Simulation-based Learning Environment Research Articles

The relation between learners’ experience in simulations and diagnostic accuracy: Generalizability across medical and teacher education

Simulation-based learning is being increasingly implemented across different domains of higher education to facilitate essential skills and competences (e.g. diagnostic skills, problem-solving, etc.). However, the lack of research that assesses and compares simulations used in different contexts (e.g., from design perspective) makes it challenging to effectively transfer good practices or establish guidelines for effective simulations across different domains. This study suggests some initial steps to address this issue by investigating the relations between learners' experience in simulation-based learning environments and learners' diagnostic accuracy across several different domains and types of simulations, with the goal of facilitating cross-domain research and generalizability. The findings demonstrate that used learners' experience ratings are correlated with objective performance measures, and can be used for meaningful comparisons across different domains. Measures of perceived extraneous cognitive load were found to be specific to the simulation and situation, while perceived involvement and authenticity were not. Further, the negative correlation between perceived extraneous cognitive load and perceived authenticity was more pronounced in interaction-based simulations. These results provide supporting evidence for theoretical models that highlight the connection between learners' experience in simulated learning environments and their performance. Overall, this research contributes to the understanding of the relationship between learners’ experience in simulation-based learning environments and their diagnostic accuracy, paving the way for the dissemination of best practices across different domains within higher education.

What makes a simulation-based learning environment for preservice teachers authentic? The role of individual learning characteristics and context-related features

AbstractTo support professional competence development in teacher education, learning environments should allow learners to engage with professional tasks. It is crucial for knowledge and skill transfer in such learning environments to real-life context that preservice teachers perceive the task as authentic. However, due to a lack of prior knowledge, novices may have difficulties in recognizing relevant elements of practice. It is thus assumed that different factors may guide their perception of task authenticity independently of the task that has to be mastered. Such factors could be, for example, overt design features of the learning environments on a physical level or the familiarity with the learning context and learning prerequisites, which act as important links for knowledge acquisition. In this study, preservice teachers’ perception of task authenticity is contrasted between two implementation types (video vs. role-play) of the same simulation aiming to foster diagnostic competence. The two types differ in approximating real-life practice concerning the professional task that has to be mastered. In an experimental, longitudinal study, N = 119 mathematics preservice teachers participated online in one type of the simulation four times during one semester (n = 66 video, n = 53 role-play). Perceived task authenticity was higher for the video simulation type and increased with repeated participation in the simulation independently of the implementation type. Further, preservice teachers’ task utility value positively influenced their perception of task authenticity. The results illustrate the role of learning prerequisites as well as familiarity with the task for novices’ perception. Also, they could be an initial indication that, depending on the level of learners’ professional development, the way of approximating real-life practice in simulations might influence the perception of task authenticity.

The Pathway to Developing a Competency-based Tool for Entry-level Nursing Simulation: A Delphi Study

BackgroundSimulation-based learning experiences allow undergraduate nursing students to develop competence and confidence through deliberate practice with immediate feedback on the learner's performance through debriefing. With the transition to competency-based nursing education, nursing faculty need more guidance in implementing competency-based evaluations in the simulation setting. PurposeThis Delphi study aims to inform the future development of a competency-based tool – SimComp – based on the American Association of Colleges of Nursing (AACN) Essentials. MethodsA Delphi framework was used to recruit expert nursing faculty to complete the surveys via an online platform. Data analysis occurred through open-ended questions and quantitative methods to ensure that the responses from expert panelists were used to form the results. ResultsAfter four rounds of this Delphi study, a consensus was achieved on 111 appropriate items for assessing competence in the simulation-based learning environment. ConclusionWhile further research is warranted, this study provides insight for nursing institutions considering implementing or increasing the use of simulation within their program for competency-based evaluations.

Intrinsic Factors and Psychological Safety Among Nursing Students During Simulation-Based Learning-A Correlational Design.

