Simulation facilitation models have developed predominantly in Western educational settings. The ways in which cultural norms, particularly kreng-jai and deference to authority, shape nursing student participation in high power-distance contexts have received limited empirical attention. This study examined how stress, role positioning, and facilitator feedback timing and tone interact to shape participation and culturally safe learning in simulation-based nursing education in Thailand. Semi-structured interviews were conducted in Thai with 24 third- and fourth-year nursing students in Eastern Thailand between August and October 2024. Interviews lasted 45–60 min and were analysed using reflexive thematic analysis. Four themes were developed. Entering a New Space positioned simulation as a threshold where visibility intersected with kreng-jai-patterned restraint; students’ reluctance to speak was culturally rational rather than disengagement. Stress as a Double-Edged Sword in Simulation showed that pressure could sharpen recall and prioritisation but could also narrow participation when abrupt feedback arrived mid-scenario. Learning Across Participation, Observation, and Debriefing identified distinct but complementary learning routes: active scenario participants acted under time pressure, whereas observers developed an analytic perspective, with both perspectives converging during debriefing. Facilitation and Cultural Safety found that calm guidance kept kreng-jai compatible with engagement, whereas abrupt correction rendered silence a response to relational risk. Participation and psychological safety in simulation were not inherent features of instructional design but were interactionally and culturally mediated through facilitation, role positioning, and hierarchical norms.
Healthcare simulation training faces significant barriers due to the “clinician-developer gap,” where educators lack programming expertise to create customized digital simulators. Natural Language-Driven Development (NLDD) is an emerging paradigm that enables clinicians to develop educational technology through conversational artificial intelligence interfaces. We implemented NLDD methodology to develop Open Vent Sim, a comprehensive mechanical ventilation simulator designed to replace anesthesia machines and ventilators in educational contexts lacking dedicated equipment. A multidisciplinary team comprising anesthesiologists, residents, a research nurse, IT, and biomedical engineers collaborated using Google AI Studio to iteratively create a web-based application through natural language prompts. Development proceeded through conversational cycles in which clinical requirements were translated into functional code via large language model assistance. Open Vent Sim was successfully developed in about 40 h over two weeks, featuring three simulation environments: anesthesia workstation, ICU ventilator, and high-flow oxygenation systems. The simulator incorporates physiological patient profiles (normal, ARDS, COPD) with dynamic compliance calculations and realistic waveform generation. Clinical validation was achieved through the integration of continuous resident feedback during iterative development. The application was successfully implemented in SimZone 1 as an interactive skill trainer and in SimZone 2 for team-based clinical scenarios during formal anesthesia and critical care education. Significant technical adaptation was required to transform the AI-generated prototype into a production-ready application. NLDD demonstrates the potential to democratize the creation of educational technology by empowering clinical domain experts to develop sophisticated simulation tools without traditional programming expertise. This approach addresses resource limitations while maintaining clinical authenticity, though professional technical oversight remains essential for production-ready implementations.
Simulation-based education is widely recognised as a key strategy in health professions training, yet the quality and sustainability of simulation initiatives depend heavily on the preparation of faculty responsible for facilitation, scenario design, and debriefing. While international standards provide guidance for simulation practice, implementing faculty development programs can be challenging in institutions characterised by limited resources, high teaching workloads, and heterogeneous faculty experience. Detailed accounts of how such programs are designed, implemented, and sustained within real institutional constraints remain limited. This paper describes the design, implementation, and reflective analysis of a hybrid faculty development architecture for simulation facilitators developed within a Brazilian higher education institution. The program was informed by experiential learning theory, adult learning principles, and implementation science perspectives, and was developed following an institutional needs assessment. The architecture combined asynchronous preparatory learning, synchronous online discussions, and experiential in-person workshops focused on scenario design and debriefing practice. A six-month responsive longitudinal support component was incorporated to facilitate transfer of learning into authentic teaching contexts. Communication and reinforcement mechanisms were integrated into institutional digital platforms already used by faculty in order to minimise participation barriers. Implementation indicators demonstrated feasibility and high participant acceptability within the institutional context. Implementation revealed both strengths and tensions. The structured experiential phase proved operationally stable and aligned with faculty learning needs. However, utilisation of the optional mentorship component remained limited, highlighting the challenges of sustaining engagement in contexts characterised by competing professional demands. Descriptive readiness profiles suggested developmental progression among participants, although the architecture was not designed as a formal competency assessment framework. Reflective analysis of the implementation process allowed the identification of design principles related to feasibility, contextual adaptation, reinforcement strategies, and institutional integration. This practice-based account illustrates how simulation faculty development initiatives can balance pedagogical rigour with contextual feasibility. Rather than proposing a new competency framework, the architecture offers an implementation-oriented approach for supporting faculty development in resource-constrained educational environments. The experience suggests that foundational experiential training, flexible reinforcement strategies, and integration within existing institutional ecosystems may offer transferable insights for institutions seeking to expand simulation capacity under similar structural constraints. The study was registered in the Brazilian Registry of Clinical Trials (ReBEC), number RBR-4dqtygd.
