Simulation Experience Research Articles

Research on the cascade modulation method for star position simulation in a weak starlight simulator

In order to surmount the challenge wherein the gray-scale resolution of liquid crystal on silicon (LCOS) imaging within a faint starlight simulator acts as a limiting factor for the precision of stellar position correction, this paper introduces a design approach for a cascaded architecture tailored to faint starlight simulators. Through the implementation of an isometric mapping technique that maps the dimming LCOS onto the surface of the imaging LCOS, the dimensionality of gray-scale adjustment for the imaging LCOS is augmented, thereby enhancing the accuracy of simulated stellar position correction. Initially, a stellar position cascaded modulation architecture is meticulously constructed to investigate the pivotal factors that impact the gray-scale resolution of the imaging LCOS within the framework of the cascaded modulation architecture. Subsequently, the optimization protocol for the concentrator system embedded within the cascaded modulation architecture is formulated. Leveraging the simulated annealing algorithm, the multi-parameter freeform surface of the concentrator system undergoes synchronous optimization. Finally, the simulation outcomes derived from the cascaded modulation architecture both prior to and subsequent to optimization clearly demonstrate that upon the implementation of the novel architecture, the accuracy of simulated stellar position correction experiences a notable enhancement of 62%.

Development of a virtual poverty simulation experience for healthcare learners

Development of a virtual poverty simulation experience for healthcare learners

Centering Empathy Through Embodied Experiential Learning in Teacher Education

ABSTRACTDeveloping empathy in teacher education is essential as it contributes to increased sensitivity and understanding between teachers and their students. This is especially important for preservice content‐area teachers (PCTs) who may have limited linguistic awareness yet will be potentially teaching emergent multilinguals in their mainstream classrooms. In response, this inquiry explored the role of a simulated language learning experience (SLLE) as an embodied approach to center empathy in PCT training. Framed by Dewey's theory of experience, it used a qualitative composite narrative approach to explore PCTs' felt experiences and empathetic development through embodiment. Findings showed that emotional intensity appeared to be the strongest factor in producing empathetic reactions followed by disengagement due to lack of understanding. In contrast to similar research, participants continued to experience intense emotional and physical responses to the lesson even when supported by TESOL strategies. The embodied experience provides a pedagogical example for building empathy while also presenting implications for increased reflection to avoid false empathy.

High-fidelity simulation training for improving nursing professional values acquisition.

Nursing professional values form the basis of nursing interventions and serve as a guide for professional practice, reflecting in all interactions with patients and other healthcare professionals. As nursing professional values constitute powerful influencers in nursing practice, a strong commitment to these values is essential for nursing students to provide high-quality care. To evaluate the impact of high-fidelity simulation training on first-year nursing students' nursing professional values acquisition. Quasi-experimental study using a longitudinal design with a single group pre- and post-intervention evaluation. 202 first-year nursing students at the Complutense University of Madrid (Spain) participated in the study between September 2023 and May 2024. Their nursing professional values were compared at baseline and after the simulation experience using the "Nurses Professional Values Scale-Revised" (NVPS-R). The acquisition of these values was also evaluated using a verification list during simulation sessions. Five simulated scenarios recreated ethics dilemmas, where students should manage conflictive situations with a standardized patient. The study was approved by the Research Ethics Committee from the Complutense University of Madrid (reference code: CE_20231116_18_SAL). Most of the students (84.87%) acquired the nursing professional values needed to manage adequately simulated ethical dilemmas. Nursing students significantly improved their nursing professional values after the simulation sessions. The effect size was medium for the "professional expertise" and "professional mastery" dimensions, and the total score of NVPS-R, whereas the obtained effect size was small for the "ethics" dimension. High-fidelity simulation training using standardized patients allows first-year nursing students to acquire and improve nursing professional values. The inclusion of simulation training programs in nursing study plans to foster nursing professional values is needed to train undergraduate nursing students, providing them with the necessary ethical concepts and principles for their future clinical practice and ensuring high-quality care.

