Learning in Technology-Enhanced Medical Simulation: Locations and Knowings

Abstract

This qualitative study focuses on how knowings and learning take place in full-scale simulation training of medical and nursing students, by drawing upon actor-network theory (ANT). ANT situates materiality as a part of the social practices. Knowing and learning, according to ANT, are not simply cognitive or social phenomena, but are seen as emerging as effects of the relation between material assemblages and human actors being performed into being in particular locations. Data consists of observations of simulations performed by ten groups of students. The analysis focuses on the emerging knowings in the socio-materialarrangements of three locations involved in the simulation-the simulation room, the observation room and the reflection room. The findings indicate that medical knowing, affective knowing and communicative knowing are produced in different ways in the different locations and material arrangements of the simulation cycle.

Towards socio-material approaches in simulation-based education: lessons from complexity theory

“…Students are observed, are often assessed and are most likely aware of the backstage orchestrations at work to maintain the illusion. Consider the following field observation from one study of student teams performing an acute trauma simulation using Sim‐man:

One of the medical students notices that there are no vital signs displaying on the computer screen, no pulse, no ECG, and the manikin is not breathing. The team interprets this as [reflecting] a deterioration of the condition and starts resuscitation.

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‘The acute trauma simulation scenario is a system of fantasy role‐play nested within the “real” hospital practice it mirrors, the medical school's schedules and assessments, the different built environments of classroom and ward, the technology and technicians, national medical practice standards, international notions of good simulation education, etc. Students’ learning is nested within all of these.’

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“…When Sim‐man “vomits” (gagging sounds from the room speaker), the tutor is side‐coaching – Get your hands in there! Really get into his mouth!’

In the multi‐ward scenario: the student doctor enters a cubicle, the patient is sitting in the bedside chair. The doctor draws near to take the history and sits on the bed, a cardinal error which he realises immediately but then seems unable to correct.

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Enacting simulation: A sociomaterial perspective on students’ interprofessional collaboration

“…Practices evolve in historical and various social contexts. Professional learning and knowing-in-practice is thereby seen as embedded in practical rationalities, emergent and enmeshed with social and material arrangements (Schatzki, 2002;Gherardi 2009;Kemmis 2009;Fenwick & Abrandt Dahlgren, 2015).…”

“…These phases encompass different challenges to educators and learners and have different sociomaterial arrangements and activities (Ahn et al, 2015). The present paper has a particular focus on the simulation phase, and the aim of the study is to describe and analyse how interprofessional collaboration emerges in a simulated emergency situation as enacted by participating students.…”