objective relaxation during anticipation (studies 5,6), when breathing is paired with a BFB, a significantly greater increase is observed (studies 6). Compared to a control condition, 15 min of BFB increase heart rate variability and reduce the global feeling of stress (studies 3,4). The additional tCDS potentiates BFB effects, inducing immediate relaxation and a greater reduction in overall stress (studies 4). Concerning performance, BREATH and BFB improve subjective feelings of performance (studies 3,4,6). While some of our studies objectivate this increase in performance (studies 5,4), others show no difference with the control group (studies 3,6). When individuals baseline level is considered, the positive impact of BFB on executive functions is confirmed (studies 4). These results make it possible to envisage the implementation of large-scale stress remediation techniques, although stress responses remain subjected to inter-individual variability. Thus, the 4th goal was to evaluate the influence of personality on stress sensitivity and the effectiveness of emotional management techniques (studies 7). Our results show that neuroticism, extraversion, and conscientiousness are important traits to consider. Our studies demonstrate, for the first time, the interest of very short duration proactive interventions, to prevent psychophysiological responses (BFB + STCC > BFB > BREATH) and cognitive deteriorations (BFB) which are frequently observed during acute stress. This work offers fruitful perspectives in preventive and individualized treatment of stress-related diseases.
... Individuals and organisations frequently avoid openness and transparency in addressing deficiencies and failings, and may therefore resist these being highlighted through simulation [19]. Whilst trainee enthusiasm for cataract surgery simulation is generally high, it is not uncommon for learners to feel that their skills are being scrutinised and their professional identities questioned [2,12,22]. Some learners are not naturally reflective, and may struggle to discuss their simulation performances during the debrief [22]. ...
... Whilst trainee enthusiasm for cataract surgery simulation is generally high, it is not uncommon for learners to feel that their skills are being scrutinised and their professional identities questioned [2,12,22]. Some learners are not naturally reflective, and may struggle to discuss their simulation performances during the debrief [22]. By affirming the 'safe learning environment'; a key factor for learning according to constructivist principles, this gives trainees assurances that their simulation-based actions will not carry negative consequences [16][17][18][19]22]. ...
... Some learners are not naturally reflective, and may struggle to discuss their simulation performances during the debrief [22]. By affirming the 'safe learning environment'; a key factor for learning according to constructivist principles, this gives trainees assurances that their simulation-based actions will not carry negative consequences [16][17][18][19]22]. ...
... [3][4][5] However, the presence of psychological safety does not mean the absence of anxiety or stress, but rather being comfortable with discomfort and willing to take interpersonal risk. 6,7 In addition, it enables learners to focus on the issue to be solved rather than protecting oneself. 6 Similarly, a psychologically safe environment promotes learning, performance, and attainment of desired outcomes. ...
... 12 These items completed in the prebrief established the notion of the "safe container," a psychologically safe context for learning. 7 Because students in these 2 studies were functioning in a primary role, considerable anxiety and stress interrupted their participation in the experiences, even with concerted efforts to create a safe place to be comfortable being uncomfortable. What follows are descriptions of what occurred. ...
... Most of the simulation literature focuses on the facilitators' role in ensuring psychological safety for participants through prebriefing methods. 7,11 Despite the prebriefing and safety measures put in place by a team of interprofessional simulation facilitators in this study, fellow participants (not facilitators) compromised the psychological safety. Because of differing roles, cultures, and level of experience in real practice settings, educators must be cognizant of the unique challenges that exist in educating multidisciplinary students together. ...
Summary statement:
Psychological safety in high-fidelity simulation-based experiences ensures that learners feel safe with new experiences in the service of learning. This article is a faculty reflection on breaches in the psychological safety among nursing students in 2 independent, high-fidelity simulation-based experience studies that were conducted in 2019. Demonstrated breaches in psychological safety included fear and anxiety in the sole provider role in multiple-patient simulations and incivility directed toward nursing students in a primary nurse role in interprofessional simulations. This article adds to the growing literature on psychological safety by sharing important lessons learned regarding role clarity and interprofessional colleagues, proposing recommendations, and providing suggestions for future research on psychological safety.
... The first half hour of the session was utilized to establish a psychologically safe environment. For this, various group dynamics were established, based on the practices proposed by Rudolph, Raemer, and Simon [36], and the good practices standards from the INACSL [33] were used to establish a psychologically safe environment. The dynamics utilized were: ...
... The results from the present study showed that the items that were best scored by the participants were related with a psychologically safe environment (item 6-"I felt comfortable and respected during the sessions"), the fidelity of the clinical scenarios (item 3-"Cases recreated real situations), and the usefulness of reflection and debriefing (items 27-"The teacher provided constructive feedback after each session", 28-"Debriefing has helped me reflect on the case", and 29-"Debriefing at the end of the session has helped me correct mistakes"), where the participants provided mean scores of >4.70 out of 5. These results were congruent with those obtained in the qualitative analysis, and this was possible because the training program followed international recommendations for the design of activities based on clinical simulation [33], the use of a psychologically safe environment [36,37], and a structured debriefing [38,39]. The analysis of the satisfaction with the training according to the variable professional category highlighted the lack of statistically significant differences between the scores provided by the physicians and nurses, although the scores provided by the nurses were slightly higher in almost all the items. ...
(1) The COVID-19 pandemic has had many consequences on health systems worldwide. In the Spanish health system, telephone-based consultations were coupled to in-person consultations. This type of consultation was mainly a challenge for the primary care teams, who had to assume the greatest load of care provision. The objective of the present study was to discover the satisfaction and perception of health professionals related to a training program on efficient communication based on high-fidelity simulation. (2) Methods: A cross-sectional descriptive study based on a convergent and parallel mixed method. The satisfaction and perception of 275 health professionals associated with COVID-19 training based on the structured communication model CERCARŠ was analyzed. (3) Results: The assessment of the satisfaction with the training and methodology was high. With respect to the transfer of information, the participants gave a high score to the categories of consolidation of learning, applicability to their work, and benefits for the institution. The qualitative results supported these findings. (4) Conclusions: The training program and its virtual modality were well received, and had a high degree of transference. The application of active, online learning methodologies is a relevant format for continuous education.