Combining Immersive Simulation with a Collaborative Procedural Training on Local Anesthetic Systemic Toxicity and Fascia Iliaca Compartment Block: A Pilot Study

Introduction: Readiness to perform a wide variety of procedures or manage nearly any patient presentation remains an essential aspect of emergency medicine training and practice. Often, simulation is needed to supplement real-life exposure to provide comfort and knowledge, particularly with rarer pathology and procedures. As the scope of practice continues to grow, newer procedures, such as ultrasound (US)-guided nerve blocks (UGNB), are becoming integrated into resident training, building on previously established skills. The fascia iliaca compartment block (FICB) is performed on patients with specific femoral fractures and is a now a component of standard multimodal pain regimens, with US-guidance limiting adverse events. Given the need for high volumes of local anesthetic to perform the block it is imperative for clinicians to understand dosing as well as recognize and treat local anesthetic systemic toxicity (LAST). With sparse literature on sequential immersive and procedural simulation involving intertwined topics, this presents a unique opportunity for learners. Methods: To study the perceived knowledge and comfort with FICB and LAST, a pilot study was developed with two separate but concurrent one-hour simulations completed encompassing one of each topic over one day. We surveyed 19 learners, consisting of residents ranging from postgraduate years 1–3, prior to and immediately following completion, regarding their perceptions. We used the Stuart-Maxwell test to compare survey data. Results: More than half of participants (56%) had not received prior formal training on FICB. There was a positive trend in perceived confidence and knowledge with visualizing relevant anatomy (4.0 [2.0–6.0] vs 9.0 [7.5–10.0], P = 0.10), performing FICB (4.0 [1.0–5.0] vs 9.0 [7.0–10.0, P = 0.08]), and perceived ability to teach their peers (3.0 [1.0–5.0] vs 8.5 [7.0–10.0], P = 0.20). Perceived ability in diagnosing and managing LAST also increased following the simulation (5.0 [3.0–6.0] vs 6.0 [6.0–7.0], P = 0.12 and 3.0 [2.0–6.0] vs 6.0 [6.0–7.0], P = 0.08, respectively). Conclusion: Learners’ perceptions of this simulation experience echo the findings of previous studies in which simulation can be used to teach procedures and pathology; of note, however, we presented a novel experience with a combination of immersive and procedural simulation.

Exploring the Use of Immersive Simulation to Teach Research Skills to Student Paramedics in Higher Education: A Mixed Methods Approach

Objectives Within paramedic education immersive simulation is widely used to teach technical skills, but its application to non-technical aspects of practice, such as research skills, is limited. This study aimed to explore immersive simulation as a tool to teach specific research skills to paramedic students in higher education to investigate its novel capacity beyond the more traditionally considered technical elements of practice. Methods A didactic pre-briefing was delivered to undergraduate paramedic students before they undertook an immersive simulation in which they were expected to assess, extricate, and treat a stroke patient, whilst also assessing whether he was suitable to be enrolled onto a clinical trial, provide information on this, and take consent. A large-scale immersive environment furnished with surround audio-visual display equipment was utilized; the environment also contained an ambulance, a hatchback car, and two actors. After the simulation and debriefing, students completed an online questionnaire comprising open-ended questions and the following scales: Simulation Design Scale (fidelity subscale only), Simulation Effectiveness Tool – Modified, and Satisfaction with Simulation Experience. Data were analyzed using descriptive statistics and a manifest qualitative content analysis. Results Data were collected from twenty-eight undergraduate paramedic students. Most students believed simulation fidelity was important (89.3%) and most agreed that the simulation was realistic (82.1%). Pre-briefing (100%) and debriefing (85.7%) opportunities were considered important for increasing student’s confidence and learning, and, overall, students enjoyed the simulation (89.3%). Three themes emerged during the qualitative analysis: the significance of an immersive “real” environment, enjoyment as important for engagement and learning, and improved confidence via opportunities for autonomous practice. Conclusions Immersive simulation is a valuable pedagogical tool for the delivery of research skills teaching. These findings align with previous research which has investigated immersive simulation for teaching clinical skills, but more broadly, also highlight the compounding positive impact of immersive technology when deployed alongside actors and high-fidelity equipment.

