High-fidelity Clinical Simulation Research Articles

Nursing Students’ Satisfaction with Clinical Simulation: A Cross-Sectional Observational Study

Clinical Simulation improves results in the students’ learning tests and allows for preserving acquired knowledge for longer periods of time, promoting more significant learning. This study was conducted to analyze Nursing students’ satisfaction with Clinical Simulation in three centres attached to a university from southern Spain. Methods: A quantitative, non-experimental and cross-sectional descriptive study was carried out. The students included were attending their third year of the Nursing undergraduate course and had already taken part in training sessions by means of Clinical Simulation. The Satisfaction Scale with High-Fidelity Clinical Simulation in Students (SSHF) was used for data collection. This scale has been validated and has 33 items grouped into eight factors. The SPSS software (version 28), was used for data analysis, establishing p-values < 0.05 for the statistically significant differences. Results: The participants were 180 students, with a mean age of 22.17 years old. Of them, 90.56% belonged to the female gender. A mean score of 3.82 out of 5 was obtained in the SSHF items. The items that obtained the highest scores were the following: benefits of Clinical Simulation as it relates theory with practise; possibility of learning based on the mistakes made; and comfort and respect while the sessions were developed. The item that obtained the lowest score was “timing for each simulation case”. We found significant differences in the results obtained according to each attached centre. Conclusions: The students showed high satisfaction levels regarding High-Fidelity Clinical Simulation in each of the three attached centres included in the study. Nevertheless, they stated the need to invest more time in Clinical Simulation sessions.

Clinical Simulation Program for the Training of Health Profession Residents in Confidentiality and the Use of Social Networks.

In the transition to a professional learning environment, healthcare professionals in their first year of specialized postgraduate clinical training (known as residents in Spain) are suddenly required to handle confidential information with little or no prior training in the safe and appropriate use of digital media with respect to confidentiality issues. The aims of this study were: (1) to explore the usefulness of an advanced clinical simulation program for educating residents from different healthcare disciplines about confidentiality and the dissemination of clinical data or patient images; (2) to explore the use of social networks in healthcare settings; and (3) to explore participants' knowledge and attitudes on current regulations regarding confidentiality, image dissemination, and the use of social networks; Methods: This was a cross-sectional study. Data were collected from all 49 first-year residents of different health professions at a Spanish hospital between June and August 2022. High-fidelity clinical simulation sessions designed to address confidentiality and health information dissemination issues in hospital settings, including the use of social networks, were developed and implemented. Data were assessed using a 12-item ad hoc questionnaire on confidentiality and the use of social media in the healthcare setting. Descriptive of general data and chi-square test or Fisher's exact test were performed using the SPSS 25.0 software; Results: All the participants reported using the messaging application WhatsApp regularly during their working day. A total of 20.4% of the participants stated that they had taken photos of clinical data (radiographs, analyses, etc.) without permission, with 40.8% claiming that they were unaware of the legal consequences of improper access to clinical records. After the course, the participants reported intending to modify their behavior when sharing patient data without their consent and with respect to how patients are informed; Conclusions: The use of advanced simulation in the training of interprofessional teams of residents is as an effective tool for initiating attitudinal change and increasing knowledge related to patient privacy and confidentiality. Further follow-up studies are needed to see how these attitudes are incorporated into clinical practice.

Socioemotional Skills in the Teaching-Learning Process Mediated by Medium- and High-Fidelity Clinical Simulation in Nursing Students: Protocol for a Scoping Review.

