Long-term experiences of being a simulation-educator: A multinational interview study

Comparing reflection levels between facilitator-led and student-led debriefing in simulation training for paramedic students

BACKGROUND

Simulation in healthcare attempts to create relevant representations of patient encounters. It provides experiential learning, bridging typical classroom activities and clinical practice. This study aims to investigate whether the principle of Peer-Assisted Learning can be used in simulation by letting simulation-experienced paramedic students prepare, deliver, and debrief their own simulations, with minimal faculty assistance. This could be a way to support student learning by being involved in teaching, and it might at the same time optimise the cost-effectiveness of simulation-based training.

METHODS

This observational non-inferiority study compared reflection levels between facilitator-led and student-led simulation and debriefing, between scenario types, and compared the number of turns in which students are involved in both settings. Third-year Bachelor in Paramedic Science students' debriefings were filmed and transcribed. The degree of reflection in students' statements was rated according to a modified version of Fleck's analytical framework of reflection levels, assigning scores from lowest (R0 description) to highest (R4 critical reflection). Facilitator-led and student-led debriefings were compared using chi-square tests. Scenarios were also analysed according to type (paediatric emergencies and complex assessments) regardless of who led the simulation.

RESULTS

Ten facilitator-led and 12 student-led debriefings were analysed. Students gave 682 (49%) contributions in the facilitator-led debriefings, and 702 (51%) contributions in student-led debriefings. Comparison of reflection levels between facilitator-led and student-led debriefings was respectively: R0-level 32.7% vs 33.8%, R1-level 44.0% vs 44.3%, R2-level 14.7% vs 17.1%, R3-level 0.1% vs 1.3%, and R4-level 0.1% vs 0.1%. There were no statistically significant differences in reflection levels between facilitator-led and student-led debriefings (p = 0.178). Comparing the reflection levels between the scenarios on "paediatric emergencies" and "complex assessments", the results were respectively: R0-level 35.4% vs. 31.7%-level, R1-level 45.3% vs. 43.3%-level, R2-level 13.4% vs. 17.8%, R3-level 0.5% vs. 0.9%, and R4-level 0.0% vs. 0.3%. These differences were statistically significant (p = 0.010). No significant differences in engagement were found between debriefings led by a student or a facilitator, when measuring the number of turns in the conversations.

CONCLUSIONS

Facilitator-led and student-led debriefings resulted in equivalent reflection levels amongst students. Student-led simulation is potentially a cost-effective supplement to regular simulation within a healthcare degree program. Since complex scenarios provided higher reflection levels than paediatric, scenario design might influence reflection levels.

Endeavouring interplay: a grounded theory study of how nurse educators' work with simulation-based learning

BACKGROUND

Simulation-based learning is frequently used as a teaching and learning strategy in nursing and other health professions educations, and educators have a key role as facilitators. This facilitator role provides them with a particularly relevant perspective to help us understand and theorize around the essence of simulation-based learning, and how it is approached. This study aims to explore nurse educators' experiences and strategies in simulation-based learning.

METHOD

Data were collected in 2018-2021 using in-depth interviews with eight nurse educators. Transcripts were analysed through constant comparison using Classical Grounded Theory approach.

RESULT

The participants' main concern was how to Maximize students' learning-space in simulation. To resolve this, four strategies were identified: legitimizing simulation, self-development, preparing students, and tailoring simulation. Legitimisation, and self-development were found to be important prerequisites for developing the learning space and were therefore defined as the background or context of the theory. Nurse students were the focus of the two remaining categories, preparing students and tailoring simulation, and are thus defined as being in the foreground of the theory. The dynamics of these four strategies were captured in the Grounded theory of Endeavouring interplay.

CONCLUSION

The theory of Endeavouring interplay illustrates the complexity educators are encountering when aiming to optimize simulation as a learning space for nurse students. The strategies used are adapted to the organisational climate, available resources and context, and include striving to legitimize simulation, pursue self-development in the role as facilitator, help students prepare for simulation-based learning, and tailor the simulation to both contextual factors and individual student needs.