... Regardless of which feedback and debriefing strategy is chosen we need to create a learning environment where learners take risks and are open to feedback and engage in debriefing [81]. Psychological safety and mutual respect can be generated through highlighting the importance of specific feedback, what type of feedback strategy you will use during the SBPT and making it clear that perfection is not expected from the start [82]. ...
... If this is the chosen strategy, learners should be made aware of the value of peer evaluation at the beginning of the SBPT [10]. These strategies are in addition to already established frameworks to foster psychological safety in simulation, for example, as outlined by Rudolph et al. [81] and Kolbe et al. [85]. ...
Simulation-based procedure training is now integrated within health professions education with literature demonstrating increased performance and translational patient-level outcomes. The focus of published work has been centered around description of such procedural training and the creation of realistic part-task models. There has been little attention with regards to design consideration, specifically around how simulation and educational theory should directly inform programme creation. Using a case-based approach in cardiology as an example, we present a blueprint for theory-informed simulation-based procedure training linking learning needs analysis and defining suitable objectives to matched fidelity. We press the importance of understanding how to implement and utilise task competence benchmarking in practice, and the role of feedback and debriefing in cycles of repeated practice. We conclude with evaluation and argue why this should be considered part of the initial design process rather than an after-thought following education delivery.
... 3,4 A thorough orientation to simulation prior to participating in simulated cases sets up learners for successful navigation of the environment, the technology, and the processes, making them more likely to engage in the activity. 5 Currently, the extent and nature of the orientation to the simulation environment are not prescribed, but the level of the student should be taken into consideration. For example, preclinical students require a more in-depth experience to ensure a safe and effective learning environment for simulations, in contrast to postgraduate learners, who are already familiar with clinical environments and comfortable with patient care. ...
Introduction:
Simulation is increasingly being used in the preclinical years of US medical school curricula to provide experiential learning opportunities for students. However, preclinical medical students may not be able to access the full benefits of immersive simulation scenarios without an in-depth introduction to the simulation environment and manikin. An escape room may be an effective way to orient students in an interactive manner to overcome this barrier.
Methods:
We designed and implemented a 90-minute escape room orientation activity to address student discomfort in the simulation environment by providing a team-based, hands-on exploration of identified critical features of the room and manikin in the guise of a routine clinic visit for a patient. We surveyed learners on their confidence immediately following the escape room and on their perceptions of the session effectiveness following their first simulation.
Results:
A total of 148 preclinical medical students participated in the escape room activity in 30 groups of four to five persons. Of those students, 130 participated in a simulated patient case within 1 month of the escape room activity, and 89 filled out a follow-up survey. Of responding students, 80% reported that the escape room activity was highly effective or very effective in preparing them for participation in a simulated patient case.
Discussion:
Implementing an escape room orientation activity for preclinical medical students was effective in preparing students to participate in their first immersive simulation scenario.
... cases 10 and 12). This important observation reminds us of the importance of ensuring a simulation learning climate that feels safe for all, and that the topics chosen for discussion in the debriefing are of interest to all [25][26][27]. In this study, the majority of recorded interactions were between the debriefer and simulation participants. ...
Background
Debriefing is an essential skill for simulation educators and feedback for debriefers is recognised as important in progression to mastery. Existing assessment tools, such as the Debriefing Assessment for Simulation in Healthcare (DASH), may assist in rating performance but their utility is limited by subjectivity and complexity. Use of quantitative data measurements for feedback has been shown to improve performance of clinicians but has not been studied as a focus for debriefer feedback.
Methods
A multi-centre sample of interdisciplinary debriefings was observed. Total debriefing time, length of individual contributions and demographics were recorded. DASH scores from simulation participants, debriefers and supervising faculty were collected after each event. Conversational diagrams were drawn in real-time by supervising faculty using an approach described by Dieckmann. For each debriefing, the data points listed above were compiled on a single page and then used as a focus for feedback to the debriefer.
Results
Twelve debriefings were included (Âľ = 6.5 simulation participants per event). Debriefers receiving feedback from supervising faculty were physicians or nurses with a range of experience ( n = 7). In 9/12 cases the ratio of debriefer to simulation participant contribution length was ⧠1:1. The diagrams for these debriefings typically resembled a fan-shape. Debriefings ( n = 3) with a ratio < 1:1 received higher DASH ratings compared with the ⧠1:1 group ( p = 0.038). These debriefings generated star-shaped diagrams. Debriefer self-rated DASH scores (Âľ = 5.08/7.0) were lower than simulation participant scores (Âľ = 6.50/7.0). The differences reached statistical significance for all 6 DASH elements. Debriefers evaluated the âusefulnessâ of feedback and rated it âhighlyâ (Âľ= 4.6/5).
Conclusion
Basic quantitative data measures collected during debriefings may represent a useful focus for immediate debriefer feedback in a healthcare simulation setting.
... e inicial se explica la experiencia gamificada a los participantes de manera clara, concisa y estructurada, proporcionando la mĂĄxima informaciĂłn posible sobre contenido, proceso y producto que se espera de la experiencia. Entusiasmo y confianza por parte de la docente son factores relevantes para conseguir una buena predisposiciĂłn de los SP. SegĂşn Rudolph et at. (2014), una actuaciĂłn eficaz por parte del facilitador es esencial para crear altas expectativas en los participantes. ...
... Psychological safety is found to be established through comprehensive group dynamics and interpersonal relationships, when facilitators recognize input and ideas, encourage students to ask questions and destigmatize failures [36,42]. The importance of students having the opportunity to become familiar with the equipment, monitors and manikins are highlighted as stress-reducing moves [2,43]. It is suggested that facilitation can be displayed by preparing well-organized simulations, demonstrating trustworthiness and accessibility, and being supportive and open [29,36,44,45]. ...
Background
Active learning situations such as simulation-based education (SBE) are found to trigger a wide range of emotions among students. Facilitators have an important educational role in SBE which include being attentive and adaptive to studentsâcognitive and affective responses. Although the importance of emotions in SBE is recognized in facilitator guidelines, little is known about how facilitators accommodate student affect. Hence, this study explores facilitatorsâ strategies for addressing studentsâ emotions in SBE.
Method
Individual interviews with nine facilitators were performed and transcripts were subjected to qualitative analyses in accordance with interpretive description approach.