In nursing education, contact with real scenarios implies the design of favorable experiences to develop prioritization, reasoning, critical thinking, and management skills that support future practice. In the context of the teaching-learning process, simulation emerges as a support strategy, but its use and management require the knowledge and appropriation of teachers. Clinical simulation during education promotes growth in technical skills and aptitudes such as critical thinking, emotional management, organization, delegation, and teamwork. The culmination positively impacts the student, reflecting on their confidence, security, and adaptability to unexpected or unknown situations and risks. The aim of this scoping review is to determine the socioemotional skills described during the teaching-learning process mediated by medium- and high-fidelity clinical simulation in nursing students. The main concepts and limits of the research area will be determined according to the 5 phases of a scoping review proposed by Arksey and O'Malley. Research articles and postgraduate theses published between 2010 and 2023 in English and Spanish will be considered. Dissertation-type documents, book chapters, editorials, abstracts, and articles focused on clinical simulation among nursing professionals will be excluded. The articles will be retrieved from databases available at the Universidad Cooperativa de Colombia, along with CINAHL, Scielo, and PubMed. The search strategy will be based on the Population-Concept-Context framework. Article selection will be carried out by 2 independent evaluators who will review titles and abstracts in stage 1 and the full text in stage 2. A database of retrieved articles will be built with the variables of interest. A qualitative thematic analysis will be conducted by 5 independent reviewers to provide an overview of the literature, focusing on identifying similarities and contrasts between studies and contributions related to the aspects of social skills described in nursing students. The investigation has not yet started. The findings aim to focus on variables within the academic environment that, when correlated with the clinical simulation experience, may determine student learning. The working hypothesis is that students who experience greater satisfaction or possess better communication skills also demonstrate superior performance during high-fidelity simulation activities. The most relevant results will be contrasted considering the stated objective and knowledge gaps. Key aspects will also be compared with other reviews addressing related topics such as communication, self-efficacy, and self-confidence. Skills described by other authors that were not considered in the initial literature review will also be mentioned. Educational institutions are responsible for including learning experiences in controlled environments such as medium- and high-fidelity simulation to ensure the acquisition of technical capabilities and additional socioemotional skills. Recognizing and managing emotions is necessary to provide adequate care for users of health care services and for the increased effectiveness of professionals. Open Science Framework p4ays; https://osf.io/p4ays. PRR1-10.2196/56436.

Nursing Students’ Perspectives on Caring Pedagogical Relationship Within the Context of Simulation: A Phenomenological Inquiry

Abstract:This phenomenological research aimed to describe and understand nursing students’ meaning of the lived experience of a caring pedagogical relationship within the context of high-fidelity clinical simulation. Being inspired by a relational emancipatory pedagogy perspective, our findings highlighted an authentic engagement of educators as the cornerstone to fostering a safe, caring, and inclusive learning space, allowing them to co-create a humanistic collaboration with students to transform their learning process. Innovative and various avenues arising from our findings have been suggested in different domains of nursing practice to promote students’ learning and develop a caring inclusive learning community within simulation centers.

An Exploration of Student Perception Toward Interprofessional High-Fidelity Clinical Simulation.

Interprofessional education is recognized for its potential for collaboration and teamwork, reflecting clinical practice; however, existing literature for simulation-based interprofessional education does not include Physician Associate (PA) students. This initiative aimed to explore the students' perception of interprofessional clinical simulation for PA students and allied health professional (AHP) students as part of our program development. A high-fidelity simulation session was designed and conducted for volunteering students from the PA, paramedic science, and physiotherapy courses. We used a mixed-method electronic questionnaire consisting of 15 statements rated on a numerical rating scale (0-5) and four open-ended questions with unlimited free-text responses to explore student perceptions. Inductive thematic analysis was used for qualitative analysis. The session design was underpinned by Allport's (intergroup) contact hypothesis with an emphasis on mutual intergroup differentiation. Forty-six students participated in the simulation teaching, with 48% (n = 22) providing feedback. Overall student perception was mainly positive toward the interprofessional simulation; however, some barriers to learning were recognized. Based on the evaluation of our initiative and existing literature, we propose 5 top tips to promote an effective learning experience for students. (1) Understand the importance of interprofessional collaboration. (2) Establish clear roles. (3) Plan the scenarios in advance. (4) Maintain equal status between groups. (5) Provide clear instructions and expectations. To our knowledge, this is the first study of high-fidelity interprofessional simulation involving PA and AHP students. We successfully explored student perception which highlighted aspects that can impact learning. This pilot study demonstrated that interprofessional simulation is a feasible and acceptable form of learning for our students and highlighted how to improve future interprofessional simulation teaching sessions.