How theories of complexity and resilience affect interprofessional simulation-based education: a qualitative analysis of facilitators' perspectives

BACKGROUND

Quality of care and patient safety rely on the ability of interprofessional teams to collaborate effectively. This can be trained through interprofessional simulation-based education (IPSE). Patient safety also relies on the ability to adapt to the complexity of such situations, an ability termed resilience. Since these needs are not explicitly addressed in IPSE, the aim of this study was to explore how central concepts from complexity-theory and resilience affect IPSE, from facilitators' perspective, when applied in debriefings.

METHODS

A set of central concepts in complexity-theory and resilience were introduced to facilitators on an IPSE course for nursing and medical students. In five iterations of focus groups interviews the facilitators discussed their application of these concepts by reviewing video recordings of their own debriefings. Video recordings of the interviews were subjected to coding and thematic analysis.

RESULTS

Three themes were identified. The first, Concepts of complexity and resilience are relevant for IPSE, points to the applicability of these concepts and to the fact that students often need to deviate from prescribed guidelines/algorithms in order to solve cases. The second theme, Exploring complexity, shows how uncertainty could be used as a cue to explore complexity. Further, that individual performance needs to account for the context of actions and how this may lead to certain outcomes. Moreover, it was suggested that several ways to approach a challenge can contribute to important insight in the conditions for teamwork. The third theme, Unpacking how solutions are achieved, turns to needs for handling the aforementioned complexity. It illustrates the importance of addressing self-criticism by highlighting how students were often able to overcome challenges and find solutions. Finally, this theme highlights how pre-defined guidelines and algorithms still work as important resources to help students in transforming perceived messiness into clarity.

CONCLUSIONS

This study suggests that IPSE provides the possibility to explore complexity and highlight resilience so that such capability can be trained and improved. Further studies are needed to develop more concrete ways of using IPSE to account for complexity and developing resilience capacity and to evaluate to what extent IPSE can provide such an effect.

Embracing multiple stakeholders' perspectives in defining competent simulation facilitators' characteristics and educational behaviours: a qualitative study from Denmark, Korea, and Australia

Background

Simulation-based learning (SBL), used for achieving various learning goals, is spreading around the world. However, it is still open, to what extend SBL needs to be adapted to local cultures. This study aimed to explore how various stakeholder groups perceive what constitutes a competent simulation facilitator across three different countries.

Methods

We conducted an interview study with learners, facilitators, and facilitator trainers. Semi-structured interviews with 75 participants underwent content analysis. Participants were recruited from Denmark, Korea, and Australia. Interviews focused on characteristics of simulation faculty, as well as educational behaviours. Interviews were audio-recorded, translated to English, transcribed, and content analysed by inductively developing codes using the Nvivo software. In the first coding round, each interview was treated separately. In the analysis round, the individual codes between countries and stakeholder groups were compared to identify similarities and differences.

Results

Our study shows high demands for the simulation facilitator role. A competent simulation facilitator should possess the following characteristics: (1) subject matter expertise, (2) personal approach and traits, (3) self-awareness and reflection, and (4) communication skills. Educational behaviours comprised (1) supporting a safe learning environment, 2) working goal-oriented with the course, (3) engaging before the course with preparation, (4) leading scenarios, and (5) facilitating debriefings. Comparative analysis showed similar wishes towards simulation facilitators from the different stakeholders in different countries, though the same terms might mean different details in the various settings.

Conclusions

These findings offer guidance for learning needs analysis and the establishment of faculty development programmes. The study also shows that the personal characteristics are an important aspect of the facilitator role above and beyond displaying educational behaviours.