Telehealth equity and access communication skills pilot simulation for practicing clinicians

Objectives This pilot study evaluated a telehealth training simulation program for practicing clinicians, specifically focused on addressing patient issues of equity and access to healthcare via improving telehealth communication. Methods Participants participated in a one-hour simulation experience with two cases. Performance was assessed pre- and post-intervention using a checklist measuring communication domains related to equity and access in telehealth. Participant satisfaction was secondarily measured via survey. Results Results showed measurable gains in clinicians’ abilities to effectively incorporate equity and access communication skills. Participants found the session useful and recommended the training experience. Conclusions The findings of this pilot study highlight the potential of simulation-based telehealth training for practicing clinicians, emphasizing clinicians’ attention to patients’ equitable access to healthcare. Future studies should aim to explore the durability of learning and investigate the generalizability of this training approach to other telehealth competencies and settings.

Increasing the Self-Confidence of School Nurses to Provide Mental Health Care to Students.

School nurses want and need continued education in student mental health care because of variability in their knowledge, skills, and confidence in assessing and responding to mental health concerns. To address this concern, two student mental health simulation scenarios were developed for a large school-based health program in Hawaii. School nurses (n = 51) participated in a 1-day skills training that included two scenarios with actors depicting students presenting with depression or anxiety. This mixed methods study used a qualitative component to explore nurses' simulation experiences and a six-item survey to assess confidence levels pre- and postsimulation. Scores for all six confidence items showed significant improvement after the intervention. Nurses highly valued the live actors and feedback sessions. Mental health care simulations can significantly increase school nurses' confidence in providing appropriate assessments and follow-up care to students. [J Contin Educ Nurs. 2025;56(1):20-26.].

Tutoring experiences of a high-risk newborn care simulation among nurse tutors and nursing student tutees in South Korea: a qualitative study.

This study aimed to explore tutoring experiences related to a high-risk newborn care simulation among nurses and nursing students to derive insights into developing effective neonatal nursing practice. A qualitative content-analysis study was conducted in March 2023. Data were collected through narrative surveys and focus group interviews with four neonatal intensive care unit nurses and 12 senior nursing students participating in a 1-day high-risk newborn care simulation program. A content analysis was performed on the collected data. Three categories ("efforts to foster a sense of presence," "efforts to promote positive awareness of the neonatal intensive care unit," and "establishing one's role as an educator") and six subcategories were derived from the nurses' responses. Three categories ("growth through a realistic virtual simulation," "improved learning effects," and "hope for continued development") and six subcategories were derived from the nursing students' responses. The nursing students experienced realistic practice with their nurse tutors in the high-risk newborn care simulation, which helped them form their professional identity as future nurses. After tutoring, the nurses' perceptions of nursing students changed positively, which affected their teaching methods.

Crisis management in the operating room: A systematic review of simulation training to develop non-technical skills.

Crises in the operating room, often resulting from human factors, endangers patient safety. Simulation-based training to develop non-technical skills shows promise in managing these crises. This review examines the simulation techniques, targeted healthcare professionals, non-technical skills, crisis scenarios, and evaluation metrics used in operating room crisis management training. Systematic review. MEDLINE, APA PsycInfo and Web of Science databases were searched for peer-reviewed articles published between January 2004 and March 2024. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review protocol has been registered on the Open Science Framework (OSF) (https://osf.io/7bsc8). The inclusion criteria were as follows: (1) The study population comprised healthcare and medical professionals or students; (2) the intervention involved a simulated learning or training experience; (3) the outcomes focused on non-technical skills or crew resource management; (4) the training setting was the operating room (simulated or real); and (5) the learning scenarios depicted a crisis or an adverse event. This systematic review identified 29 eligible articles. The findings highlight the predominance of high-fidelity simulations, primarily targeting medical staff rather than nurses or other healthcare professionals. Training focused on communication, teamwork, situation awareness, problem solving, and decision making, with scenarios mostly addressing patient deterioration. Assessments reached up to Kirkpatrick's Level 3, demonstrating a positive training impact through learners' reactions and learning metrics rather than behavior and organizational results. Despite their effectiveness, current training practices exhibit limitations. Incorporating nurses and other paramedical staff in interprofessional training, as well as emphasizing team-related scenarios and evaluating behavioral changes in practice, could enhance training effectiveness. This has implications for interprofessional healthcare education and skills transfer to real-world settings, ultimately improving patient safety.

