The simulated clinical environment: Cognitive and emotional impact among undergraduates

Abstract

Context: Simulated clinical immersion (SCI) is used in undergraduate healthcare programs to expose the learner to real-life situations in authentic simulated clinical environments. For novices, the environment in which the simulation occurs can be distracting and stressful, hence potentially compromising learning.

Objectives: This study aims to determine whether SCI (with environment) imposes greater extraneous cognitive load and stress on undergraduate pharmacy students than simulated patients (SP) (without environment). It also aims to explore how features of the simulated environment influence students’ perception of learning.

Methods: In this mixed-methods study, 143 undergraduate pharmacy students experienced both SCI and SP in a crossover design. After the simulations, participants rated their cognitive load and emotions. Thirty-five students met in focus groups to explore their perception of learning in simulation.

Results: Intrinsic and extraneous cognitive load and stress scores in SCI were significantly but modestly higher compared to SP. Qualitative findings reveal that the physical environment in SCI generated more stress and affected students? focus. In SP, students concentrated on clinical reasoning. SCI stimulated a focus on data collection but impeded in-depth problem solving processes.

Conclusion: The physical environment in simulation influences what and how students learn. SCI was reported as more cognitively demanding than SP. Our findings emphasize the need for the development of adapted instructional design guidelines in simulation for novices.

Acknowledgements

We are grateful for the collaboration of Geneviève Lesage who acted as a simulation instructor for this study. We are also thankful for the support of the program director and direction of the Faculty of Pharmacy at Laval University for authorizing this research. We also want to thank the technical staffs at Apprentiss Simulation Center – Pharmacy for supervising the technical aspects of this study. Finally, we are grateful for the support of Dr Andreas Gegenfurtner and Prof. Jan-Joost Rethans who provided feedback on the design and manuscript.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing this article.

Glossary

Simulated Clinical Immersion: Simulated clinical immersion is a simulation modality reproducing real-life situations in an authentic simulated workplace environment. It may comprise simulated patients and/or simulators if required within the simulation scenario. This simulation modality is typically used to develop clinical reasoning skills and team training.

Chiniara G, Cole G, Brisbin K, Huffman D, Cragg B, Lamacchia M, Norman D. 2013. Simulation in healthcare: a taxonomy and a conceptual framework for instructional design and media selection. Med Teach. 35:e1380–e1395.

Notes on contributors

Marie-Laurence Tremblay, B.PHARM, M.Sc., M.Sc., BCPS, is a pharmacist and a simulation educator at Centre Apprentiss, Université Laval, Canada.

Alexandre Lafleur, M.D., M.Sc., FRCPC, is a general medical internist at CHU de Québec and an educator at Université Laval, Canada.

Jimmie Leppink, PhD, is a postdoctoral researcher at the School of Health Professions Education (SHE), Maastricht University, The Netherlands. His research focuses on adaptive approaches to learning and assessment, cognitive load theory and measurement, and multilevel analysis of educational data.

Diana Dolmans, PhD, is Professor at the School of Health Professions Education (SHE) Maastricht University in the Netherlands. Her special interest relates to teaching and learning in innovative learning environments.