Promoting medical student engagement through co-development and peer-assisted learning: a new patient safety course as a case study

INTRODUCTION

Peer-assisted learning programs have been focused on providing students with competencies to deliver lectures and facilitate workshops, whereas involvement of students as co-developers of educational programmes has been relatively under-described in the literature. Likewise, the use of students as facilitators in simulation-based training and debriefing is also scarce. In this paper, we describe how medical students were co-developers of a novel course on patient safety and how they were trained as student facilitators to conduct simulation-based training and debriefing, as well as workshops.

METHODS

Medical students co-developed a course in patient safety consisting of three simulation-based scenarios and three workshops. The students were educated in relevant patient safety topics. They were trained to become student facilitators to conduct workshops, simulations and debriefings at a patient safety course for medical students. A questionnaire was developed to evaluate the course participants´ perception of the learning objectives and the student facilitators following the latest course in 2020. In addition, semi-structured interviews with the student facilitators were conducted to explore their perceptions of being part of the course.

RESULTS

A total of 92% of the course participants completed the evaluation of the course. The majority of the course participants found that the student facilitators created a safe learning environment and had the necessary skills to teach. The learning objectives for the course were found to be useful. A total of 10 interviews with the student facilitators were conducted. We found that the student facilitators were motivated to teach in the course, as a way of improving their teamwork, leadership qualities and communication skills, as well as their resume. Some of the student facilitators mentioned that they were able to create a safe learning environment, whereas others mentioned a feeling of inadequacy for their teacher role. In addition to developing their teaching skills, they mentioned that they developed their medical expertise, alongside their communication-, collaboration-, leadership- and professional skills.

CONCLUSION

This study illustrates how medical students were involved in the co-development, delivery and implementation of a course in patient safety. The evaluation of the course shows that student facilitators succeeded in creating a safe learning environment. The interviews of the student facilitators reveal their various motivations for teaching, in addition to different perceptions of their experience as a student facilitator. Some expressed a positive feeling of being able to establish a safe learning environment, whilst others expressed a feeling of inadequacy when facilitating peers. In addition, the student facilitators indicated that they developed themselves both professionally and personally.

Communication content during debriefing in simulation-based medical education: An analytic framework and mixed-methods analysis

BACKGROUND

Debriefing is an indispensable component of simulation-based medical education, and it has great potential for contributions to reflective learning. Little is known about the relevance of communication during debriefings. We developed a category framework to assess the communication content of debriefings, which we used to analyze possible relationships to participant learning outcomes.

METHOD

We deductively and inductively developed a category framework for qualitative content analysis of debriefings. We coded 20 debriefings using this framework, and correlated debriefing frequency with learning outcomes (i.e. engagement, satisfaction, individual and team learning success).

RESULTS

The category framework comprised 9 main and 81 subcategories (48 debriefers, 27 participants, 6 simulated patients), which yielded good intercoder agreement. Debriefers and participants communicated equally using mostly advocacy, inquiry, illustration, and confirmation. Debriefer questions and participant inputs were positively related to learning outcomes. In contrast, guess-what-I-am-thinking, apologies, observations, use of materials, participant descriptions, simple repetition of statements, and evaluation by other participants were not positively associated with learning outcomes.

CONCLUSION

This study provides important new information about communication content during debriefings. The association between communication content and learning outcomes appears particularly relevant to further enhance efficacy of debriefings and simulation-based medical education.

Is simulation-based team training performed by personnel in accordance with the INACSL Standards of Best Practice: SimulationSM?-a qualitative interview study

BACKGROUND

Anesthesia personnel was among the first to implement simulation and team training including non-technical skills (NTS) in the field of healthcare. Within anesthesia practice, NTS are critically important in preventing harmful undesirable events. To our best knowledge, there has been little documentation of the extent to which anesthesia personnel uses recommended frameworks like the Standards of Best Practice: SimulationSM to guide simulation and thereby optimize learning. The aim of our study was to explore how anesthesia personnel in Norway conduct simulation-based team training (SBTT) with respect to outcomes and objectives, facilitation, debriefing, and participant evaluation.