The simulation community has invested heavily in educational rigour (validated debriefing methods, high-fidelity technology, faculty development), yet evidence linking simulation to sustained clinical improvement remains limited. We propose this gap exists not because simulation is ineffective, but because it is poorly positioned within organisational systems. Drawing on a decade of programmatic experience at a non-academic hospital, including multiple initiatives that did not produce sustained outcomes and subsequent methodological pivots, we argue that simulation achieves sustainable impact only when embedded within quality improvement infrastructure. Using the Donabedian model as a conceptual framework, we demonstrate that process-focused interventions (education, training) without corresponding structural supports (equipment, systems, protocols) produce transient change at best. Integrated approaches, where simulation serves as a quality improvement tool to identify system threats and monitor interventions through Plan-Do-Study-Act cycles and the SAFER-Matrix, produce measurable, sustained improvements. Evidence from in situ programmes across emergency departments and cardiac catheterisation laboratories, multi-site collaboratives, and AI-powered telehealth simulation demonstrates that this integrated approach succeeds where education alone falls short. We have formalised these principles in the Simulation-Quality Integration (SIM-QI) Framework, currently submitted for independent peer review, which provides a practical blueprint for embedding simulation within QI infrastructure. We present actionable implications for simulation educators, institutions, and researchers seeking to bridge the gap between educational excellence and clinical translation.
NHS Scotland Academy functions as a national mechanism for translating Scottish Government workforce and quality priorities into deployable, simulation-enabled interventions. This article is presented in three parts. The first section describes how NHS Scotland Academy operationalises simulation within a commissioning-to-closure infrastructure comprising staged initiation and approvals, collaborative co-design, structured delivery supported by embedded faculty development, iterative evaluation, proportionate change control, annual review, and formal close/transfer processes. Part 2 presents two exemplar programmes which illustrate how this lifecycle connects simulation to healthcare quality and safety through a translational simulation lens: the Accelerated Anaesthetic Practitioner Programme, commissioned to address prolonged anaesthetic practitioner training and perioperative service pressures; and the National Endoscopy Training Programme, designed as a simulation-powered workforce and quality driver within endoscopy recovery. Building on the broader evolution of IPO (inputs-processes-outputs) in team science, Part 3 suggests the ways in which the learning from NHS Scotland Academy may contribute to the development of translational simulation theory, particularly through recognition of mediating mechanisms, episodic temporality, and cross-level causation. NHS Scotland Academy’s infrastructure and exemplars make these features more visible and suggest how the theory might be refined while retaining the pragmatic utility of IPO. Overall, this Advancing Simulation Practice article positions NHS Scotland Academy both as an effective national delivery platform for simulation-enabled workforce and quality programmes and as a testbed for advancing translational simulation conceptual models.
