'Dancing with emotions': An Interpretive Descriptive study of facilitators recognition and response to students' emotions during simulation.

Introduction: Immersive simulations can evoke a range of emotions in students. However, little is known about how facilitators recognise and respond to students' emotions during simulations. This study aims to understand how simulation facilitators perceive and respond to students' emotions during simulation-in order to optimise learning.

Methods: We conducted semi-structured interviews with 10 simulation facilitators who had varying experiences in simulation-based practice. We explored their experiences of students' emotions in simulations and reactions to these perceived emotional states. Applying an Interpretive Descriptive methodology, drawing upon control-value theory, we iteratively and reflexively developed themes to address our research question. Based on a contrasting analysis, we used the concept of 'crafted stories' to represent our findings.

Results: We identified three recurring issues and crafted these into stories: (1) facilitators that recognise emotions and adjust the complexity of the simulation in order to dampen intense negative emotions and 'preserve learning'; (2) those that recognise mainly negative emotions and argue that it is better to let them feel the 'heat' in order to prepare them for the realities of clinical practice; (3) those that recognise both negative and positive emotions but let the simulation run as planned for all learners and attend to emotional responses during debriefing.

Conclusion: Simulation facilitators become aware of students' emotional responses through a range of cues. While some facilitators continually move and react to students' emotions, others intentionally hold back from attempting to alter students' emotional responses. Facilitators' beliefs about how to optimise learning mediate how they react to students' emotional states. Beliefs about learning are predominantly shaped by their experiences in both teaching and real-world clinical practice. By understanding the delicate balancing act of students' emotional states and altering the complexity of a simulation, we have the opportunity to inform facilitator training in order to enhance learning.