Well-designed simulation-based learning (SBL) experiences enhance students' self-confidence, self-efficacy, clinical judgment, and psychomotor skill development. An emerging concept in SBL research is psychological safety. There is currently no research on factors influencing psychological safety specifically related to the SBL environment, nor is there any literature found to determine whether intrinsic student characteristic, such as self-compassion and resilience, contributes to SBL learning outcomes. The aim of this study is to determine whether there is a relationship between nursing students' intrinsic characteristics (self-compassion, resilience, and anxiety sensitivity) and their psychological safety. Bivariate correlation was used to examine associations among sociodemographic variables and outcome variables. Multiple regression was used to determine the predictive nature of the sociodemographic variables. Assumptions for variables in multiple regression models were tested (normal distribution, heteroscedasticity, multicollinearity). All data were analyzed in SPSS, Version 28. The P value of significance was set at 0.05 for all analyses. Most of the 118 participants were non-Hispanic (89%), White (65%), and females (95%). Results of the demographic bivariate analysis revealed no significant differences among this diverse group or semester in the curriculum for psychological safety. The multiple regression found self-compassion (β = 29, P = 0.004), anxiety sensitivity (β = -0.16, P = 0.049), and resilience (β = 0.26, P = 0.004) predict psychological safety. The importance of creating a psychologically safe learning environment has been recognized as essential to best practices. Our findings suggest that an understanding of student characteristics that impact their perception of psychological safety will allow educators to develop strategies to better support learners in the simulation environment.

Simulation in engineering education: The transition from physical experimentation to digital immersive simulated environments

Besides its use as a powerful systems analysis tool, simulation has also been used for decades in educational settings as a teaching and learning method. Simulation can replace or augment real-world inquiry-based experiences by providing learners with a low-cost and risk-free experimentation platform to develop knowledge and skills in a simulated environment. This paper presents an overview of current applications and the ongoing transition from physical experimentation to digital simulations and immersive simulated learning environments in engineering education. The paper highlights major implementation and research gaps related to simulation-based learning and immersive simulated learning environments, namely, lack of integration with learning theories and limited formal assessments of effectiveness. Potential implementation approaches and important areas for future educational research are discussed and exemplified in response to the identified gaps. The discussions presented are intended for simulationists, educational researchers, and instructors who are interested in designing and/or utilizing engineering education interventions involving simulated learning environments and immersive technologies in their teaching and educational research. In particular, the Immersive Simulation-Based Learning (ISBL) approach discussed in the paper provides a framework for simulationists to reuse the models developed as part of their simulation projects for educational purposes.

COMPARISON OF THE EFFECTS OF THE IN SITU SIMULATION AND SIMULATED CLINICAL IMMERSION METHODS ON CANCER NURSING STUDENTS’ EXTRAVASATION MANAGEMENT: RANDOMIZED CONTROLLED TRIAL

In situ simulation is thought to offer a good learning environment due to the fact that it is carried out in real clinical practice. This study was performed to compare the effect of in situ simulation and simulated clinical immersion environment on cancer nursing students extravasation management. The study was carried out with a randomized controlled pretest-posttest comparative design. The participants were randomly assigned to either the simulated clinical immersion group (n=19) or the in situ simulation group (n=24). The study data were collected using Extravasation Management Knowledge Test, Objective Structured Clinical Assessment, Students’ Satisfaction and Self-Confidence Scale and the State Anxiety Inventory. The pre-posttest mean scores for the knowledge level and anxiety mean scores of the participants in the simulated clinical immersion group and the in situ group were not statistically significant (p˃.05). The satisfaction and self-confidence scale mean scores and the skill levels of the students in both settings were similar after the implementation (p˃.05). The students' knowledge, skills, anxiety, self-confidence and satisfaction were similar in both simulation-based learning environments. In situ simulation can be recommended for use in nursing education. Considering cost-effectiveness and resources, both simulation methods can be used.