Qualitative Assessment of Undergraduate Nursing Students' Perceptions of Combined Virtual Reality and Group Discussion Learning Interventions: A Focus Group Study

Context: The coronavirus disease 2019 (COVID-19) pandemic has forced major changes in the learning environment. The author’s institution created virtual reality (VR) learning content to enhance readiness for on-the-job training students by allowing them to enter situations and circumstances beyond traditional learning, experience simulations of target individuals, and think about the nursing assistance needed. The education combined VR and 360-degree video content with group discussions to increase learning depth. A qualitative analysis of the evaluations from the participating students’ perception was performed to obtain suggestions for future educational methods. Aim: This study aimed to elucidate how undergraduate nursing students perceive the effectiveness of education that combines VR learning content with group discussions. Methods: This qualitative descriptive study summarizes the educational effectiveness from data obtained through focus group interviews (FGI). In the data collection process, two focus group interviews were conducted with five nursing students at a nursing university in the Tokyo metropolitan area in March 2023, using an interview guide that was independently created. The study subjects participated in the nursing practical training and exercises that combined VR learning content with group discussions. Results: Based on the FGI of five participants, two main themes were identified, "educational effectiveness" and "challenges." Educational effectiveness" contains the following four subthemes as effects of the combination of VR learning content and group discussions: Opportunities to think about the experiences of patients receiving care and the ethical behavior of nurses, promotion of understanding of clinical situations that are normally inaccessible, opportunities for reflection through recollection of previous experiences, and expanding and deepening learning in group discussions. Moreover, "challenges" contains two subthemes: Introducing mechanisms and devices to enhance learning effectiveness and VR sickness while viewing the VR learning content. Conclusion: The introduction of VR learning interventions allows for the simulated experience of three-dimensional reconstructed scenes of places and situations that are normally inaccessible and is provided for learners to be useful as a learning opportunity intended to reconstruct knowledge and understanding. Additionally, the emotional experience of VR learning content based on learners' different perspectives and sensitivities can be combined with group discussions to deepen learning through multifaceted opinions and realizations. An effective educational method for fostering critical thinking skills is to incorporate group work into VR-based educational programs.

Debriefing Methodologies in Nursing Simulation: An Exploratory Study of the Italian Settings.

Background: As part of simulation-based learning, it is well known that debriefing plays a crucial role; ineffective debriefing can lead to a reiteration of errors in decision-making and a poor understanding of one's limitations, compromising the learner's psychological safety and making future simulated learning experiences less effective. In Italy, although simulation has been used in nursing education for more than 20 years, there is a general lack of data regarding the elements of debriefing. Methods: An exploratory, cross-sectional, multicenter nationwide study was conducted to identify current debriefing practices in Italian simulation-based nursing education. A non-probability sample of all directors of the Italian Bachelor school of Nursing and the directors of simulation centers on Italian national territory was surveyed with an online questionnaire. Results: Fifty-four nursing degree programs and 11 simulation centers participated in the survey. Significant differences were found between debriefing practices used by simulation centers and those used by the Bachelor School of Nursing. Specifically, differences concerned the training of debriefers, the knowledge of a debriefing framework, the use of different rooms for debriefing and the time spent on this activity. Conclusions: There is an emerging need for a harmonization process in Italian nursing education debriefing practices that would align the current reality with the best practices of the literature.