Results
Findings show that facilitators are attentive to and continuously assess studentsâ emotional responses in SBE. Both positive emotions, such as interest and surprise, and negative emotions such as anxiety are cultivated, yet adapted to the perceived needs of the individual student. Psychological safety was seen as a prerequisite for optimal learning, regardless of the studentsâ previous level of knowledge. Furthermore, significant learning was seen as something that might also arise from uncomfortable experiences, such as students realizing their own mistakes or uncertainty. Hence facilitators were found to balance levels of difficulty, emotional arousal and psychological safety during the various phases of SBE.
Conclusion
Facilitators recognize the emotional dimension of learning in SBE and have numerous strategies for accommodating studentsâ emotions. This study highlights the complexity of the facilitatorâs role in adapting training to individual cognitive and emotional needs. These findings have implications for facilitator training which should include awareness of the role of emotions in learning and strategies for observing and accommodating training to meet emotional needs.
... ImplementaciĂłn: es la realizaciĂłn de la actividad de instrucciĂłn; en esta fase recomendamos hacer una muy buena introducciĂłn (briefing), conocer a los participantes, ofrecerles nuestra ayuda para alcanzar sus objetivos de aprendizaje, despejar sus dudas, informar las fortalezas y debilidades que tiene la simulaciĂłn a distancia, explicar quĂŠ esperamos de ellos y quĂŠ haremos. 38 Si lo hacemos bien, es muy probable que los participantes tengan un adecuado enganche cognitivo con la actividad y que participen activamente durante la reflexiĂłn posterior al evento (debriefing). ...
La investigaciĂłn sobre el uso de simulaciĂłn como estrategia educativa en los postgrados estĂĄ en aumento. Las particularidades de los pacientes pediĂĄtricos justifican el desarrollo de conocimiento especĂfico. Se llevĂł a cabo un estudio aleatorizado y controlado para evaluar la eficacia de una intervenciĂłn educativa para entrenamiento en habilidades clĂnicas. Treinta y ocho pediatras en formaciĂłn participaron en forma voluntaria de un programa en el que recibieron de manera aleatorizada una capacitaciĂłn y posterior evaluaciĂłn en dos habilidades combinando escenarios de procedimientos y de habilidades de comunicaciĂłn. Dos evaluadores independientes calificaron el desempeĂąo pre y postintervenciĂłn mediante listas de cotejo y otorgaron calificaciĂłn considerando el puntaje global y los errores graves cometidos. Se observĂł una mejora significativa en el desempeĂąo luego de un periodo de lavado de dos meses. La presencia de controles permitiĂł relacionar el desempeĂąo al entrenamiento. Se encontraron diferencias significativas en las habilidades procedimentales y una mejorĂa tanto en las calificaciones, como en los errores graves de los participantes. Las habilidades de consejerĂa reportaron una mejorĂa marcada en ambos grupos
... ImplementaciĂłn: es la realizaciĂłn de la actividad de instrucciĂłn; en esta fase recomendamos hacer una muy buena introducciĂłn (briefing), conocer a los participantes, ofrecerles nuestra ayuda para alcanzar sus objetivos de aprendizaje, despejar sus dudas, informar las fortalezas y debilidades que tiene la simulaciĂłn a distancia, explicar quĂŠ esperamos de ellos y quĂŠ haremos. 38 Si lo hacemos bien, es muy probable que los participantes tengan un adecuado enganche cognitivo con la actividad y que participen activamente durante la reflexiĂłn posterior al evento (debriefing). ...
... It helps to identify A. Khan, A. Amerjee, J.M. Dias, et al. areas of improvement with guidance provided by skilled instructors. 12 Most traditional training on obstetrical emergencies, like shoulder dystocia and PPH, has been mainly through lectures, drills on pelvic models and through actual patient encounters. Although international studies have shown improved performance after simulation training, this teaching modality is new and just beginning to emerge in Pakistan. ...
Objective:
To determine if simulation-based team training improves the management of shoulder dystocia compared to traditionally taught obstetrical emergencies.
Methods:
The prospective mixed-method study was conducted at the Centre for Innovation in Medical Education at the Aga Khan University, Karachi, from June to August 2018, and comprised doctors and nurses having up to five years of labour and delivery experience. The subjects were divided into two equal groups which were further subdivided into four equal teams. Group 1 was taught to manage shoulder dystocia using traditional lectures and hands-on pelvic models, while group 2 was trained in a simulated environment with a simulated scenario of shoulder dystocia. After two weeks, the performance of both teams were assessed and compared. Data was analysed using SPSS 19. A focus group discussion was subsequently conducted on the quality of the simulation experience.
Results:
Of the 32 subjects, 16(50%) each were doctors and nurses. They were divided into groups having 16(50%) members each, and each group had 4 teams having 4(25%) subjects. The overall mean age of the sample was 31.9Âą2.8 years (range: 28-38 years). The mean score for performance on technical and communication task of group 2 was 10.25Âą1.258 compared to 5.7Âą2.500 in group 1 (p=0.028). Focus group participants agreed that training in a simulated environment was far superior than being traditionally taught.
Conclusions:
Simulation-based team training in shoulder dystocia management was associated with better feedback than traditional-style teaching.
... During formative learning sessions, any performative elements should be removed, and a climate that minimizes fear of mistakes should be sought. This includes not only following principles of pre-briefing (i.e., learning contract, trust, respect) [56,57], but also fostering a broader institutional culture of learning. c. ...
In simulation-based education, there is growing interest in the effects of emotions on learning from simulation sessions. The perception that emotions have an important impact on performance and learning is supported by the literature. Emotions are pervasive: at any given moment, individuals are in one emotional state or another. Emotions are also powerful: they guide ongoing cognitive processes in order to direct attention, memory and judgment towards addressing the stimulus that triggers the emotion. This occurs in a predictable way. The purpose of this paper is to present a narrative overview of the research on emotions, cognitive processes and learning, in order to inform the simulation community of the potential role of emotions during simulation-based education.
... The effectiveness of simulation in psychiatry has previously been examined and provides a safe learning space to 'put oneself in someone else's shoes' (McNaughton, Ravitz, Wadell, & Hodges, 2008). However, simulation for difficult conversations should not be undertaken without first considering the psychological safety of those engaging in the immersive learning experience (Rudolph, Raemer, & Simon, 2014). Learners need to feel safe to push themselves to the edge of their ability, without fear of humiliation if they make a mistake, in order to achieve a positive learning experience. ...
