The power of simulation: a large‐scale narrative analysis of learners’ experiences

Abstract

Context Simulation‐based education ( SBE ) includes a broad spectrum of simulation activities, which are individually well researched. An extensive literature reports on SBE methods, topics and modalities, but there are limited studies investigating how simulation as a holistic phenomenon promotes learning. This study seeks to identify the ways in which health professionals narrate powerful SBE experiences and through this to understand in what ways SBE may influence learning. Methods Three hundred and twenty‐seven narratives about powerful learning through SBE were gathered from participants’ online reflections from a national faculty development programme in SBE . Narrative and thematic analyses were conducted on included texts, using ‘transformative learning theory’ as a sensitising notion. Results Narratives were categorised into the following categories: progress (267/327 = 81%); transformation (25/327 = 8%); practice (27/328 = 8%); and humiliation (8/327 = 2%). Recurrent features across narrative categories were as follows: early experiences in training; dramatic scenarios; developing appreciation of SBE ; highly emotional experiences; things that ‘went wrong’; and ongoing reflection. Themes regarding mechanisms that supported learning were as follows: verisimilitude; feedback, debriefing and facilitation; observation of self and others; repetition of activities; and role‐playing the patient. Conclusions The results generally support the notion that SBE is experienced as a holistic phenomenon, rather than separate modalities. The narrative categories, recurrent features and learning themes tended to work across all simulation modalities, with the exception of ‘being in the patient's shoes’ being supported by role‐play in particular. Although powerful experiences were not necessarily transformative ones, they often occurred at formative stages of training. There was a strong sense that things going wrong in simulation scenarios (and the associated emotions and reflection) were a key part of learning. This underlines SBE 's potential role in helping learners see fallibility as part of professional practice.

Exploring transformative learning when developing medical students' non‐technical skills

“…The first phase described by Mezirow is that of a ‘disorienting dilemma’ in which the individual is faced with an experience that challenges his or her prior assumptions . This phase has previously been accepted to align with a medical student's experience of taking part in an immersive simulation scenario in which the student encounters the responsibility of assessing an acutely unwell patient …”

“…Simulation‐based education (SBE) can have significant, sustained effects on medical learners and its potential transformational effects have been considered . Such effects have been found to be attributable to ‘learning through verisimilitude’, or the reality of the immersion, social learning through debriefing, and the observation of self and others . Transformative learning theory has been applied in nursing education in the contexts of virtual patient simulation and immersive high‐fidelity simulation .…”

Simulation: the power of what hurts

“…The work psychologist Dejours argues that it is precisely the suffering caused by failures at work that drives professional development. The power of this suffering may undermine capacity – the damage referred to by Bearman et al –. but is also what gives the associated experiences such resonance.…”

“…In this way, mistakes can be put into a social context that means they no longer, necessarily, represent a personal failure but rather a systemic feature limiting the capacity for effective work. This may be one approach by which SBE may offer ‘an opportunity for participants to come to understand the role of error in healthcare over time, and to transform thinking about failure to thinking about fallibility’, as called for by Bearman et al …”

“…Simulation‐based education is now well established within medical education and simulation centres can expand their repertoire to tackle more directly the frustrations in the workplace that hamper performance and ultimately curtail patient care. Bearman et al . describe the ‘power’ of simulation as ‘the learning that resonates long after the experience has passed’.…”