Emotional Activation in Simulation: Measuring the Influence of Participant Roles and Scenario Design.

INTRODUCTION: The degree of emotional activation required for optimal learning in either hands-on or observer roles is unclear, as is the level of stress that impedes learning. Measuring emotional activation is time-consuming, and many scales measure threat or anxiety without considering pleasurable activation. This study examined emotional activation in the observer and hands-on roles in 2 different scenario designs. METHODS: This study was a 2-cohort, parallel study of graduate nurses and doctors completing 2 different courses in managing the deteriorating patient. We examined emotional activation by role across 2 scenario designs. We measured emotional activation on 3 anchored measures scales: the State Trait Anxiety Inventory, Cognitive Appraisal Index, and the Affect Grid with data analysis using analysis of variance and repeated measures. RESULTS: Hands-on learners experienced higher anxiety, threat, and arousal levels and less pleasure than observers in both scenario designs. There were no differences in pre-emotional and postemotional activation in immersive scenarios for either role and increased arousal and decreased threat and anxiety in the hands-on role in the pause-and-discuss scenario design. CONCLUSIONS: Hands-on learners were more emotionally activated than observers in both scenario designs. There was significant perceived anxiety, threat, and pleasurable arousal in both roles and both scenario designs. Pause-and-discuss scenarios demonstrated similar levels of activation as the immersive scenario design. The Affect Grid provided a quick subjective view of arousal and pleasure in simulation participants, potentially providing educators with an indication of whether emotional activation is positive (excitement) or negative (stressful) and may be helpful in educational planning and future research.

Remotely Versus Locally Facilitated Simulation-based Training in Management of the Deteriorating Patient by Newly Graduated Health Professionals: A Controlled Trial.

INTRODUCTION: This study evaluated delivery of immersive simulation-based training (SBT) by distance education. Newly graduated health professionals' experience of and learning outcomes from videoconference-enabled remotely facilitated (RF) were prospectively compared with a locally facilitated (LF) format within a course addressing management of the deteriorating patient. METHODS: Participants were exposed to both RF and LF formats in an intervention course (IC). The primary outcome measure was a questionnaire detailing participants' experience of 1 RF scenario and 1 LF scenario. The 16-item questionnaire measured perceived learning, comfort, interaction with other learners and instructor, as well as quality of instruction, factors that are considered essential in both SBT and distance education. As a secondary outcome measure, learning outcomes, measured as precourse and postcourse scores and pass rates in multiple-choice question tests, were also measured and compared with those of participants completing control courses, in which only the LF format was used. RESULTS: The study was conducted between April 2013 and April 2014. Among the 155 participants who participated in ICs, questionnaire results revealed a small, significantly higher median total score (25-75 interquartile range) for LF versus RF format scenarios [78 (72-80) vs. 76 (68-80), P = 0.01]. Multiple-choice question test scores compared between 155 IC and 150 control course participants showed no significant differences. CONCLUSIONS: Participants' experience of SBT using the RF format was slightly less positive than the LF format; however, it had no measured impact on knowledge. The impact of RF-SBT on more complex training applications remains poorly understood. Instructors could potentially optimize learner comfort and engagement by improving their interactive skills.