Understanding synchronous collaborative learning via telesimulation for health professions education

Background: Simulation for health professions education is viewed as an educational strategy where near to real-life critical events can be enacted for learning. Teleconferencing and telesimulation have been purported as the vehicles to help increase access to essential medical education around the globe. It has been suggested however that technological and other barriers may preclude synchronous (real-time) collaborative learning via telesimulation. Collaborative learning is defined as a situation in which particular forms of interaction among people are expected to trigger learning opportunities, but there is no guarantee that expected interactions will occur. Very little research has explored how synchronous collaborative interactions can be supported for learning across distances during multisite Virtual Patient (VP) and manikin-based telesimulations. Aims and objectives: The aims and objectives of this study are to contribute new insights about how to identify and support meaningful synchronous collaborative learning opportunities during telesimulation. Three main research questions were constructed to fulfil these aims and objectives: 1. What is currently known about synchronous collaborative learning via telesimulation-based healthcare education? 2. How do synchronous collaborative learning opportunities emerge during virtual patient (VP), mixed modality and manikin-based transatlantic telesimulations? 3. How are synchronous collaborative learning opportunities supported (or not) during VP, hybrid, and manikin-based transatlantic telesimulations? Methodology: In this thesis, learning opportunities and supports were conceptualised as boundaries and boundary object assemblages within an integrated sociocultural, sociomaterial, and discourse analytical framework, aligned within Interactional Ethnography and a Gee-informed discourse analysis. Methods: I carried out a scoping review to answer the first research question (RQ1). To answer the next two research questions (RQ2 and RQ3), I designed a qualitative case study within which synchronous collaborative learning interactions across three different types of telesimulation settings were explored: i) transatlantic Virtual Patient (VP) telesimulations between same level medical students; ii) transatlantic hybrid telesimulations between different level medical students; and iii) transatlantic manikin-based telesimulations between interprofessional healthcare teams. In terms of data, I collected video-recordings, group interviews, follow-up focus group interview, reflections, emails, and scenario design documents. I created field notes from observation and from video, as well as transcriptions, event maps and video frame grabs. From this I selected and followed all synchronous interactions within the dataset which included site A (transatlantic site) within multi-site telesimulation activities. Results: What is currently known about synchronous collaborative learning via telesimulation-based healthcare education (RQ1) can be considered in terms of effectiveness, conditions, interactions and processes. Except for feasibility studies however, no studies have gleaned any light on synchronous collaborative learning via VPs or multisite manikin-based simulations. In terms of learning opportunities (RQ2), it was found that institutional, pedagogical, and knowledge boundaries came to the fore in different ways during synchronous VP simulations and that knowledge, technological and distributed team design boundaries emerged during hybrid telesimulations between medical students. Interprofessional, institutional and geographical boundaries emerged as learning opportunities during manikin-based telesimulations between multi-professional healthcare teams. In terms of support (RQ3), it emerged that ‘design scripts’, VP software tools, VP scenarios, peers and tutors, supported synchronous collaborative learning during VP telesimulation. The co-construction of conceptual and concrete products as boundary objects by participants supported synchronous collaborative learning in interprofessional manikin-based telesimulations. It was found however that these materials and participants did not do this on their own but within sociomaterial assemblages. Conclusions: This doctoral study has contributed new knowledge, empirically and theoretically, towards an enhanced understanding of synchronous collaborative learning in different telesimulation settings for health professions education. Its originality lies in its research questions, theoretical framework, integrated research approach and novel distance learning setting