Background: First responders regularly encounter both operational stressors and potentially traumatic events, increasing their risk of mental health issues (Declercq et al., 2011). Due to unique cultural complexities, they turn mostly to peers for early psychosocial support (Isaac & Buchanan, 2021). However, peer support and/or mental health assistance may not always be available or easy to access and first respondersâ mental health suffers.
Objective: We need more accessible routes to crisis intervention to ensure first responder
resilience and wellbeing, so they may continue to function in the service of public safety.
Family members and close friends may be ideally placed to provide this immediate care.
This article outlines the protective role of social support as an early intervention strategy to mitigate the effects of first responder trauma, exploring the potential opportunity for family members and friends to play an increasingly supportive role in their loved oneâs wellbeing. This paper serves as a call to action for practical educational interventions that will prepare family members for these critical conversations.
Conclusion: We see potential in combining early intervention theory, psychoeducation, and a strengths-based gender specific positive psychology approach. Further study should investigate how best to help first responders break down barriers to support, by bolstering their existing social supports and ultimately reducing the stigma associated with experiencing traumatic stress.
... Before each activity, participants (students, SPs, and instructors) were asked to agree to the terms of a telesimulation agreement, which stipulated that active participation and respectful orientation during the activity were mandatory [38]. The Qualtrics XM ⢠platform was used to distribute and collect the information from this agreement. ...
This article provides a road map, along with recommendations, for the adoption and implementation of telesimulation at a large scale. We provide tools for translating an in-presence simulation curriculum into a telesimulation curriculum using a combination off-the-shelf telecommunication platform. We also describe the roles and tasks that emerged within the simulation team when planning and delivering a telesimulation curriculum.
... The Self-Learning Methodology in Simulated Environments (MAESŠ) is an active teaching-learning method involving highfidelity clinical simulation. Work is conducted with small groups of participants guided by a facilitator (a maximum of 12 to 18 students) in a simulated, psychologically-safe environment [3], and with specific guidelines in which the group and work teams that comprise it have autonomy, identity, ability to make decisions, and high commitment to collaborative learning [4,5]. ...
Motivation and critical thinking are fundamental for the development of adequate learning. The purpose of the present study was to assess the motivation for learning and critical thinking among nursing students before and after self-directed simulation-based training using the MAESŠ methodology. A cross-sectional and descriptive quantitative study was conducted with a sample of third-year nursing students. The instruments utilized were the Spanish-adapted version of the Motivated Strategies for Learning Questionnaire (MSLQ-44), and the Critical Thinking for Nursing Professionals Questionnaire (CuPCPE). The students improved their levels both of motivation components, (such as self-efficacy, strategy use, self-regulation) and critical thinking components (such as personal characteristics, intellectual and cognitive abilities, interpersonal abilities and self-management, and technical abilities). These improvements could be a result of the intrinsic characteristics of the MAESŠ methodology (as a team-based, self-directed, collaborative and peer-to-peer learning method).
... For example, players in this sample discussed transitioning out of international squads, back to their club, or where players were exhausted from constant judgement and competitive demands. For this reason, there are potentially transferable dimensions of the concept of the 'safe container', a temporally constrained block of time where increased perceptions of safety can be generated via contracting lower levels of judgment [89]. ...
(1) Background: The interpersonal dimensions of coaching in high performance sport have been subject to increasing scrutiny but with limited evidence to guide practice. Similarly, there is increasing practical interest in the concept of psychological safety, often portrayed as an implicitly desirable characteristic of all sporting environments but, as yet, still to receive research attention in high performance. As a first step to addressing these deficiencies, the present study addressed two research aims: (a) to examine the extent to which matched groups of international and released professional rugby union players perceived psychological safety to be an adaptive feature of their developmental experience and (b) to understand what elements of the playerâs coaching experience were perceived to be enabling or disenabling of future progress. (2) Methods: Seven rugby union players who had âmade itâ and eight players who had been released from their professional contracts took part in a semi-structured interview exploring their developmental experiences. Data were subsequently analysed using Reflexive Thematic Analysis. (3) Results: Both groups of players found each of their talent development and high performance environments to be psychologically unsafe. Furthermore, players perceived coaches who were the most impactful in their development as offering âtough loveâ. This included a range of âharderâ and âsofterâ interpersonal approaches that presented the player with clear direction, role clarity and a sense of care. It appeared that this interpersonal approach helped the player to navigate, and benefit from, the psychologically unsafe high performance milieu. (4) Conclusions: There appear to be a number of balances for the coach in the high performance setting to navigate and a need for more nuance in applying constructs such as psychological safety.
... Each resident participated individually in one scenario. Simulations were always structured as follows: briefing (one to five min), scenario (10 to 20 min), and debriefing (30 to 45 min) [22][23][24]. The scenarios dealt with crisis situations in the intensive care unit, operating room, and delivery room (Tamponade, Neonatal, Amniotic Fluid, Pacemaker), no residents performed these scenarios beforehand (App. ...
Background
Active participation in high-fidelity simulation remains stressful for residents. Increased stress levels elicited during such simulation impacts performance. We tested whether relaxing breathing, paired or not with cardiac biofeedback, could lead to enhanced performance of residents during simulation.
Methods
This randomized pilot study involved the fifth-year anesthesiology and critical care residents who participated in high-fidelity at Lyon medical simulation center in 2019. Residents were randomized into three parallel interventions: relaxing breathing, relaxing breathing paired with cardiac biofeedback, and control. Each intervention was applied for five minutes immediately after the scenario briefing. The primary endpoint was the overall performance during the simulation rated by two blinded independent investigators. The secondary endpoints included component scores of overall performance and changes in psychological states.
Results
Thirty-four residents were included. Compared to the control group, residents in the relaxing breathing (+ 7%, 98.3% CI: 0.3 to 13.7, P = 0.013) and relaxing breathing paired with cardiac biofeedback (+ 8%, 98.3% CI: 0.82 to 14.81, P = 0.009) groups had a higher overall performance score. Following the interventions, compared to the control group, stress level was lower when participants had performed relaxing breathing alone ( P = 0.029) or paired with biofeedback ( P = 0.035). The internal relaxation level was higher in both the relaxing breathing alone ( P = 0.016) and paired with biofeedback groups ( P = 0.035).
