Work to make simulation work: ‘Realism’, instructional correction and the body in training

Abstract

This article explores the organization of instructional corrections in pre-clinical dental education. The students are practising manual skills using a simulator and tutors are inspecting and evaluating their progress. Simulators and simulation are critical to the organization of contemporary healthcare training, and the academic literature that explores forms of simulation in healthcare tends to consider the ‘fidelity’ (or ‘realism’) of systems and the extent to which they match the clinical situations that they are designed to mimic. In contrast, this article considers how tutors and students explicitly attend to matters of realism in the course of instructional sequences. We highlight the ways in which tutors routinely invoke ‘real life’ in instructional corrections and we discuss how these sequences reveal the work that tutors undertake to compensate for the ‘chronic insufficiency’ of the simulator. We show how tutors emphasize the reasoned character of manual bodily skills, reasons linked to the complexities and contingencies of clinical practice. To explore these issues and concerns, the article draws on the analysis of audio-visual data of everyday instruction.

Representing and enacting movement: The body as an instructional resource in a simulator-based environment

“…Moreover, their results show that both similarities and differences with clinical practice are important to grasp and understand in terms of work practice in the simulator environment. Hindmarsh et al (2014) argue that these kinds of moments should be seen as instructional resources rather than a deficiency of the simulator. In their study on the use of simulators in dental education, inconsistencies between the simulator environment and the real world were used to highlight aspects of the curriculum for the students.…”

“…Without making a substantive review of an on-going debate on how to describe matters of learning settings and activities as authentic representations, a relevant concept for this study is to view this as a matter of realism and relevance for learning the real world work practice (see, e.g., Rystedt and Sjöblom 2012;Hindmarsh et al 2014). However, it is important to recognize that realism and relevance are complex questions that, like the concept of psychological fidelity, go beyond technical features of the simulator.…”

“…Hontvedt (2015) argued that training sessions have to be carefully configured in order to avoid such pitfalls. As highlighted by Hindmarsh et al (2014) in a study on dental students in training, that the simulator offers little in terms of learning. It also does not provide instructions on how to perform a manual skill or contribute with any explanations of why a certain conduct is right or wrong.…”

“…In this study the development of the sort of knowledge that has been described as bodily skills is in focus (e.g. Hindmarsh et al 2014). The argument is that this sort of bodily knowledge is, similar to professional vision, part of the socially situated and historically constituted practices of a profession.…”

“…It also does not provide instructions on how to perform a manual skill or contribute with any explanations of why a certain conduct is right or wrong. What Hindmarsh et al (2014) emphasize as important in instruction is instead to explore the seams between the simulation and the real work practice that the students are training for, which were found to occasion debate and discussion that was important for their development of professional expertise. In this way the inconsistencies between the simulator environment and the real world work practice were actually an instructional recourse rather than a deficiency of the simulator.…”