404 Management of Acute Coronary Syndrome by Nursing students through high-fidelity clinical simulation

404 Management of Acute Coronary Syndrome by Nursing students through high-fidelity clinical simulation

Including audience response systems in debriefing. A mixed study during nursing simulation-based learning

BackgroundThe audience response systems are being implemented to support active learning in nursing degree programs. The benefits of audience response systems have been studied in lecture-based classes and seminars, but their advantages or inconveniences when included in the debriefing phase of a high-fidelity clinical simulation have not been explored. The study aim was to discover student´s experience about using of interactive questions during debriefing, and the self-perceived effects on attention, participation and motivation.MethodsA Mixed-methods study was used exploratory sequential design in a university. The participants were 4th-year students enrolled in the Nursing Degree in a university in Southern Spain. (1) Qualitative phase: a phenomenological approach was utilized, and focus groups were used for data-collection. (2) Quantitative phase: cross-sectional descriptive study using a questionnaire designed “ad hoc”, on the experiences on the use of interactive questions in the debriefing phase and the Debriefing Experience Scale.Results(1) Qualitative phase: the students highlighted the facilitating role of the interactive questions during the reflection part of the debriefing, and mentioned that the interactive questions helped with stimulating attention, participation, and motivation during the analytical part of the debriefing; (2) Quantitative phase: it was observed that the best evaluated dimension was “Motivation”, with a mean of 4.7 (SD = 0.480), followed by the dimension “Participation”, with a mean of 4.66 (SD = 0.461), and lastly, the dimension “Attention”, with a mean of 4.64 (SD = 0.418).ConclusionsThe use of interactive questions contributed the attention, participation, and motivation of the students during the debriefing, contributing towards a highly satisfactory experience of high-fidelity clinical simulation.

Effects of a Clinical Simulation-Based Training Program for Nursing Students to Address Social Isolation and Loneliness in the Elderly: A Quasi-Experimental Study.

The population of older adults is rapidly increasing worldwide, presenting both prospects and complexities for society and healthcare professionals to maximize the functional capacity of this age group. Social isolation and loneliness significantly affect this population. The objective was to determine the effectiveness, satisfaction, and perceptions of the simulation-based education practices of a training program for nursing students, which was created to palliate the social isolation and loneliness of older adults. A quasi-experimental study was conducted with nursing students who participated in an online training program using teleservice based on high-fidelity clinical simulation. The program included asynchronous theoretical training and synchronous practical training using an online platform. Five scenarios were designed using simulated phone calls to address the social isolation and loneliness of older adults. Twenty-five nursing students participated in the program, and they had a mean age of 27.44, with 76% of them being women. After the training program, the participants showed statistically significant improvements (p < 0.05) with respect to their knowledge and attitudes towards older adults, and the program was adapted to the best educational practices in simulations. Simulation-based online training efficiently improved the knowledge and attitudes of nursing students towards older adults, improving their ability to address social isolation and loneliness. The high satisfaction and adhesion to the best educational practices underline the usefulness of high-fidelity online simulations, especially in situations in which face-to-face training is not feasible, and accessibility and equilibrium could be guaranteed between work and personal life.

A Feasible Web-Conference-Style Remote Simulation using Demonstration Video Clips in Anaesthesia under the COVID-19 Outbreaks: A Preliminary Survey Study.

The Coronavirus disease-2019 (COVID-19) outbreak has deprived simulation-based medical education for health care workers. Attendees are strictly prohibited to converge at a simulation training venue because of the COVID-19 outbreaks. To address this issue, we developed a web-conference-style remote simulation program using demonstration video clips. This report introduced the method and described participants' satisfaction. This preliminary survey study evaluated learners' satisfaction in multiple institutions. The Satisfaction Scale Questionnaire with High-Fidelity Clinical Simulation (SSHF) by a 5-degree scale was used to evaluate participants' satisfaction. The survey was conducted immediately after completing the simulation sessions. Ten (100%) participants (7 anaesthesia individuals, 2 anaesthesia residents and 1 nurse anaesthetist) from nine institutions responded to the survey. All median values of the satisfaction scores were ≥4.0, whereas the median values of scores for environmental fidelity and psychological insecurity were 3.5 and 3.0, respectively (P=0.005). A web-conference-style remote simulation using demonstration video clips is a feasible method for conducting simulation-based medical education under COVID-19 that showed high satisfaction scores. Further, additional studies are required to explore the internal and external validity and the effectiveness of mastery learning.