Conclusions
Performing five minutes of relaxing breathing before the scenario resulted in better overall simulation performance. These preliminary findings suggest that short breathing interventions are effective in improving performance during simulation.
Trial registration
The study protocol was retrospectively registered on clinicaltrials.gov ( NCT04141124 , 28/10/2019).
... Pre-briefings and briefings are conducted to prevent misunderstanding [11]. As some aspects of simulations, whether it is full-scale, screen-based, or virtual, are not always true to real-life from a physical (environment, equipment, and patient representation), semantical, or phenomenal point of view, learners need to be informed regarding the limitations of these various elements [12][13][14][15] and of their expected behaviour and actions during SBE activities. The pre-briefing at the start of a session is when a fiction contract should be presented to learners as a ground rule whereby they need to consent to appropriately engage in the activity, be respectful, and maintain confidentiality [12]. ...
The level of performance of every clinician and of the overall multiprofessional team relies on the skills and expertise they have individually and collectively acquired through education, training, self-directed learning, and reflection. Simulation-based education (SBE) is playing an increasingly important role in that respect, and it is sometimes said that it is an art to facilitate. Many explanations can justify this assertion. Although there is generally an emphasis on making everything as realistic or âhigh-fidelityâ as possible, it is often futile and this is where the art of simulation comes into play with an element of modulation of realism linked to the intended learning objectives. The atmosphere created by the educators; how the learners are made to engage and interact; how physical, technical, and contextual elements are simulated or represented; and what type of technology is used need to be appropriately adapted to contribute to the immersiveness of any SBE activity. Although it inevitably carries a negative connotation, some form of âdeceptionâ is more commonly used than one may think for the benefit of learners during SBE. High levels of realism are sometimes achieved by making learners believe something works or reacts as would be expected in real life, whereas it is achieved in a totally different manner. Learners do not need to know, see, or understand these âtricks of the tradeâ, shortcuts, or artistic or technological aspects, and this can be considered a form of benevolent deception. Similarly, information may be withheld to recreate a realistic situation and push learners to demonstrate specific learning outcomes, but it needs to be practised with caution and be justifiable. These forms of âpositiveâ deception are part of most SBE activities and are used to help learners bridge the reality gap so they can suspend disbelief more easily, exercise critical thinking, and treat the simulation more realistically without damaging the trust they place in their educators. This article will discuss how aspects of SBE activities are often manipulated, modified, or hidden from learners to facilitate the learning experience and present a simulation fidelity model encompassing the environmental, patient, semantical, and phenomenal dimensions.
Disasters are complex and require teams to navigate uncertain situations, communicate effectively across teams, craft unified messages, and address inputs from multiple stakeholders in real time. It is vital that students learn to work in interprofessional teams while they are in school so that when they become practicing professionals they have the teamwork and communication skills necessary to collaborate during a disaster. The aim of this interprofessional tabletop simulation was to engage first semester graduate health administration students and upper level undergraduate public health students in an incident command center response to an F5 tornado. Best practices in simulation design, including creating mutual objectives, promoting a safe learning environment, and utilizing a structured debriefing, were used to craft the incident command simulation. Evaluation of the simulation was conducted through direct observation, as well as surveys assessing knowledge gain and satisfaction. Evaluation of quantitative data indicated knowledge gain in incident command system sections and roles, job action sheets to perform necessary actions, and coordination of services to respond to a disaster. Students also reported high levels of satisfaction with the experience and improvements in teamwork and communication skills. Qualitative themes described characteristics of interprofessional education (role clarity, communication, collaboration, teamwork) and simulation (value of practice, complexity of response). Applying evidence-based practices to the design and implementation of this interprofessional simulation helped ensure students gained knowledge with incident command system structure and function and improved their ability to communicate.
Background:
A variety of stressors are encountered while working in the emergency department and are often recreated in simulation-based medical education. We seek to examine the physiologic and stress state response of participants in a simulated clinical environment to commonly encountered stressors.
Methods:
Emergency medicine (EM) residents participated in a randomized, controlled trial of six simulated patient encounters with one of three stressors, medical difficulty, interpersonal challenge, and technology/equipment failure, randomized into each scenario. Participants wore smart shirts to measure heart rate variability (HRV) at rest and just after the introduced stressor and completed the Short Stress State Questionnaire (SSSQ) before and after each scenario.
Results:
Twenty-seven EM residents participated in the study. Interpersonal challenge resulted in increased distress as measured by SSSQ compared to the other two stressors (one way ANOVA, F[2,144] = 9.95, p < 0.001). There was no difference in worry or task engagement across stressors. HRV decreased significantly from rest for all stressors (p = 0.0003, p = 0.0112, p = 0.0027 for medical difficulty, interpersonal challenge, and equipment failure, respectively), but there was no statistically significant difference between mean change in HRV across stressors (one way ANOVA, F[2,120] = 0.17, p = 0.8452).
Conclusions:
Interpersonal challenge stressor was significantly associated with an increase in distress in EM residents during the simulated encounters as compared to the other stressors. While heart rate variability decreased from rest for each stressor as expected following stressor introduction, differing stressors did not produce a differential change.
