“The world of simulation and immersive learning technologies is developing rapidly and in parallel to the existing and predicted future requirements of health and care on a global scale”.
[Enhancing education, clinical practice and staff wellbeing. A national vision for the role of simulation and immersive learning technologies in health and care HEE, 2020]
This #Take 5 reflects upon ways in which paramedic students responded to a compassionate pedagogical approach to debriefing groups after a high intensity simulation experience. Their experience through changing the ambience of the debrief transformed their session from one where students reported anxiety, insecurity where lecturing staff noticed students showing signs of stress to relaxed bodies, a calm atmosphere and a readiness for self and peer reflections. This was now a space where individual voices could be heard, and deep learning took place.
The JISC Students digital experience INSIGHTS survey experience (2022) reported 43% of students do not perceive their learning materials to be engaging/motivating; and can lead to a disconnect between study and careers. Immersive technology and simulation may offer the solution to this disconnect, as simulations offer an immersive and embodied experience. Martin-Rodriguez et al. (2021) describe clinical simulation as both an essential and a powerful learning tool used extensively throughout nursing, medicine, and emergency care. Simulation is designed to support, engage and challenge health care students as they build their confidence and competence in their disciplines. The pedagogy of clinical simulation-based learning has become integral to healthcare education; combining practical skills with pertinent skills such as problem solving, team working, peer review, critical thinking and clinical reasoning (Briese et al 2020). However, there is evidence to support that this type of pedagogy has the potential to cause students to experience elevated levels of stress and anxiety (Jowesy et al 2020).
This short illustrative video clip shows the contrast between a high stress, high intensity environment (a rail crash scenario where students were expected to triage and the treat mannequins with different injuries) to their low stress environment (a virtual aquarium of tropical fish swimming and soothing water ripple sounds) enabled by using the resources available in an immersive classroom – a Blended Learning Interactive Simulation Suite (BLIS). The ‘classroom’ is a mixed reality platform, comprising three fully interactive walls, with any imaginable scenario projected onto them, with video, audio and tactile capabilities.
https://www.youtube.com/watch?v=ygFshwj-kSQ , 1min 39secs
“Compassion, guided by reason, is fundamental; and without it, we cannot teach well”
(White, 2017, p.30)
Studies have shown that students can find clinical simulation to be extremely stressful and anxiety provoking (Jowesy et al. 2020 and Mills et al. 2016). Could a potential solution to controlling the amount of stressor added by the educator be to embed compassionate pedagogies in clinical simulation training? Compassionate pedagogy is a teaching approach that emphasizes empathy, care, and understanding in the educational process by focusing on and creating a respectful and understanding learning environment. Here the students’ emotional, personal, and academic needs are recognised, fostering both their professional competence and well-being. This method enhances the development of compassionate, patient-centered care by modeling empathy in the educational process.
Evidence suggests peer-support is an effective way of dealing with stressors that have been encountered in education and practice (Phillips et al 2022). Clinical debriefing following a clinical event has been found to confer benefits for staff and has the potential to improve patient outcomes (Phillips et al. 2022). The use of a structured, evidenced based debriefing model may provide a more standardised approach and help overcome barriers to clinical debriefing. The STOP5 peer-led debrief model has been shown to improve morale, team cohesion, improved patient care, promoting a culture of learning, patient safety and quality improvements in multidisciplinary teams (Walker et al 2020).
So the challenge for the Paramedic educators was to ensure engagement through realistic simulation with traumatic components; and to balance this with students being capable of applying the STOP5 principles to their debrief in a meaningful way that promotes and enhances deep learning. Wellbeing needs to be at the heart of student simulation experiences, and studies show exposure to multisensory immersive spaces by creating a nature inspired relaxation can dramatically reduce short-term stress and significantly reduce anxiety in frontline healthcare workers Putrino et al (2020).
Paramedic students discuss their recent experiences (image taken with consent)
Creating an atmosphere of quiet and calm is enabled through transforming the immersive classroom into an ‘aquarium’, with rippling water and fish swimming. This dramatically different space offers the student an atmosphere reducing stress and anxiety caused by the simulation and a place to consolidate their learning.
Student feedback:
Not all of us have access to state-of-the-art immersive classrooms, and the LD community works in many different settings. Here in our Health and Social Sciences Faculty we have been trying out different ideas (Holley and Holland 2023), and across the sector Learning Developers have also been busy, with Bälter et al (2018) exploring walking seminars; Frith et al (2022) considering academic skills and wellbeing; Gilmours’ amazing work on kindness; and Greogry looking at embedding nature as learning. In a fast paced and changing world, using techniques to enable our students to learn effectively and safely, with their wellbeing at the heart of practice, we argue, matters.
References:
Bälter O, Hedin B, Tobiasson H, Toivanen S. Walking Outdoors during Seminars Improved Perceived Seminar Quality and Sense of Well-Being among Participants. International Journal of Environmental Research and Public Health. 2018; 15(2):303.
Bayne, S., Evans, P., Ewins, P., Farrell, K., Gallagher, M., Ghazali-Mohammed, Z., Knox, J., Lawson, T., Manches, A., Menzies, J. and Odai, L. (2019) ‘Centre for Research in Digital Education Annual Report 2019’. Available at: https://era.ed.ac.uk/bitstream/handle/1842/37968/DE_Report_2019_web.pdf?sequence=1 Blended learning Interactive Simulation (BLIS) https://g8spaces.com/
Briese, P., Evanson, T. and Hanson, D., 2020. Application of Mezirow’s Transformative Learning Theory to Simulation in Healthcare Education. Clinical Simulation in Nursing, 48, 64-67.