Electronic Workflow for High-Fidelity Clinical Simulation in Nursing.

Recognizing the importance of following the International Nursing Association for Clinical Simulation and Learning Standards: Healthcare Simulation Standards of Best Practice to ensure a successful simulation-based experience, this study aimed to update an electronic workflow created to guide teachers in the development and conduct of a clinical simulation for undergraduate nursing students, according to the latest evidence published in the International Nursing Association for Clinical Simulation and Learning Standards; implement it for online access; and describe the results of its usability criteria evaluation. It is a technological production and study of quantitative nature, descriptive and exploratory. The workflow was reconfigured according to the Contextualized Instructional Design model. The usability criteria analysis occurred through the application of a questionnaire to 23 undergraduate nursing courses professors. It was possible to identify that the technology reached high levels of global classification among faculty, being classified as "excellent" (M [SD], 81.9 [14.9]) by the final score. In view of the results obtained, it is concluded that the Electronic Workflow for High-Fidelity Clinical Simulation in Nursing can serve as a reference to promote the best simulation-based learning for professional training in nursing.

Use of high-fidelity clinical simulation for the development of cultural competence of nursing students

BackgroundThe increasing growth of migrant populations in Spain has changed the cultural profile of healthcare system users. Cultural competence in health care settings has become an increasing worry for health professionals, specifically for nurses. Therefore, the training in cultural competency of nursing students is indispensable. ObjectiveTo explore the views on the use of high-fidelity simulation in fourth-year nursing students to improve their cultural competence. MethodsA qualitative descriptive study was conducted with an interpretative phenomenological approach. Before and after taking part in simulated scenarios, 56 semi-structured interviews were conducted. We explored the perceptions of the nursing students when addressing a simulated clinical case with a patient who is a migrant, including the training deficiencies in cultural competences perceived before the simulation, the benefits perceived, and the improvement suggestions. We also analyzed their views on the skills and knowledge developed during the simulation experience. ResultsBefore entering the simulation scenario, we found the existence of insecurity, uncertainty, and cultural differences in the nursing students, with the main worry being the language barrier. They also mentioned the need to improve their intercultural communication and cultural adaptation of the care in their training. After finishing the simulation, they indicated positive aspects, aspects to be improved, learning acquired, and learning to be strengthened, highlighting the existing cultural differences and asking for training on cultural competence. ConclusionsThe use of high-fidelity simulation provides a positive learning experience, which increases a student's comfort when working with patients of varied cultural origins. Its usefulness in teaching is found in its capacity to develop communication skills and interpersonal skills, such as empathy, in the students. This study provides evidence on the importance of specific training on cultural competence in the Nursing Degree, and the usefulness of high-fidelity clinical simulation to achieve this.

O IMPACTO DA SIMULAÇÃO CLÍNICA DE ALTA FIDELIDADE NO ENSINO DE ENFERMAGEM PEDIÁTRICA: ESTUDO EXPERIMENTAL

ABSTRACT Objective: to assess the impact of high-fidelity clinical simulation on undergraduate teaching, specifically in the Pediatric Nursing area. Method: a quasi-experimental study of the pre- and post-test type, developed at three public Higher Educations Institutions (HEIs) in Brazil. The participants were 93 undergraduate Nursing students, enrolled in the Pediatric Nursing academic disciplines, and randomly allocated to the control or experimental groups. The data were collected in the first half of 2017, through a structured knowledge test and the Satisfaction with Simulated Clinical Experiences Scale. The experimental group received the usual intervention (participation in the theoretical and theoretical-practical activities offered in the disciplines) and the study intervention (high-fidelity clinical simulation); the control group only received the usual intervention. The data were analyzed by means of descriptive and analytical statistics. An explanatory model was prepared by means of multiple linear regression to assess the impact of simulation on teaching. Results: the mean difference between the knowledge pre- and post-tests was 4.04 points (p=0.0004) higher among the experimental group participants, indicating a greater increase in knowledge with the simulation. The participants from University A, who performed the simulation after the theoretical activities and before the theoretical-practical activities, obtained a higher mean difference between the knowledge pre- and post-tests (by 3.89 points, p=0.0075) than that of obtained by the participants from the other institutions. In relation to the satisfaction scale, high scores were achieved (mean=9.11±0.67). Conclusion: high-fidelity clinical simulation in Pediatrics contributed to increasing the Nursing students’ knowledge and satisfaction levels.