BACKGROUND:This study aimed to determine whether a distance-based CPR training program with asynchronous feedback for laypersons is non-inferior to the traditional in-person Heartsaver® First Aid CPR AED course. METHODS:After approval by the ethics committee, 192 non-medical personnel were recruited to participate in this study. Participants were randomly assigned to two different training methods: Traditional in-person Heartsaver® First Aid CPR AED course (T-course).Distance-based course offering asynchronous feedback through an online platform (D-course). For the distance-based course, materials for practice were available at the participants' workplace (pad, resuscitation torso, an automated external defibrillator). The video-based assessment and feedback platform C1DO1 was used (https://c1do1.ai/). The course was structured in 9 stages on the platform, with theoretical and practical steps. Participants reviewed the videos and practiced unsupervised, uploading video recordings of their practice, and instructors assessed and provided feedback asynchronously on these videos. Participants then reviewed their own videos with the feedback and practiced again until approval. Both groups completed a pre-training (PRE) and post-training assessment (POST). During both assessments, participants were recorded performing CPR. Videos were evaluated by two independent, blinded reviewers who rated participants' performance using the AHA Heartsaver Adult CPR and AED skills testing checklist. Additionally, the quality of chest compressions (CC) was measured with the Prestan simulator application. RESULTS:Of the 192 participants recruited, 172 completed the training, and 158 took the PRE and POST assessments. (83 finished the T-course and 75 the D-course). Median Heartsaver Adult CPR and AED skills testing checklist scores increased from 2 (0-3) to 15 (14-16.5) points in the T-course and from 1 (0-2.5) to 16 (15.5-17) points in the D-course. The difference in POST assessment median scores between groups was -1 (95% CI: [-1.5, -0.5]), with the lower bound above the pre-established non-inferiority margin, confirming the non-inferiority of the D-course. The median CC rate increased from 82 (0-106)/min to 105 (102-110)/min in the T-course and from 86 (0-109.5)/min to 105 (105-108)/min in the D-course. The median CC depth rose from 38 (0-57.5) mm to 58 (49.5-60) mm in the T-course and from 32 (0-56) mm to 59 (55-60) mm in the D-course. CONCLUSIONS:Both training programs significantly improve participants' proficiency in CPR. The distance-based course with asynchronous platform feedback was non-inferior to the traditional Heartsaver® First Aid CPR AED course.
High-fidelity simulation (HFS) provides a controlled environment for training, allowing ambulance clinicians’(ACs) to practice and refine their skills without risking patient safety. Additionally, it enables the replication of complex scenarios, ensuring comprehensive preparedness for real-life emergencies. However, there remains a need to understand how frontline professionals in ambulance services experience these simulation-based activities. This is especially true when using high-fidelity modalities that aim to replicate real-world scenarios for research purposes. To explore clinically active ACs´ experiences of participating in HFS. A qualitative design involving dyadic interviews with 16 ACs participating in a simulation scenario was conducted. The data were analyzed using the inductive content analysis method outlined by Elo and Kyngäs. Participants emphasized the importance of adopting the right mindset from the start of the scenario, as mental readiness was crucial for immersion. Although the scenario felt realistic, achieving full psychological fidelity remained challenging, as participants’ awareness of the simulation setup influenced their behavior during the scenario. The study underscores the importance of carefully designed HFS scenarios that prioritize psychological and environmental fidelity to support authentic engagement among clinically active ACs. This is particularly important in pre-hospital care, where direct access to real clinical situations is often restricted by ethical, practical, and organizational constraints. The findings indicate that well constructed simulations with coherent workflow sequences, professional actor–based patient representation, and realistic settings can function as a methodological bridge for capturing complex cognitive and emotional processes that are otherwise difficult to study in real world practice. Further refinement of simulation design, focusing on psychological presence rather than complete physical or technical realism, may strengthen simulation-based research as a method for investigating experiential aspects of pre-hospital care.
Post-resuscitation debriefing (PRD) enhances individual and team performance in emergency care, thereby improving patient outcomes and provider well-being. Despite support from the European Resuscitation Council and the American Heart Association, the optimal PRD framework remains undefined. This study compares how team members experience PRD when conducted using either the DISCERN or Post-Code Pause (PCP) debriefing framework in pre-hospital cardiac arrest simulations. In a randomized cross-over study, 40 medical doctors participated in four advanced life support (ALS) simulation scenarios. Participants acted exclusively within their usual roles as team leaders, while the remaining team members performed standardized roles in accordance with the scenario scripts. Each participant experienced two DISCERN and two PCP debriefings, with the order randomized. The primary outcome was the total score on the Debriefing Experience Scale (DES), with item scores as secondary outcomes. Linear models with generalized estimating equations (GEE) were used to account for repeated measures when comparing the mean scores between the debriefing frameworks. A total of 158 DES questionnaires were analyzed. Mean total DES scores were 4.15 (4.02; 4.28) for PCP and 4.16 (4.02; 4.29) for DISCERN (p = 0.93 for the comparison). These scores indicate a favorable debriefing experience for both frameworks. At the DES item level, no statistically significant differences were observed between frameworks, except for perceived physical comfort in the debriefing environment, which was rated significantly higher for DISCERN (DISCERN = 4.44 (4.27; 4.62), PCP = 4.13 (3.96; 4.30), p = < 0.0001). DISCERN and PCP provide similarly favorable debriefing experiences following simulated cardiac arrest scenarios, with no significant difference in overall DES scores. These findings suggest that both frameworks can be implemented without compromising perceived debriefing quality. Further research should include more professionally diverse participant samples and assess long-term debriefing outcomes. Clinical Trial Center UZ Leuven, S65846 September 2021.