Safe training in the current clinical workplace requires careful participant proximity management. Delivering simulation in a confined clinical environment can impact scenario fidelity and affect psychological safety
The aim of the study was to assess the practical efficacy of a portable AV streaming solution to enable real-time
The Scotia Medical Observation and Training System (smotsâ˘) offers a portable AV solution with flexibility, through the addition of cameras and microphones as required, to create bespoke simulation viewing. Smots⢠was incorporated into the
Smots⢠was an effective platform to meet our aims. Delivery users reported smots⢠to be reliable in streaming the AV footage to a target audience in a remote debriefing room. The system was compact, easily transportable and had a low burden of training to achieve user competence. Participant feedback was positive, in that the system provided good AV clarity and narration, thereby enabling a successful training evolution. Smots⢠offers a reliable capability to stream simulation scenarios to an alternative viewing area with the ability to be relocated as needed. Local wireless broadcasting range is finite and may limit usersâ ability to stream information to discrete departments within a larger trust. Mitigation is possible using a secondary streaming platform or integrating it into a secure internal Wi-Fi or ethernet network. Assistance from trust information technology departments is recommended and this capability is something our team will consider as a future option. Expanding connectivity is an effect multiplier, offering distanced, streamed training across trusts and regions, as well as the inclusion of participants working from home. The portable nature of this smots⢠solution offers flexibility for rapid deployment to areas of novel clinical capability and community partnerships. This system has proved exceptionally useful during a prolonged period of social distancing, enabling ongoing high-efficacy
Remote simulation in education predates the COVID-19 pandemic, and its more widespread contemporary use can help inform future teaching practices. This article outlines the development of a remote-facilitated mental simulation (RFMS) delivered to second-year paramedic science students at a UK university. This was created using Sprick et al's simulation design model: preparation, briefing, simulation activity, debriefing, reflection and evaluation. Mental simulation is a teaching modality where participants mentally rehearse processes rather than practical skills. Speaking thoughts aloud helps learners to reflect on their thought processes and decision-making. While studies on remote simulation involve a facilitator viewing participants interacting with a simulation, in this study the participants were observers and the facilitator interacted with the simulation equipment. This arrangement may increase access to simulation for learners who do not have access to such facilities. Participants were engaged through group activities and psychological fidelity was maintained by providing real-time streaming of patient observations. The RFMS was evaluated positively by respondents.
Telehealth in health care delivery grew exponentially throughout the COVID-19 pandemic. This growth occurred because of necessity, yet requires capacity building to maximize the technology's use. In this article, we discuss the development, implementation, and evaluation of a telehealth fair to build capacity in the use of telehealth technology within primary care nursing. The telehealth fair consisted of didactic and simulation components. Undergraduate and graduate nursing students completed the telehealth fair supported by a team of 12 nursing faculty and 6 clinical partner sites. Findings suggest statistically significant increases in student self-assessment of knowledge in telehealth, self-confidence in the use of telehealth, and readiness in the use of telehealth technology. Participant satisfaction following completion of the telehealth fair was high, with average scores of 4.2 to 4.58 (out of 5) for the didactic and 4.57 to 4.86 for the simulation components. The telehealth fair provided an invaluable opportunity for participants to enhance their learning relative to telehealth within primary care nursing. The experience also provided an opportunity for students to gain clinical hours during a pandemic when clinical placements in the community were limited. The experience also enhanced telehealth practice readiness of nursing students entering the workforce.
Debriefing is an foundamental instructional approach of simulation-based medical education in the field of healthcare simulation. In order to improve the understanding of debriefing as an instructional approach and ensure the quality of simulation-based medical education, this paper reviews the relevant critical literatures of debriefing in simulation-based medical education, and outlined the essential elements and current development status of debriefing, debriefing models, different methods used in analyze phase of debriefing, as well as the research progress of debriefing in China and abroad. Despite various debriefing models, âdebriefing with good judgmentâ would be more likely to assure better learner improvement. In the process of debriefing, directive feedback, students' self-assessment, and focused facilitation can be reasonably used. However, there are still room for future research on how these practices could be translated and better applied in China.
This chapter seeks to explain the role of facilitators in gaming simulation. It is the responsibility of facilitators to ensure participants are provided with ample opportunities to learn through gaming simulation in safe environments. Focusing on their role, this chapter discusses the following questions: What is facilitation? What should facilitators do or not do? and What should facilitators consider for a fruitful gaming session? Facilitation begins well before the execution of a game and continues until the end of debriefing, when facilitators help participants process what was learned through the activities that were carried out. Facilitators should anticipate how participants will act and react during and after the game and react appropriately and flexibly. Facilitators are responsible for allowing participants to undertake activities and experience learning transfer in a safe environment throughout the entire process. I hope this chapter provides a supportive push to present/future facilitators who are going to find profound meaning in facilitation.
Background:
Designing and engaging learners in active learning are critical skills for nursing faculty with the resulting educational pay-off of increased engagement and learning. Moving away from the standard PowerPoint presentations can be uncomfortable for faculty and result in not taking risks when designing new learning experiences. However, creating psychological safety for both the faculty and learners can result in deeper learning and growth for the faculty's skill set.
Method:
This article describes a pilot implementation of an escape room to facilitate an exam review for an undergraduate pathophysiology course.
Results:
This pilot allowed the program to determine the feasibility of integrating escape rooms into undergraduate nursing curriculum while including evidence-based pillars of active and experiential learning such as the creation and maintenance of psychological safety for students and faculty.
Conclusion:
Lessons learned about in-person and virtual escape rooms are included as well as next steps. [J Nurs Educ. 2022;61(X):XXX-XXX.].
Background:
Prebriefing before simulation is a recommended practice that increases learner satisfaction and improves performance. Promoting situation awareness through prebriefing facilitates optimal learning outcomes.
Method:
Endsley's Model of Situation Awareness is applied to the cognitive work of nursing practice that occurs during the prebriefing phase of simulation. Perceiving, comprehending, and projecting about elements of a situation lead to clinical judgement, reasoning, decision making, and ultimately nursing actions.
Results:
Developing situation awareness in prebriefing is a supported process that connects learners' prior knowledge and experience with the needed knowledge, skills, and abilities in the simulation environment. These mental models become the foundation for understanding the relevance of perceived information, comprehending its meaning, and directing nursing actions.
Conclusion:
The simulation facilitator influences the development of situation awareness by focusing perception on key elements and scenario objectives, fostering psychological safety, and enhancing familiarity with the simulation environment during prebriefing. [J Nurs Educ. 2022;61(5):250-256.].
Objectives:
Effective emergency department care requires individuals and teams to adapt to changes in patient condition, team factors, environmental issues, and system-level challenges. Adaptability is often listed as an important skill for emergency medicine physicians; however, conceptual models describing the processes involved in adaptive performance have not been translated for health care settings. Similarly, educators have not described training design strategies that support the development of adaptive performance.
Methods:
We examined the team science and health care literatures for key concepts in adaptive performance, health care team performance, and diagnostic decision-making. Using expert consensus, we integrated these concepts to develop the team adaptive performance model and to identify training design approaches that support the development of adaptability.