Effectiveness of an Educational Intervention With High-Fidelity Clinical Simulation to Improve Attitudes Toward Teamwork Among Health Professionals.

Failures in teamwork are a common reason for adverse medical events. The goals of this study are to evaluate attitudes toward teamwork among an interprofessional group of health professionals and to analyze the effectiveness of an educational intervention with high-fidelity clinical simulation to improve these attitudes. An educational intervention was developed that used a 6-hour session that included three simulated clinical cases. The Attitudes Toward Health Care Teams Scale was used for assessment. Mean difference before and after the intervention was calculated with the Wilcoxon test. Positive attitude toward teamwork after completion of the training activities was measured. The health care professionals who showed the most positive attitude toward teamwork were physicians (93.92, SD = 6.58) and resident physicians (95.01, SD = 6.33). The greatest increase was observed among orderlies (p < .001) and nursing assistants (p < .001). The use of clinical simulation for interprofessional training of health care professionals showed a positive effect on attitudes toward teamwork. [J Contin Educ Nurs. 2021;52(10):457-467.].

Effectiveness of Clinical Simulation and Peer-Assisted Learning to Teaching About the Sexuality of People With Spinal Cord Injury.

BACKGROUND: The sexuality of people with spinal cord injury (SCI) is a subject often neglected by healthcare professionals because of their lack of knowledge or understanding of how to proceed in this context. Different teaching strategies can be used to fill this knowledge gap, such as clinical simulation and peer-assisted learning. This study evaluates the effects of an educational intervention on nursing students' knowledge acquisition about the sexuality of individuals with SCI and on the students' self-confidence and satisfaction with the experience. METHODS: Quasi-experimental, pretest-posttest design was conducted with nursing students (N = 54). The intervention was the application by a senior-level nursing student of 2 scenarios of high-fidelity clinical simulation. The primary outcome was the knowledge about the sexuality of people with SCI. The secondary outcome was the satisfaction and self-confidence in learning. We performed descriptive and inferential statistics and built multiple linear regression models. RESULTS: The effect of the intervention on knowledge acquisition ranged from the mean of 1.26 in the pretest to 3.10 in the posttest. The means in the scores of satisfaction and self-confidence were considered excellent and correlated with knowledge acquisition. Previous attendance of a class on SCI positively interfered in the scale of knowledge acquisition. CONCLUSION: We verified an effect size ranging from medium to large magnitude for knowledge acquisition, and great satisfaction and self-confidence in learning through the use of simulated experience and peer-assisted learning.

Using Eye Tracking for Measuring Cognitive Workload During Clinical Simulations: Literature Review and Synthesis.

High-fidelity clinical simulations can be used by clinicians to acquire technical (physical ability and knowledge) and non-technical (cognitive and social processes) skills. Excessive cognitive workload contributes to medical errors because of the impact on both technical and non-technical skills. Many studies measure cognitive workload with psychometric instruments that limit the assessment of cognitive workload to a single time period and may involve response bias. Using eye tracking to measure task-evoked pupillary responses allows the measurement of changes in pupil diameter related to the cognitive workload associated with a specific activity. Incorporating eye tracking with high-fidelity clinical simulations provides a reliable and continuous assessment of cognitive workload. The purpose of this literature review is to summarize the use of eye-tracking technology to measure cognitive workload of healthcare providers to generate evidence-based guidelines for measuring cognitive workload during high-fidelity clinical simulations. What this manuscript adds to the body of literature is a summary of best practices related to the different methods of measuring cognitive workload, benefits and limitations of using eye tracking, and high-fidelity clinical simulation design considerations for successful integration of eye tracking.