Throughout Europe, Emergency Medical Services (EMS) rely heavily on Medical First Responders (MFR) to ensure early stabilization and appropriate handling of complex Mass Casualty Incidents (MCI). Mixed Reality (MR), also known as Augmented Reality (AR), provides interactive training by integrating real environments with digital components. This technology enables MFR to practise complex decision-making and hands-on interventions in high-stress, simulated scenarios. However, assessing its genuine effectiveness remains challenging, as true competency is often difficult to demonstrate outside real-life emergencies. This study aims to measure pre- and post-test changes in perceived self-efficacy among MFR following a targeted MR intervention focused specifically on the initial management of MCI. A pre-test/post-test survey design was employed with 274 MFR who underwent detailed MR training simulating complex, early-stage MCI scenarios. To analyze the intervention’s precise impact on participant confidence, data were analyzed using both within- and between-subjects ANOVA, providing information about the change in self-efficacy across the cohort. The analysis revealed a statistically significant increase in perceived self-efficacy among the 274 participants following the training (F(1,270)=169.36, p<.01, η2=.385). The mean score increased from 34.45 (SD=6.27) to 38.38 (SD=5.40), representing an absolute increase of 3.93 points. This corresponds to an 11.41
Artificial intelligence is increasingly being integrated into healthcare education and simulation-based education. However, its role in supporting the debriefing phase of simulation remains underexplored and inconsistently described. This scoping review aimed to map the existing literature on the use of artificial intelligence to support debriefing in simulation-based healthcare education. A scoping review was conducted in accordance with Arksey and O’Malley’s framework and Joanna Briggs Institute guidance and reported in line with PRISMA-ScR. MEDLINE, Scopus, Web of Science, and CINAHL were searched without date restrictions. Eligible studies examined the use of artificial intelligence to support debriefing-related processes within healthcare simulation. Data were charted using a structured extraction form and synthesised descriptively and thematically. Seven studies published between 2023 and 2026 met the inclusion criteria. Studies were conducted in the United States, Switzerland, Chile, and South Korea. Artificial intelligence applications clustered into three domains: communication and performance analytics using speech recognition and natural language processing; generative artificial intelligence systems supporting facilitator feedback and structured report generation; and learner-facing reflective dialogue systems. Across the included studies, artificial intelligence was mainly positioned as an adjunct to human facilitation rather than as a replacement for facilitators. Reported outcomes focused primarily on feasibility, usability, technical accuracy, and perceived educational value, with limited evidence of objective improvements in learner performance or clinical outcomes. Artificial intelligence is emerging as a supportive tool for debriefing in simulation-based healthcare education. Current evidence remains limited, exploratory, and largely single-institutional, indicating the need for more rigorous research on educational effectiveness, ethical implementation, and the continuing role of human facilitation.
Abstract Background Surgeons need to master many manual skills, which potentially decrease with age. Yet, there is no standardized approach to objectively assess how aging affects basic surgical performance and skills training. In this context, simulation offers a promising solution, being widely used to train and test novice clinicians. This study aims to evaluate the impact of age on performance using a visuo-haptic surgical simulator. Methods A total of 39 participants were divided in two groups: 20 young (20–40 years) and 19 older adults (50–70 years). All participants completed multiple repetitions of three basic surgical tasks using a custom visuo-haptic simulator: incision, an adapted version of the needle threading task, and suturing. Performance metrics such as errors, trajectory, and task duration were compared between groups and across repetitions. Results Younger participants outperformed older ones in all tasks. Specifically, they cut more tissue, made fewer errors in the dexterity task, and sutured faster. Both groups partially improved with practice, although older subjects improved less than younger ones. Conclusions Altogether these results suggest that age significantly affects performance in basic surgical tasks; moreover, older subjects might benefit from periodic training sessions to maintain their skills. In this regard, visuo-haptic simulation can serve as an effective training and evaluation tool to assess and counteract the effects of aging on surgical ability.