Frith, L., Maitland, L. . and Lamont, J. (2022) “The impact of departmental academic skills provision on students’ wellbeing”, Journal of Learning Development in Higher Education, (25). doi: 10.47408/jldhe.vi25.978.
Gilmour, A. (2021) “Adopting a pedagogy of kindness”, Journal of Learning Development in Higher Education, (22). doi: 10.47408/jldhe.vi22.798. https://journal.aldinhe.ac.uk/index.php/jldhe/article/view/798
Gregory, J. (2023) “How can we incorporate nature connection into our work as learning developers?”, Journal of Learning Development in Higher Education, (29). doi: 10.47408/jldhe.vi29.1098.
Health Education England (2020). Enhancing education, clinical practice and staff wellbeing. A national vision for the role of simulation and immersive learning technologies in health and care.
Holley, D and Holland, S (2023) Creating a culture for learning presented to Bournemouth University Fusion Learning Conference 5th July 2023 Link to Pecha Kucha: https://bournemouth.cloud.panopto.eu/Panopto/Pages/Viewer.aspx?id=3a2bf991-29cb-4113-8fb4-b03600f5de54
JISC (2022) ‘Student digital experience insights survey 2021/22: Higher education findings. Available at https://www.jisc.ac.uk/reports/student-digital-experience-insights-survey-2021-22-higher-education-findings
Jowsey, T, Peterson, L., Mysko, C., Cooper-Ioelu, P., Herbst, P., Webster, C.S., Wearn, A., Marshall, D., Torrie, J., Lin, M.P., Beaver, P., Egan, J., Bacal, K., O’Callaghan, A. and Weller, J., 2020. Performance, identity formation and professionalism: Ethnographic research to explore student experiences of clinical simulation training. PLoS ONE, 15(7), e0236085. Available from: https://doi.org/10.1371/journal.pone.0236085 [Accessed 22 November 2021].
Martin-Rodriguez, F., Castro Villamor, M.A., Lopez-Izquierdo, R., Portillo Rubiales, R.M., Ortega, G.J. and Sanz-Garcia, A., 2021. Can anxiety in undergraduate students in a high-fidelity clinical simulation be predicted? A randomized, sham-controlled, blind trial. Nurse Education Today 98 -104774
Mills, B., Carter, O., Rudd, C., Claxton, L and O’Brien, R., 2016. An experimental investigation into the extent social evaluation anxiety impairs performance in simulation-based learning environments amongst final-year undergraduate nursing students. Nurse Education Today, 45, 9-45. Available from: An experimental investigation into the extent social evaluation anxiety impairs performance in simulation-based learning environments amongst final-year undergraduate nursing students – PubMed (nih.gov)
Phillips EC, Smith SE, Tallentire V, et al. (2022) Systematic review of clinical debriefing tool: attributes and evidence for use. BMJ Qual Saf Epub.doi: 10.1136/bmjqs-2022-015464
Pollock, C and Biles, J, 2016. Discovering the Lived Experience of Students Learning in Immersive Simulation. Clinical Simulation in Nursing, ISSN: 1876-1399, Vol: 12, Issue: 8, Page: 313-319. Available at: Discovering the Lived Experience of Students Learning in Immersive Simulation – ScienceDirect
Putrino D, Ripp J, Herrera JE, Cortes M, Kellner C, Rizk D and Dams-O’Connor K (2020) Multisensory, Nature-Inspired Recharge Rooms Yield Short-Term Reductions in Perceived Stress Among Frontline Healthcare Workers. Front. Psychol. 11:560833. doi: 10.3389/fpsyg.2020.560833
Walker CA, McGregor I, Taylor C, Robinson S. STOP5: a hot debrief model for resuscitation cases in the emergency department. Clin Exp Emerg Med 2020;7(4):259-266. https://doi.org/10.15441/ceem.19.086
White, R., 2017. Chapter 2: Compassion in Philosophy and Education. In: Gibbs, P. (ed.) (2017). The Pedagogy of Compassion at the Heart of Higher Education. Springer: Cham, Switzerland, 19-32.
Biographies:
Una Brosnan is a Lecturer in Paramedic Sciences and an expert simulation scenario designer and trainer. Enhancing and innovating simulation practice is a key area of her research, along with student welfare and wellbeing. She prides herself on student engagement and uses technology enhanced learning (TEL) to continue to innovate simulation pedagogies within the Paramedic Science team and the wider Health and Social Sciences Faculty at Bournemouth University. https://staffprofiles.bournemouth.ac.uk/display/ubrosnan
Debbie Holley is Professor of Learning Innovation at Bournemouth University. Her expertise lies with blending learning to motivate and engage students with their learning inside /outside the formal classroom, at a time and place of their own choosing. This encompasses the blend between learning inside the classroom and within professional practice placements, scaffolding informal learning in the workplace. She writes extensively about the affordances of technologies such as Augmented Reality, Virtual/ Immersive Realities and Mobile Learning. https://staffprofiles.bournemouth.ac.uk/display/dholley