Mixed-method study on the satisfaction of a high-fidelity simulation program in a sample of nursing-degree students

BackgroundTraining emotionally complex communication skills with standardized patients brings realism to simulation scenarios, and moreover, is associated with high levels of satisfaction among the students. Objectives(1) To measure the satisfaction of nursing students and factors related to their satisfaction and (2) to explore the effects perceived by nursing students after having a high-fidelity simulation training program using standardized patients. Design and participantsMixed design. Pre-post quasi-experimental phase in which the Satisfaction Scale Questionnaire with High-Fidelity Clinical Simulation was administered in 156 students; a second, semi-structured interview qualitative phase was completed by 11 students. ResultsNursing students showed high satisfaction scores. The scores for utility and communication were correlated with the students' attitudes towards communication. In the second phase, two main themes and four sub-themes emerged. ConclusionsTeachers could implement high-fidelity simulation programs with standardized patients for training emotionally complex communication skills to nursing students. These programs allow students to participate in their own learning processes and help them to feel motivated and satisfied about the usefulness of their learning experiences.

Efeito da simulação de alta fidelidade na ansiedade do estudante de Enfermagem: ensaio clínico randomizado

Este artigo objetivou comparar o efeito da simulação clínica de alta fidelidade com o ensino tradicional em laboratório de habilidades e com a primeira experiência clínica em instituições de saúde na ansiedade do graduando em enfermagem. Empregou-se o de ensaio clínico randomizado realizado com estudantes de graduação em enfermagem, entre 2015 e 2016. Os participantes foram aleatorizados em grupo controle - aula teórica e prática em laboratório de habilidades, e grupo experimental - aula teórica, prática em laboratório de habilidades e simulação de alta fidelidade. A ansiedade foi avaliada, antes e após as práticas em laboratório e a primeira experiência clínica. Como resultados foram incluídos 54 participantes (25 – controle; 27 – experimental). Durante a simulação o grupo experimental apresentou ansiedade elevada. Antes da primeira experiência clínica os grupos não diferiram, contudo, após, o grupo controle apresentou aumento significativo da ansiedade (p=0,0372), enquanto o grupo experimental apresentou redução significativa (p=0,0247). Conclui-se que a simulação eleva a ansiedade, mas parece contribuir para diminuição da ansiedade frente a primeira experiência clínica em instituições de saúde. REBEC:RBR-352v3G.

Psychometric properties of the Spanish version of a questionnaire to evaluate clinical simulation in Health Sciences degrees

ObjectiveTo determine the psychometric properties of the Spanish version of the Jeffries questionnaire to assess perception, satisfaction and learning results in Clinical Simulation (QJSC) for students of Health Science degrees. MethodFor the transcultural adaptation to the Spanish language of the QJSC questionnaire, the inverse method was applied with a back translation. Internal consistency analysis was performed to assess reliability, analysed with Cronbach's alpha, a value between 0.90 and 0.95 was considered acceptable. To establish the content validity, a factor analysis was performed, only items with factor saturations greater than 0.60 were considered for interpretation. Statistical analyses were performed with the SPSS 19 programme. The administration of the questionnaire was carried out in 10–12 clinical simulation training sessions according to the subject programme with 10–12 students per session, for high-fidelity clinical simulation between 2017 and 2018, in a sample of 443 undergraduate students of the Health Sciences degrees corresponding to Nursing, Nutrition and Dietetics, Medical Technology and Kinesiology in the Clinical Simulation Centres (CSC) of the Coquimbo region, La Serena, Chile ResultsThe internal consistency level for QJSC was Cronbach's Alpha = 0.963. The data fulfilled the Kaiser–Meyer–Olkin criteria for adequate sample MSA (measure of sampling adequacy) of 0.981 with an acceptable minimum of 0.500. The data also met the requirements of the Bartlett sphericity test (χ2 = 53971, df = 561, p < .0001). The questionnaire showed a factorial structure of two factors which were named Active-Participatory Learning and Perception of Autonomy in learning. ConclusionsIt was concluded that the evidence on the validity and reliability of the scores for the Spanish version of the QJSC indicates that it is an adequate tool to evaluate the perception, satisfaction and learning outcomes of students in this teaching and learning methodology.