Abstract Background Simulation-based learning is a core component of health professional education, yet designing simulations that are culturally responsive, educationally robust, and locally relevant remains challenging. Existing international standards reflect the cultural contexts in which they were developed and provide limited guidance for adapting simulation design for Australia and Aotearoa New Zealand, including effective inclusion of Australian First Nations and New Zealand Māori perspectives. The Quality Simulation Assurance Framework (QSAFe) was developed to address this gap and support culturally safe, high-quality simulation design. This study explored two research questions: (1) How do participants evaluate the applicability of the framework, including its relevance and feasibility, to their simulation practice? and (2) How does the framework support users in their design and delivery of quality simulation, including perceived helpfulness, value, and educative impact? Methods A pilot evaluation was conducted across five tertiary institutions. Twenty-six educators used the framework to benchmark an existing simulation-based learning activity, and four participated in semi-structured interviews. Quantitative data were analysed using descriptive statistics. Qualitative data were examined using reflexive thematic analysis to explore perceptions of applicability and educative value. Results Participants reported that the framework and supporting materials were broadly applicable to their simulation practice. Most participants rated their experience positively and indicated an intention to use the framework in future design or documentation. Four themes described the framework’s perceived value: usability, promoting best practice, supporting reflection on design, and encouraging consistent learner experience. Although the consultation and co-design element of the framework received the lowest quantitative relevance rating, findings showed this element to be least understood, particularly in relation to cultural safety and Australian First Nations and New Zealand Māori inclusion. Participants suggested improvements such as a brief orientation, video walkthroughs, and an online version with embedded guidance. Limitations included a small sample, incomplete survey responses, and challenges recruiting interview participants. Conclusions The Quality Simulation Assurance Framework appears feasible, useful, and educative, supporting more consistent and culturally responsive simulation design. Further refinement should focus on strengthening guidance for co-design with Australian First Nations and New Zealand Māori and enhancing usability.
Debriefing is widely recognised as a central mechanism for learning within healthcare simulation, enabling learners to reflect on clinical actions, decision-making, and team interactions. However, high-quality debriefing is resource-intensive, dependent on facilitator expertise, and increasingly challenged by the growing complexity and volume of data generated during modern simulation activities. Artificial intelligence (AI) offers emerging opportunities to augment aspects of debriefing by analysing performance data, structuring reflective dialogue, and supporting learning environments. This article explores the emerging role of AI within debriefing. Drawing on the current literature, we describe four modes of AI being integrated into debriefing practice: metric-based AI tutors, large language model-assisted debriefing tools, conversational chatbot debriefers and hybrid integrated AI systems. For each mode, we examine their underlying mechanisms, current applications, and current contributions to, and limitations within, debriefing. Using these four modes as a scaffold, we offer practical guidance for simulation practitioners considering the integration of AI tools within their own practice, including considerations related to faculty AI literacy, educational alignment, governance, and implementation. While the empirical evidence base is evolving, AI-driven approaches offer new ways of supporting facilitators in augmenting reflective practice. When implemented thoughtfully and with appropriate human oversight, the integration of AI into debriefing portends a new era supporting reflective learning within healthcare simulation.
Abstract Background Simulation-based education can improve procedural training, but national adoption depends on governance, scalability, quality assurance, and alignment with postgraduate certification requirements. This Advancing Simulation Practice report describes how bronchoscopy simulation developed from a pilot educational initiative into a mandatory national component of postgraduate pulmonary medicine training. Main body We present a practice-based implementation account of a national reform in procedural training, using bronchoscopy as the index procedure. Rather than testing an effectiveness hypothesis, we examine programme design, governance, scale-up, instructor development, quality assurance, and regulatory embedding. The Consolidated Framework for Implementation Research and the RE-AIM framework were used to structure reflection on implementation determinants and programme outcomes, rather than as prospectively applied measurement instruments. The national simulation programme trained 402 physicians across procedural specialties, supported by 85 nationally certified instructors, and delivered 184 structured training cycles comprising 5,999 instructional hours. The bronchoscopy component enrolled 186 pulmonary specialty trainees, of whom 185 completed the course; 46 instructors were certified to deliver bronchoscopy training. Post-course evaluations showed high perceived relevance and increased self-reported confidence, which are interpreted as acceptability and early implementation indicators rather than evidence of clinical competence. Following national evaluation, bronchoscopy simulation was incorporated in 2024 as a mandatory component of postgraduate specialisation training in pulmonary diseases. Scale-up was supported by national-level European Union structural funding for health workforce development and simulation infrastructure, including POWER project POWR.04.03.00-00-0291/16, in which bronchoscopy formed one component of broader endoscopic simulation capacity. Conclusion The main contribution of this programme was the governance pathway that enabled simulation to progress from local innovation to national training policy. Sustainable implementation depended on staged scale-up, explicit curriculum design, instructor certification, common standard operating procedures, external quality assurance, distributed simulation-centre capacity, and alignment with regulatory postgraduate training requirements. Future evaluation should examine clinical transfer, workplace performance, and patient-safety outcomes.