Zombies and Aliens: Fantasy and Science-Fiction Simulations in Teaching Political Science, International Relations and Security Studies

The article explores the pedagogical potential of integrating fantasy and science fiction simulations into teaching political science, International Relations or security studies at the university level. Recognizing the influence of popular culture on contemporary students, the article advocates for leveraging the immersive experience of simulations based on unusual topics. Drawing inspiration from similar successful didactic endeavors, we introduce an outline for a pedagogical experiment and key takeaways from its preliminary tests on students from various courses. Theoretical and empirical foundations are provided to support the experiment’s methodology, emphasizing the use of imaginative scenarios to engage students and provide them with a set of important skills, as well as foster critical thinking and enhance creative problem-solving in an empowering educational experience. The article presents the structure of the experiment, conducted over three years with diverse student groups, yielding promising early results and positive feedback, but also touches on its challenges and limitations. It concludes that team-based role-playing simulations provide an accessible, low-tech yet innovative tool which could make its way into more curriculums.

When common cognitive biases impact debriefing conversations

Healthcare debriefing is a cognitively demanding conversation after a simulation or clinical experience that promotes reflection, underpinned by psychological safety and attention to learner needs. The process of debriefing requires mental processing that engages both “fast” or unconscious thinking and “slow” intentional thinking to be able to navigate the conversation. “Fast” thinking has the potential to surface cognitive biases that impact reflection and may negatively influence debriefer behaviors, debriefing strategies, and debriefing foundations. As a result, negative cognitive biases risk undermining learning outcomes from debriefing conversations. As the use of healthcare simulation is expanding, the need for faculty development specific to the roles bias plays is imperative. In this article, we hope to build awareness about common cognitive biases that may present in debriefing conversations so debriefers have the chance to begin the hard work of identifying and attending to their potential detrimental impacts.

The possibility of applying metaverse in cultural heritage tourism: A case study on the ancient city of Babylon

This paper explores cultural heritage tourism decision makers’ perspectives on adopting metaverse technologies to enhance experiences and preservation at the ancient Mesopotamian city of Babylon in Iraq. The metaverse represents an emerging phenomenon of persistent 3D virtual environments accessed through augmented and virtual reality. Babylon’s sprawling ancient ruins could be vividly recreated to attract tourists both on-site and online. However, challenges around authenticity, infrastructure, and competing priorities may inhibit metaverse adoption. To investigate this complex issue, 8 semi-structured interviews were conducted with Iraqi government heritage and tourism officials and museum administrators. Interview transcripts were thematically analyzed to identify key opportunities and barriers. Findings revealed knowledge gaps around metaverse benefits, concerns over the inauthenticity of simulated experiences, enthusiasm for widening youth access, and various adoption challenges. Core recommendations include starting with small experimental pilots, building decision makers digital literacy, framing metaverse experiences as complements not replacements, and improving supporting technology infrastructure over time. This formative qualitative study provides crucial insights into Iraqi expert perceptions to inform policies guiding effective, context-specific integration of metaverse technologies to ultimately enrich cultural tourism and the preservation of ancient Iraqi heritage. Further research measuring pilot metaverse project outcomes is warranted.

Optometry students’ views on preparing for private practice via standardised patient simulation

Background: Standardised patient (SP) simulation can significantly enrich the learning environment in health professions education. Simulation in optometry has yet to be widely adopted, especially in Africa, prompting this study to investigate whether students perceived the use of SP simulation in optometry education as an effective method for enhancing the development and refinement of core competency skills.Aim: This study aimed to determine optometry students’ perceptions of simulation learning experiences with a SP.Setting: This study was done at the Department of Optometry at the University of the Free State, South AfricaMethods: A qualitative case study was undertaken. All 17 final-year optometry students (n = 17) were invited to participate. Data were collected using an open-ended questionnaire. Content analysis was used to analyse the experiences and perceptions of the participants.Results: The response rate was 100%. The students perceived that the educational objectives of the simulation experiences were successfully achieved. They felt that the simulation helped them develop core competencies like professionalism and communication while boosting their confidence. They attributed this success to the realistic, appropriate and safe learning environment that the simulation provided.Conclusion: The findings suggest that optometry students perceive SP simulations as a valuable tool in preparing them for private practice. This study highlighted the effectiveness of SP-based training in bridging the gap between academic learning and real-world practice.Contribution: This study is the first in South Africa to explore optometry students’ preparation for private practice through SP simulation. The findings offer insights that can guide other optometry programs using SPs to support students’ holistic development, enhancing their professionalism and readiness for practice.