Developing culturally responsive practice using mixed reality (XR) simulation in Paramedicine Education

The department of Paramedicine at Auckland University of Technology is committed to establishing informed evidence and strategies representative of all ethnicities. The MESH360 team propose that immersive mixed reality (XR) can be employed within the learning environment to introduce critical elements of patient care through authentic environmental and socio-cultural influences without putting either students, educators, practitioners or patients at risk.&#x0D; Clinical simulation is a technique that replicates real-world scenarios in a controlled and non-threatening environment. However, despite the legal and moral obligations that paramedics have to provide culturally competent care, a lack of evidence and guidelines exist regarding how to adequately integrate simulation methods for cultural competence training into paramedicine education. In our curriculum, clinical simulation has been used mainly to teach the biomedical aspects of care with less focus on the psychological, cultural, and environmental contexts. A potential, therefore, exists for high-fidelity clinical simulation and XR as an effective teaching strategy for cultural competence training by providing learners with the opportunity to engage and provide care for patients from different cultural backgrounds, ethnic heritages, gender roles, and religious beliefs (Roberts et al., 2014). This is crucial preparation for the realities of professional practice where they are required to care for patients that represent the entirety of their community.&#x0D; This presentation explores the MESH360 project and the development of a theoretical framework to inform the design of critical thinking in enhanced culturally diverse simulation clinical scenarios (ResearchGate, n.d.). The project aims to develop a transferable methodology to triangulate participant subjective feedback upon learning in high stress environments within a wide range of cultural-responsive environments. The implications for practice and/or policy are the redefinition of the role of simulation in clinical health care education to support deeper critical learning and paramedic competency within cross-cultural environments within XR.&#x0D; The aim of the research is to develop simulation based real-world scenarios to teach cultural competence in the New Zealand paramedicine curriculum. Using a Design-Based Research framework in healthcare education the project explores the impact of culturally-responsive XR enhanced simulation for paramedicine students through the triangulation of participant subjective feedback, observation, and participant biometric data (heart rate) (Cochrane et al., 2017). Data analysis will be structured around the identification and description of the overarching elements constituting the cultural activity system in the study, in the context of XR in paramedicine education (Engeström, 1987).&#x0D; Our research objective focuses upon using XR to enable new pedagogies that redefine the role of the teacher, the learner, and of the learning context to:&#x0D; &#x0D; Develop clinically appropriate and contextually relevant simulation-based XR scenarios that teach students how to respect differences and beliefs in diverse populations whose world view may be different from ones’ own.&#x0D; &#x0D; &#x0D; Inform culturally-responsive teaching and learning in paramedicine education research and practice.&#x0D; &#x0D; &#x0D; Implementation of pedagogical strategies in paramedicine critical care simulation to enhance culturally-responsive understandings and practice.&#x0D;

Debriefing and Learning Strategies: A Comparison between Two Reflective Analysis Styles with/without a Graphical Record of Strengths/Weaknesses.

Background: Clinical simulation efficiently complements the training of Nursing Degree students. The debriefing phase is the most important feature of simulation-based learning, where the students are able to acquire the necessary competences. It is at this stage where learning strategies and motivation play a crucial role. The objective of the study was to analyze the relationship between the style of debriefing utilized in the simulation sessions, and the learning strategies of Nursing Degree students who participated in a high-fidelity clinical simulation. Method: This was a quasi-experimental study conducted with a sample of 200 students in their third and fourth years at university. To obtain the data, an evaluation Questionnaire for the Evaluation of Learning Strategies of University Students (CEVEAPEU) was utilized, as well as two different types of structured debriefing styles, namely, with or without a graphical representation of the strengths/weaknesses during the analytical phase. The data analysis was performed with the SPSS® v25 program. Results: Statistically significant differences were found, with higher scores obtained when utilizing debriefing with a graphical representation, on both scales of the questionnaire (affective and cognitive), on the motivational, metacognitive and processing, and use of information subscales, and twelve learning strategies mostly belonging to the subscales of motivation; searching, collecting, and selecting information; and processing and using information. Conclusion: Debriefing with a graphical representation is deemed, a priori, as the most adequate approach for our context, based on the greater number of learning strategies utilized by our students. The use of a written graphical record of the strengths and weaknesses in the analytical phase is recommended.