When technology fails during simulation: Time for reflection?

Abstract

Simulation-based education has been a key development in health care education, providing a safe learner-centred educational environment. It is a valuable tool, giving learners the opportunity to develop their knowledge and skills, engage in deliberate practice, think about team processes and develop non-technical skills. Simulation-based education allows learners to work towards curriculum competencies in a safe environment where mistakes are expected with no detrimental impact on patient care. This is thought to have an impact on patient safety in the clinical environment when learners take these skills forward into clinical practice. As technology has evolved, it has increasingly been incorporated into simulation-based education. Faculty can use audio-visual technology for remote observation of learners within the simulated environment, allowing faculty the option of video-assisted debriefs. These facilitated debriefs are key to supporting learners to get the greatest benefit from simulation-based education. They allow learners to gain knowledge of their practice and reflect on events guided by facilitators. This style of learner-centred debriefing focuses on the collaborative process between learners and facilitators, with facilitators supporting learners to derive meaning from their experiences. In Lanarkshire, audio-visual technology has been used in simulation-based education since 2010. Faculty use instructor-driven simulators within scenarios, while observing learners in the simulated environment through the audio-visual system. We developed a new immersive simulation course focusing on interprofessional clinical reasoning. The interprofessional team consisted of a medical student, nursing student, pre-registration pharmacist, physiotherapy student and occupational therapy student in their final or penultimate year of study. The simulation was set within an acute medical receiving ward, followed by a facilitated team debrief for learners (Figure 1). While piloting this course, the audio-visual technology failed. This left faculty unable to observe learners during the simulation. Faculty were concerned how they would debrief safely and effectively if they were unaware how learners had performed through observing. Learners were oblivious to the technical issues while immersed within the simulated environment, and this was only disclosed during the debrief. Facilitators became aware of how the simulation had unfolded when learners recounted events as part of the debrief. When facilitators disclosed that they had been unable to see or hear anything, learners laughed and appeared to relax. The apparent pressure they felt, due to being watched, evaporated. Their response appeared to play a part in post simulation decompression, reducing the learner–facilitator power imbalance. This disclosure supported everyone in creating a psychologically safe team which the facilitators became integrated into. The learners observed the discomfort and vulnerability in experienced faculty, perhaps mirroring their own experience within the simulation. There was a sense of everyone reflecting and learning from the experience together, with learners feeling they could truly guide their debrief. Facilitators were enabling reflection through actively modelling their own reflective process. Given that the establishment of psychological safety is essential for successful teams, should we actively consider how this is established in a post simulation debrief? Furthermore, this is a reminder that learning is something learners do themselves and facilitators should recognise the need to step back and allow this to happen.