An Exploration of Motivation, Relevance and Realism in Simulation Based Medical Education

: "I don't want to look like an idiot"

Abstract

The use of simulation in medical education, as well as the literature in the area, has increased dramatically in the past two decades. There is emerging evidence that simulation can be effective and the features of simulation which result in improved training and patient outcomes are becoming clearer. It is known that attitudes and motivation influence learner behaviour and outcomes, yet there is a paucity of evidence for the effectiveness of simulation which takes this into account. This work offers an original contribution by providing a theoretically underpinned insight into motivation for simulation. It also adds to the literature by reviewing current evidence on the effectiveness of simulation, reviewing the literature on motivation in medical education and qualitatively exploring the factors which can enhance or hinder motivation for simulation in a range of medical professionals. Twenty-three doctors and senior medical students, sampled in existing learning groups, including medical students, foundation doctors, anaesthetists and general practitioners, participated in seven group interviews: transcribed interviews were analysed for content and theme using framework analysis. The results demonstrated a range of simulation experiences, positive and negative value perceptions and pragmatic factors which can enhance or undermine motivation. Positive value perceptions of simulation included providing a rehearsal opportunity, an opportunity to experience rare situations, a trigger for feedback and reflection, and an opportunity for teamworking, in a context free from the risk of patient harm. Negative value perceptions included anxiety about role play, peer scrutiny, and making mistakes whilst observed by peers: ‘I don’t want to look like an idiot’, and issues about appropriate degree of realism. Some groups of learners, such as GPs indicated that simulation based courses were less relevant to their learning needs, in contrast with anaesthetic mid-career doctors who considered simulation highly relevant and a normal part of their experience. Pragmatic moderators were also identified, such as time, cost and location. These findings were consistent with existing theories of learner motivation. This thesis makes a further original contribution to the literature by identifying the importance of realism (particularly semantic realism) as a factor influencing motivation. In this study the influence of realism on learner motivation was not readily mapped to existing theories of learner motivation, identifying a gap in the literature. This thesis highlights the importance of recognizing anxiety in simulation, and ensuring appropriate realism. It recommends addressing anxiety as part of briefing and de-briefing for simulation, and recommends that course designers enhance internal consistency and semantic realism within simulation scenarios. Future research should take motivation and other learner attitudes into account when evaluating the effectiveness of simulation based educational interventions.

Date of Award	2017
Original language	English
Awarding Institution	University of Dundee
Supervisor	Keith Topping (Supervisor) & Jean Ker (Supervisor)