METHODS

Individual qualitative interviews with healthcare professionals, with experience and responsible for SBTT in anesthesia, from 51 Norwegian public hospitals were conducted from August 2016 to October 2017. A qualitative deductive content analysis was performed.

RESULTS

The use of objectives and educated facilitators was common. All participants participated in debriefings, and almost all conducted evaluations, mainly formative. Preparedness, structure, and time available were pointed out as issues affecting SBTT.

CONCLUSIONS

Anesthesia personnel's SBTT in this study met the International Nursing Association for Clinical Simulation and Learning (INACSL) Standard of Best Practice: SimulationSM framework to a certain extent with regard to objectives, facilitators' education and skills, debriefing, and participant evaluation.

Professional Development for Simulation Education

Professional development in simulation methodologies is essential for implementation of quality, consistent, simulation-based experiences. Evidence demonstrates that participation in comprehensive training positively impacts learner outcomes. There are many benefits to professional development, however, challenges exist requiring thoughtful planning, administrative buy-in, and fiscal support. While there are no established guidelines, the literature provides an ongoing consensus related to overall concepts and strategies for training in simulation. We describe a continuum of growth for simulationists, ranging from novice/advanced beginner, competent/proficient, to expert. As a novice, one must conduct a self-assessment of current strengths and create a development plan to advance simulation skills and knowledge. A simulationist should use evidenced-base guidelines, mentorship, and feedback to inform simulation practices. They should be knowledgeable of the standards of best practice, modalities, simulation design, learning theories, and professional integrity. Simulationists must seek ongoing advancement through certification, scholarship, and lifelong learning. This chapter describes the continuum of education and methodologies for the development of simulationists.

Formal Training Efforts to Develop Simulation Educators: An Integrative Review

STATEMENT

Formal training for educators who use simulation-based education (SBE) is required by standards of best practice, simulation guidelines, regulatory, and accrediting bodies. Training efforts to establish educator competency for SBE are being offered. However, a systematic review of this body of literature has yet to be conducted. The purpose of this integrative review was to appraise formal training efforts of educators who use SBE. The aims were to summarize the training topics, describe the structure of training programs, and explore evaluation methods of educators. The New World Kirkpatrick Model guided the review. A PRISMA search approach yielded 2007 citations of which 38 met inclusion criteria. Analysis supports a formalized training process that uses a combination of didactic material, time for repetitive practice, and ongoing feedback with longitudinal and scaffolded delivery approaches. An identified gap in the literature is threshold levels for determining competency of educators. Recommendations for planning simulation training programs are provided.

Closing the Gap: Experienced Simulation Educators' Role and Impact on Everyday Health care

INTRODUCTION

Trained simulation educators (SEs) usually work both at simulation centers and in everyday health care, and thus, they possess dual expertise. Experienced SEs are known to grow confident with their expanding experience, but evidence is scarce about how this affects their development as clinical professionals. The aim of this study was to explore how experienced SEs describe their role within the context of everyday health care.

METHODS

An explorative descriptive study including 14 semistructured interviews and 27 questionnaires was conducted with 41 experienced SEs. An inductive thematic analysis was used to identify and analyze patterns describing SEs' perceptions of the influence of their educational work on everyday health care.

RESULTS

The SEs' descriptions of their encounters during everyday clinical work, which were affected by the fact that they had experience of facilitating simulation training, were gathered into three main themes with three of their own subthemes: education (educational needs, routines/guidelines, and being a resource), nontechnical skills (communication, feedback, and leadership/coworkership), and clinical proficiency (situational insight, role model, and confidence in clinical practice). The insights gained and actions taken as clinical professionals are all intended to be implemented with the ultimate aim of safe patient care.

DISCUSSION

All the aspects of the SEs' work are perceived to be successfully translated into clinical practice and can be summarized by the main themes of education, nontechnical skills, and clinical proficiency as delineated by this study. These themes are demonstrated at the individual, team, and organizational levels through increased competence and confidence.