Dual Processing and Social Minefields: How Autistic Healthcare Learners Experience Simulation-Based Education.

Abstract

Simulation-based healthcare education presents complex sensory, social, and cognitive demands that may systematically disadvantage autistic learners. Although contemporary research acknowledges autistic professionals' presence in healthcare practice, the literature remains conspicuously silent on how autistic learners actually experience simulation-based environments. Without understanding these lived experiences, we risk perpetuating educational practices that exclude neurodivergent talent and missing insights that could improve simulation design for all learners. This study aimed to explore the lived experiences of autistic healthcare learners in simulation-based education and understand how they make sense of these experiences. This interpretative phenomenological analysis explored the lived experiences of seven autistic healthcare learners from the UK and Europe. Participants included medical students and qualified doctors with simulation experiences spanning undergraduate curriculum-based training, postgraduate education, and professional development activities. We conducted semi-structured online interviews lasting approximately 60 minutes between February and May 2025, with interviews progressing from descriptive accounts to reflective consideration of ideal simulation experiences. Data analysis followed established interpretive phenomenological analysis (IPA) procedures, developing emergent themes and identifying patterns across participants whilst preserving individual voices. We developed four interconnected themes from participants' accounts. First, "Navigating Artificial Realities" captured how participants developed strategic, performance-based approaches to simulation's predictable structure, often prioritising technical success over genuine skill development. Second, "The Social Minefield of Group Learning" revealed how group composition and social dynamics served as gatekeepers to meaningful engagement. Third, "The Cognitive Burden of Dual Processing" described participants' exhausting experience of simultaneously managing clinical learning and social monitoring, with educational engagement competing against social performance demands. Fourth, "Communication as a Structural Barrier" highlighted participants' need for clear, direct instruction and feedback across all simulation phases. Our findings suggest that autistic learners may experience well-documented challenges in simulation-based healthcare education with particular intensity, revealing how simulation learning environments that appear inclusive may present challenges for autistic learners through design failures rather than learners' individual limitations.