Exploring the Lived Experiences of Participants in Simulation-Based Learning Activities

There is currently a small body of research on the experiences of participants, both facilitators and learners, during simulated mock codes (cardiac arrest) in the healthcare setting. This study was based on a practitioner's concerns that mock codes are facilitated differently among educators, mock codes are not aligned with andragogy theory of adult learning, and there is no standardized method to evaluate participant reflection achieved during the debriefings immediately after mock codes. The study took place in a large federal government healthcare organization. The qualitative study method, interpretive inquiry, was used to explore the lived experiences of clinicians and facilitators who participate in mock codes. A validated reflection rubric was used as a method of assessing the achieved level of reflection in a group setting during the debriefing sessions that follow mock codes. Data were collected from interviews, observations, and transcribed mock code video recordings. Five themes emerged: (a) preparation, (b) consistency, (c) use of video recordings, (d) opportunity for follow-up, and (e) self-reflection. The two most significant findings were the lack of consistency in the design, facilitation, and evaluation of the mock code and debriefing processes that lead to confusion, anxiety, and stress among both learners and facilitators, and the gap between facilitator knowledge and understanding of the assumptions of adult learners and the andragogical practice model. Data analysis identified the need for additional participant support through follow-up opportunities for reflection, and the need for andragogy education for the facilitators of mock code exercises. Though the element of surprise makes the mock code realistic much like a fire drill, the study findings indicate learners perceive they would benefit from being prepared for the learning experience in the form of a pre-briefing. Recommendations for future research include a study of the application of andragogy to the competency framework currently within the VHA system, an evaluation of an evidence-based structure and standardized method for designing and delivering high-quality simulation activities that align with the andragogy, and development of standardized and easy to use methods of assessing the levels of achieved learner reflection during and after the debriefing process