The Application of Augmented Reality in Simulation-Based Design Evaluations of Trauma Rooms.

This study examined the augmented reality (AR) application in design evaluations through an immersive experience of medical task simulations in combination with a full-scale physical mock-up of a trauma room. Augmented reality technology is emerging in various fields including architectural design. Traditionally, building physical mock-ups has been the most effective tool to involve end-users in design evaluations. However, AR can eliminate cost- and labor-intensive components of a physical mock-up by replacing them with holograms. Two simulation sessions with emergency department clinicians were conducted using AR. The research team collected user feedback through simulations and interviews. Clinicians' feedback was systematically categorized and summarized according to various design elements. The integration of mock-up and AR simulations enabled the evaluation of design elements that were previously unattainable. Examples include simulating color-coded floor boundaries and adjusting door widths, which enhanced clinicians' immersion and involvement in design changes. Interviews and analyses of video recordings captured from the clinicians' perspectives supported the design evaluations during simulations. Augmented reality has great potential to be used widely in the evaluation of healthcare environment design. Augmented reality is an innovative approach that can benefit end-users in interacting with a mix of real spaces and virtual components. It also introduces new ways of data collection and analysis to architectural design evaluation methods.

"Room of Horrors": A Proof-of-Concept Simulation Model for Error Reduction Training in the Emergency Department.

This pilot study aimed to assess the effectiveness of a "room of horrors" (RoH) simulation in identifying patient safety threats in a pediatric emergency department (PED) and to evaluate health care workers' (HCWs') perceptions of the experience. We developed an RoH simulation featuring 25 potential safety hazards derived from actual PED incidents and "never events." The teams of physicians and nurses who participated in the simulation identified as many hazards as they could within a 10-minute window followed by a debriefing session during which errors were corrected and missed hazards were pointed out. The participants' perceptions were measured on a 5-point Likert scale of a questionnaire. Twenty sessions that included a total of 45 participants were conducted. The teams identified an average of 23 of 25 safety threats, yielding a mean detection rate of 86% for electronic medical record errors, 95% for physical space errors, and 97% for communication errors. The simulation received high ratings for overall positive experience (4.88/5) and impact on daily activities (4.68/5). The RoH simulation experience was effective in evaluating the level of retention of earlier training and the ability of multidisciplinary teams to correctly identify major safety threats in a PED setting. The participants found the experience valuable and engaging. Future research should focus on other means by which the retention of learned skills can be reinforced and new safety threats can be identified with a high level of alertness.

Performance Comparison of Various Tunnel Lighting Scenarios on Driver Lane-Changing Behaviours in a Driving Simulator

Recent advances in tunnel infrastructure have emphasized safety, operational efficiency and low operating costs. Modern tunnels are equipped with systems to improve both safety and operational performance. This study investigates the effect of tunnel lighting and vehicle breakdown scenarios on driver lane changing behaviour (LCB) using a driving simulator modelled on the third longest twin-tube tunnel. Data were collected from 125 drivers considering various driver characteristics with different lighting conditions and the presence of a stopped vehicle in a lane. The results show that drivers tend to slow down and change lanes more safely in response to red and flashing lights. In contrast, blue sky lights, which are designed to reduce stress and compare with other dangerous scenarios, had no significant effect on LCB. In addition, demographic factors such as gender and previous simulator experience played a role in influencing LCB tendencies. Female drivers and those familiar with simulators showed more cautious behaviour. The findings showed valuable insights into how tunnel lighting systems can improve safety. Results highlighted the potential for dynamic lighting and targeted driver training programs to improve tunnel safety. All these findings may contribute to ongoing efforts to improve traffic management and reduce accidents in tunnel environments.

Enhancing Clinical Practice Through Simulation.

Nurse leaders are obligated to ensure that nurses are prepared to engage in the provision of safe high-quality nursing care by creating a learning environment where their clinical knowledge and critical reasoning can be safely developed and refined. Simulated educational experiences can accelerate learning and provide nurse's the ability to confidently and competently deliver clinical care in a highly efficient manner.