In situ simulation (ISS) enables healthcare teams to test systems, identify safety threats, and strengthen interprofessional practice. Compared with off-site simulation (OSS), ISS may promote greater fidelity and transfer of learning. Cross-training, where participants adopt roles outside their profession, is widely used in healthcare education but remains controversial, with little evidence on how participants perceive its impact. We conducted a qualitative study in a Danish teaching hospital intensive care unit, using ethnographic observations, field notes, and semi-structured interviews. Sixteen interviews with physicians and nurses, supported by audio recordings of debriefings, were thematically analysed using a phenomenological-hermeneutic approach with consensus coding. Four themes were identified: fidelity, psychological safety, transfer, and cross-training. Participants described fidelity as multidimensional, including environmental, team, scenario, time, and resource aspects. ISS was perceived as more realistic and immersive than OSS, supporting deeper engagement and learning. PS was enhanced by familiarity with colleagues and environment, limited observation, and absence of cross-training. Facilitator competence at facilitating politely and creating room for all participants to speak up strongly influenced PS. ISS was viewed as promoting greater transfer of technical and social-cognitive skills to clinical practice, with some learning leading to organisational change. Cross-training was met with mixed reactions. Most participants, especially junior staff, preferred training in authentic roles, citing negative effects on PS and learning. More experienced clinicians occasionally valued cross-training for its reflective potential, though often only in less advanced roles. In situ simulation promotes learning by aligning fidelity, psychological safety, and transfer within participants’ authentic clinical roles and environments. Cross-training was frequently perceived as undermining both learning and psychological safety, particularly among less experienced staff, suggesting a misalignment between role substitution and learners’ developmental needs. Careful scenario design emphasising authentic roles, realistic fidelity, and skilled facilitation may optimise simulation learning outcome, Cross-training should be applied selectively, with explicit attention to learners’ experience levels, role authenticity, and potential impacts on psychological safety.
Shadowbox simulation is an educational approach that utilises the ShadowBox method, originally developed in high-stakes fields such as firefighting and the military, adapted for healthcare education. Grounded in cognitive transformation theory and drawing heavily on naturalistic decision-making, shadowbox simulation makes expert reasoning visible and accessible, enabling learners to compare their decision-making with that of experts and develop complex cognitive and behavioural skills. Early applications of shadowbox simulation in healthcare have demonstrated feasibility across diverse contexts. Building on these foundations, we describe the implementation of a hybrid shadowbox simulation format within Scotland’s national Internal Medicine Training program. This model combines video vignettes of expert practice, structured decision-points, group discussion and procedural practice, all supported by expert facilitation. Evaluation across more than 40 sessions shows that learners value the safe learning environment, the opportunity to embrace uncertainty and explore multiple perspectives, and the balance of reflective discussion with procedural refreshers. Feedback indicates that the format may foster deeper engagement, greater knowledge retention, and broader participation compared with traditional immersive simulation, while requiring fewer resources. By synthesising evidence from outside healthcare, reviewing recent adaptations, and presenting the principles and outcomes of national implementation, this article positions shadowbox simulation as a theory-informed, resource-efficient, and scalable method that advances simulation practice. We argue that shadowbox simulation offers particular promise for developing non-technical or behavioural skills, supporting reflective learning, and widening access to simulation-based education. Future potential applications extending to leadership, delegation, and induction training across healthcare professions are discussed.