Results:
We identify nine training principles supported by the team adaptive performance model and the adaptive learning system. Each training principle is accompanied by recommendations and mechanisms for implementation in emergency medicine simulation-based education.
Conclusion:
Training experiences can be designed to target processes that support adaptive performance.
In the last few years, virtual reality technologies have been applied to training in a variety of field, such as industry or medicine. The use of these technologies aims to promote interaction therefore improving users learning. This approach has been found useful in teaching tasks that involve interaction with risky tools or procedures. Using VR, the user is in a safe environment while developing new abilities required for the field he is learning about. This project is focused on the field of medicine. An immersive virtual reality environment is developed to teach a basic medical procedure to students at a medical technician school, where interactive lessons could be attended in a distance modality. This work aims to be as close as possible to learning in real facilities. Real lessons of the school are translated to virtual exercises where a score is kept to grade performances of students. The lessons involve tasks such as reading a patient's file, practicing hygiene and comfort techniques and muscle strength tests as a health care activity. To increase the sense of presence for the students, the facilities where they would be performing in real life are translated to the rooms of a virtual simulation.
Ethics is a challenging subject, especially when applied to the already social complex reality of simulation games (SGs). In this chapter we explain the factors involved and provide suggestions on how to deal with the challenges that arise. Our aim is to create learning opportunities for both participants and facilitators. Ethical challenges in SGs stem from two main sources; the first is the context of the SG and its participants as they start interacting in the gameplay, and the second is within the SG itself. In this chapter we take you on a journey to provide insights into the kinds of challenges you may encounter and how they can enable you as designer and facilitator to optimize learning both within and beyond the SG. Because SGs as tools are adding much of their value by connecting to specific (ethical) issues relevant for learners, it is important for facilitators to understand how these may become problematic as a SG proceeds.
Aim
This study aimed to explore active studentsâ experiences of emotions during simulation-based education (SBE) sequences when a simulation was performed as a part of formal curriculum in natural educational settings and to consider the practical educational implications of the findings.
Background
An SBE approach is used widely in nursing education. Emotions are necessary for learning to take place and some of these can prevent or promote learning. This is an active and affective learning activity that can trigger various emotions. Previous research in SBE has studied student anxiety, which has been frequently measured quantitatively. An understanding of studentsâ emotions can give valuable insight into the learning process and improve nursing educational practice.
Methods
The study took place in four Norwegian universities. It was guided by interpretive descriptions, which involve qualitative methodology. This study was approved by the Norwegian Centre for Research Data (No: 59059). Data were collected using an interpersonal process interview with eight healthcare professional students after participating in SBE.
Results
The results show that students experienced coexisting and changing emotions during the shifting academic scenes in the simulations. During briefing, scenario and debriefing, students experienced being activated and had coexisting pleasant and unpleasant emotions. Unpleasant emotions were found to decrease during the simulation. Numerous identified emotions were found to be valuable for learning.
Conclusion
The insight into studentsâ experience of arousal, negative emotions and the potential for SBE to trigger studentsâ comprehensive academic emotions have implications for nurse educators when planning and facilitating simulations.
Background
Conducting simulations to address sensitive topics such as bias or racism in healthcare can be daunting or lead to unintended adverse consequences. The content and nature of the prebrief is critical to set the tone for a rich learning experience.
Methods
This method is based on the Theory of Cultural Humility, aligns with the Healthcare Simulation Standards of Best Practice⢠Prebriefing: Preparation and Briefing, and may be used in conjunction with the method of Debriefing for Cultural HumilityŠ.
Results
The method of Prebriefing for Cultural HumilityŠ is described. Prebriefing for Cultural Humility entails use of the following:Ground Rules, Acknowledge, Safe Psychological Environment, and Define (GRASPED).
Conclusion
Prebriefing for Cultural Humility may assist educators and learners to embrace potentially uncomfortable dialogue to foster learning and appreciation for diversity and cultural humility.
Background
Online, virtual, and distant simulation modalities were used emergently during the pandemic and continue to be used to support learners in meeting clinical outcomes. Little research has been conducted on how to prebrief specifically for these modalities.
Method
Best practices in simulation design and prebriefing were used to create this step-by-step guide for preparing students for multiple types of distant learning in a synchronous or asynchronous learning environment.
Results
The new Healthcare Simulation Standard of Best Practice⢠Prebriefing: Preparation and Briefing was published for all simulation modalities without regard to one specific type such as virtual simulation. This prebriefing guide for online, virtual, and/or distant simulation experiences is cross referenced with the new HSSOBP⢠to demonstrate how the standard can be used to support any modality.
Conclusion
The prebriefing guide for online, virtual, and/or distant simulation experiences demonstrates a practical application for use of this standard for these modalities. More research is indicated to augment the prebriefing evidence for distance simulation education.
Aim:
Simulation originates from its application in the military and aviation. It is implemented at various levels of healthcare education and certification today. However, its use remains unevenly distributed across the globe due to misconception regarding its cost and complexity and to lack of evidence for its consistency and validity. Implementation may also be hindered by an array of factors unique to the locale and its norms. Resource-poor settings may benefit from diverting external funds for short-term simulation projects towards collaboration with local experts and local material sourcing to reduce the overall cost and achieve long-term benefits. The recent shift of focus towards patient safety and calls for reduction in training duration have burdened educators with providing adequate quantity and quality of clinical exposure to students and residents in a short time. Furthermore, the COVID-19 pandemic has severely hindered clinical education to curb the spread of illness. Simulation may be beneficial in these circumstances and improve learner confidence. We undertook a literature search on MEDLINE using MeSH terms to obtain relevant information on simulation-based medical education and how to best apply it. Integration of simulation into curricula is an essential step of its implementation. With allocations for deliberate practice and mastery learning under supervision of qualified facilitators, this technology is becoming essential in medical education.
Purpose:
To review the adaptation, spectrum of use, importance, and resource challenges of simulation in medical education and how best to implement it according to learning theories and best practice guides.
Conclusion:
Simulation offers students and residents with adequate opportunities to practice their clinical skills in a risk-free environment. Unprecedented global catastrophes provide opportunities to explore simulation as a viable training tool. Future research should focus on sustainability of simulation-based medical education in LMICs.
