What can simulation educators learn from the reluctant participant? An exploration of the factors influencing engagement amongst adult learners participating in paediatric simulation training.

Abstract

Background: Simulation educators are typically passionate advocates for simulation as a training modality; however, we frequently encounter participants who do not share our enthusiasm. The voice of the highly engaged participant is well publicised; however, the experience of those who do not readily engage in simulation has not been extensively studied and may offer valuable insights for educators. This qualitative study will explore factors which influence learner engagement in paediatric simulation training, informing the practice and approach of simulation educators to optimise learning experiences.

Methods: We conducted a reflexive thematic analysis of 12 semi-structured interviews with medical and nursing professionals from a large paediatric teaching hospital in New Zealand who self-identified as reluctant participants in simulation-based education. Interviews explored factors which have influenced their engagement in simulation-based education over the course of their careers.

Results: Three overarching themes were developed which describe the factors influencing adult-learner engagement in simulation-based education. The first, participant anxiety, explores the participants' narratives related to anxiety before, during and even following simulation which can impact on their ability to engage in current and subsequent simulation-based education. The second, protective behaviours, relates to the defensive mechanisms employed by participants in response to vulnerability experienced during simulation activities. The third theme, perception of the facilitator, examines the impact of simulation facilitator characteristics and behaviours on learner engagement.

Conclusions: These narratives highlighted that regular simulation activities with transparent learning objectives in which facilitators demonstrate vulnerability and adopt a co-learner attitude act to reduce participant anxiety. Emergent defensive behaviours, particularly "group shielding", interfere with collective learner engagement and should be both recognised and addressed by facilitators. Finally, there are potential discrepancies in the perceptions of facilitators and learners regarding what constitutes psychologically safe education environments. A collaborative and iterative approach to simulation-based education design may act to improve psychological safety for reluctant participants.