Abstract Objective Increasingly in psychiatric and psychotherapeutic training, simulated patients (SPs) participate in the teaching and evaluation of clinical skills and knowledge. Despite their widespread involvement, doubt remains as to whether a genuine therapeutic alliance can be established with SPs. Further, little is known about the SP’s perspective on alliance formation which is an important gap given the correlation between patient perception of alliance and therapeutic success. Methods We interviewed three simulated patients about their perception of the bond formed during role plays of standard full-length psychiatric diagnostic assessments. Each SP played their role multiple times yielding sixteen unique interactions and therefore sixteen interviews. SPs watched a complete video recording of each of their role plays. After watching each role play, they rated their interaction with the psychiatrists using the bond subscale of the Working Alliance Inventory (WAI). Following the ratings, each SP was interviewed about the bond formation in each interaction. Results Despite the simulation, SPs were able to form bonds with psychiatrists across full-length diagnostic assessments. Feeling respected by the psychiatrist, both in the psychiatrist’s attempt to understand the problem and in their approaches to finding solutions facilitated bond formation. However, SPs had different preferences as to how respect should be conveyed. When it went well and when it went wrong, bond formation was affected by the same factors in the simulations as is the case in real practice. Conclusions Our results suggest that from the point of view of SPs, a therapeutic alliance as reflected by bond formation can be established between psychiatrists and SPs in the context of full-length diagnostic assessments. These findings would be strengthened through replication involving comparison of both the SP and the psychiatrist perspectives.
Abstract Background Clinical decision-making is a core nursing competency that develops progressively through education and practice. However, nursing students frequently report reduced self-confidence and increased anxiety when required to make clinical decisions. High-fidelity simulation (HFS) provides a safe, realistic environment to practice clinical decision-making and may influence these psychological determinants. Longitudinal studies on how repeated exposure to HFS affects anxiety and self-confidence across an entire nursing curriculum remain limited. Methods A four-year longitudinal study examined changes in nursing students’ self-confidence and anxiety in clinical decision-making during repeated annual exposure to HFS within a single cohort. A total of 143 students completed pre- and post-intervention questionnaires using the Nursing Anxiety and Self-Confidence with Clinical Decision-Making—High-Fidelity Simulation scale (NASC-CDM-HFS) . Linear mixed-effects models with random intercepts for participants examined year-by-year changes in self-confidence and anxiety, adjusted for age and prior healthcare experience. The anxiety models were further adjusted for baseline self-confidence levels. Results Pre-intervention self-confidence increased naturally across the program, whereas pre-intervention anxiety declined, indicating growing familiarity with clinical practice. After participating in HFS, significant improvements were observed during the first year. Self-confidence increased ( b = 6.64, 95% CI [4.17, 9.11]) and anxiety decreased ( b = –2.90, 95% CI [–5.27, –0.68]). In subsequent years (Y2–Y4), HFS produced no additional statistically significant effects. Conclusion High-fidelity simulation enhancess self-confidence and reduces anxiety during clinical decision-making among novice nursing students. However, significant effects were only found during the first training year. This suggests that the psychological impact of HFS is strongest when students are exposed to simulationtraining for a first time. To repeat these psychological benefits throughout the curriculum, simulation activities should be progressively adapted in complexity, integrated more frequently, and aligned with students’ advancing clinical competencies.
BACKGROUND: Training is required to build the capacity of future leaders to dismantle disadvantage, influence change and strengthen diversity and inclusion across higher education institutions. The LIBRA pilot project uses a novel simulation-based approach to equip student leaders with skills to address biases and promote gender equality. METHODS: Kern’s Curriculum Framework was utilised to systematically design a simulation-based gender equality training programme for students, employing a six-step approach that included problem identification, a comprehensive needs assessment using a mixed methods approach, and development of educational objectives and strategies. The LIBRA programme was piloted by 19 student leaders across two sites. The programme was evaluated by assessing participants’ pre- and post-event confidence to deploy skills and techniques which foster gender equity in post-secondary settings. Participant feedback was also collated via an online questionnaire. RESULTS: Students’ confidence in their ability to communicate, be actively aware and challenge gender equality matters increased post-intervention. They found the programme engaging, interesting, accessible, and relevant. Students felt comfortable participating in the training and found that the feedback provided to them was useful. The majority of students strongly agreed that simulation is a valuable approach to support the acquisition of gender equality competencies. CONCLUSIONS: Within the LIBRA pilot project, a simulation-based approach to tackling gender inequality was positively received by student leader participants. The LIBRA programme can be adapted for use in local contexts to create a co-operative simulated learning experience for participants. Further research is required to evaluate the impact and value of such training programmes within the context of wider Equality, Diversity and Inclusion (EDI) initiatives.