Interprofessional simulation-based education (IP-SBE) supports the acquisition of interprofessional collaborative competencies. Psychologically safe environments are necessary to address socio-historical hierarchies and coercive practices that may occur in IP-SBE, facilitating fuller student participation. A scoping review was conducted to understand the barriers and enablers of psychological safety within IP-SBE. Research papers were eligible if they included two or more undergraduate and/or post-graduate students in health/social care qualifications/degrees and discussed barriers and/or enablers of psychological safety within simulation-based education. Sources of evidence included experimental, quasi-experimental, analytical observational, descriptive observational, qualitative, and mixed-methodological peer-reviewed studies. English or English-translated articles, published after January 1, 1990, were included. Data were extracted by two members of the research team. Extraction conflicts were resolved by the principal investigators. In total, 1,653 studies were screened; 1,527 did not meet inclusion criteria. After a full-text review, 99 additional articles were excluded; 27 studies were analyzed. Psychological safety enablers include prebriefing-debriefing by trained facilitators, no-blame culture, and structured evidenced-based simulation designs. Hierarchy among/between professions, fear of making mistakes, and uncertainty were considered barriers. Recognition of barriers and enablers of psychological safety in IP-SBE is an important first step towards creating strategies that support the full participation of students in their acquisition of IPC competencies.
Against the backdrop of the kinds of competences sought after in the work life today, such as problem solving and critical thinking, we argue that institutions of higher education are wise to pay attention to the quality of student engagement, and the quality of their learning. One aspect that presumably needs to develop is epistemic beliefs, which refer to studentsâ perceptions of the nature of knowledge and how it is created.
The aim of the present study is to investigate how the quality of motivation is associated with different epistemic beliefs, and furthermore how they are associated with critical thinking. Survey data was collected from first year Arcada students (N=436) at the start of their first study year, and correlative analyses performed.
The results suggest that autonomous motivation is associated with more complex knowledge perceptions, and critical thinking, whereas controlled motivation showed no clear pattern and only weak correlations with some epistemic beliefs. Controlled motivation was unrelated to critical thinking. More complex epistemic beliefs correlated positively with Critical thinking, especially constructivist learning.
These initial findings suggest that more attention needs to be paid to the quality of motivation and studentsâ epistemic beliefs as both are associated with critical thinking, and plausibly other competences needed in the work life today.
Background
The Accreditation Council for Graduate Medical Education Common Program Requirements require residents to participate in real or simulated interprofessional patient safety activities. Root cause analysis (RCA) is widely used to respond to patient safety events; however, residents may lack knowledge about the process.
Objective
To improve clinicians' knowledge of the tools used to conduct an RCA and the science behind them, and to describe this course and discuss outcomes and feasibility.
Methods
A flipped classroom approach was used. Participants completed 5 hours of pre-course work then attended an 8.5-hour program including didactic sessions and small group, facilitator-led RCA simulations. Pre- and post-surveys, as well as a 10-month follow-up on knowledge of and comfort with the RCA process were compared. Statistical significance was evaluated for matched pairs using a repeated measures analysis of variance.
Results
Of 162 participants trained, 59 were residents/fellows from 23 graduate medical education programs. Response rates were 96.9% (157 of 162) for pre-course, 92.6% (150 of 162) for post-course, and 81.5% (132 of 162) for 10-month follow-up survey. Most participants had never participated in an RCA (57%, 89 of 157) and had no prior training (87%, 136 of 157). Following the course, participants reported improved confidence in their ability to interview and participate in an RCA (P<.001, 95% CI 4.4-4.6). This persisted 10 months later (P<.001, 95% CI 4.2-4.4), most prominently among residents/fellows who had the highest rate (38.9%, 23 of 59) of participation in real-world RCAs following the training.
Conclusions
The course led to a sustained improvement in confidence participating in RCAs, especially among residents and fellows.
Purpose
Psychological safety is key to effective debriefing and learning. The COVID-19 pandemic necessitated rapid adaption of simulation events to virtual/hybrid platforms. We sought to determine the effect of utilizing the Community of Inquiry framework (CoI) for debriefing virtually connecting interprofessional learner teams on the psychological safety experienced during trauma simulations.
Methods
General surgery (GSR), emergency medicine (EMR) residents, trauma nurses/nurse practitioners and medical students participated in multiple simulation events designed to improve teamwork and leadership skills. Pre-course materials were provided before the event for learners to prepare. Briefings delineating expectations emphasized importance of and strategies employed to achieve psychological safety. Four unique clinical scenarios were run for each simulation event, with a debrief after each scenario. Virtual team-to-team debriefings were structured using the Community of Inquiry (CoI) conceptual framework. All learners completed pre-/post-assessments utilizing Inter-professional Collaborative Competencies Attainment Survey (ICCAS).
Results
Twenty-five learners participated (13 GSR, 5 EMR, 3 medical students, 2 trauma APRNs and 2 trauma RNs). Learner assessment found 88% (22) âagreedâ/âstrongly agreedâ that virtual team-to-team debriefing had social, cognitive and educator presence per the CoI domains. However, one GSR and two nurse learners âstrongly disagreedâ with these statements. Most learners felt the debriefing was effective and safe. All participants âstrongly agreedâ/âagreedâ the simulation achieved ICCAS competencies.
Conclusions
Debriefings utilizing a virtual platform are challenging with multiple barriers to ensuring psychological safety and efficacy. By structuring debriefings using the CoI framework we demonstrate they can be effective for most learners. However, educators should recognize the implications of social identity theory, particularly the effects of hierarchy, on comfort level of learners. Developing strategies to optimize virtual simulation learning environments is essential as this valuable pedagogy persists during and beyond the COVID-19 pandemic.
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.
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 safetyâa shared belief held by members of a team that the team is safe for interpersonal risk takingâand 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.
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.
On the basis of a new model of motivation, the authors examined the effects of 3 dimensions of teacher (
nâ=â14) behavior (involvement, structure, and autonomy support) on 144 children's (Grades 3â5) 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 studentâteacher 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.
Winnicottâs 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 Winnicottâs 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.
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 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 âexpert knowledgeâ 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 âlearning inactionâ (Vince, 2008) is also possible, particularly where tutors are unable to provide a sufficient âholdingâ 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.
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.
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
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 selfâassessment 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.