Where salience goes beyond authenticity

Abstract: This meta-analysis builds on and extends Chernikova, Heitzmann, Stadler, et al.’s (2020) meta-analysis on simulation-based learning in higher education by summarizing the findings of 214 empirical studies. The main focus of the current meta-analysis was to investigate the role of prior knowledge and design features, namely (1) the authenticity of simulated scenarios (as both functional correspondence with a real task and a physical resemblance of the environment) and (2) the salience of relevant information in moderating the effects of simulation-based learning on facilitating complex skills in higher education. The analysis identified that the salience of relevant information contributes significantly to explaining the variation in the effectiveness of simulation-based learning environments. We conclude that authenticity and salience can be assessed independently of each other, and both can be considered important design features in creating effective simulation-based learning environments to meet the needs of learners with different levels of prior knowledge.

519: ENHANCING NEUROCRITICAL CARE EDUCATION THROUGH MULTIDISCIPLINARY SIMULATION TRAINING

Introduction: Early recognition and response are paramount in treatment of neurologic emergencies. Due to its complexity, neurocritical care continues to provoke unease for practitioners and trainees. A simulation environment can provider a realistic opportunity for learners to detect and make rapid-fire decisions for an acutely deteriorating neurologic patient. A multidisciplinary simulation-based learning environment may improve education and trainee confidence when caring for the neurocritical care patient population. Methods: Three 45-minute simulation lab sessions were performed with a multidisciplinary team including medical students, neurology residents, critical care medicine fellows, advanced practice providers, and a critical care pharmacist. High fidelity manikins capable of reproducing acute neurologic and physiologic emergencies were used. Prior to the simulation, participants received Emergency Neurological Life Support resources. The simulation session lasted 45 minutes with an additional 10-minute debriefing with a neurointensivist and neurocritical care APP. After the simulation, participants were asked to complete a survey utilizing Likert scale responses, containing questions regarding pre- and post-simulation comfort levels managing specific acute neurologic emergencies. Results: Three simulation lab sessions were conducted and thirteen surveys were completed. Mean learner comfort levels in managing patients improved from pre- to post-simulation in patients with coma [3.25 vs 4.25 (p=0.007)], status epilepticus [3.25 vs 4.25 (p=0.007)], and procedures such as central lines [2.2 vs 3.8, p=0.003], intubations [2 vs 3.2, p=0.004], and bronchoscopies [2 vs 3.2, p=0.004]. Consistently, learners strongly agreed that faculty were knowledgeable, and sessions were well informed and thorough. Learners commented that the simulation experiences were realistic and allowed them to identify areas for improvement. Conclusions: Simulation training can be an effective method to improve education of neurocritical care team members by increasing clinician comfort in managing neurologic emergencies and procedures as well as providing opportunities for multidisciplinary collaboration. Further evaluation of the effectiveness of simulation education in this patient care setting is warranted.

Neural Correlates of Cognitive Load While Playing an Emergency Simulation Game: A Functional Near-Infrared Spectroscopy (fNIRS) Study

Functional near-infrared spectroscopy (fNIRS) provides reliable results for determining cognitive load based on averaged cortical blood flow during multiple repetitions of short cognitive tasks. At the same time, it remains unclear how to use this technique for assessing cognitive load during prolonged single-trial activity. In this study, we used a computer-based emergency simulation game for inducing different levels of cognitive load. We propose a novel approach to measure cognitive load using specific time slots, determined based on simulation log-data interpreted in light of Barrouillet's time-based resource-sharing model. To validate this approach, we compared cortical activity in dorsolateral prefrontal cortex (DLPFC) and left inferior frontal gyrus (IFG) regions measured at four specific time slots during a simulation. We found significant associations between cognitive load and neuronal activity within the DLPFC depending on the chosen time slot, whereas no such dependencies were found for the IFG. These results illustrate how knowledge of task structure could be used advantageously for the identification of cognitive load. Although requiring further investigation in terms of reliability and generalizability, the presented approach can be considered promising evidence that fNIRS might be suitable for more general reliable assessments of cognitive load during prolonged single-trial activities and for real-time adaptations in simulation-based learning environments.

How Does Simulation Contribute to Prospective Mathematics Teachers’ Learning Experiences and Results?

In this research, the aim was to evaluate a simulation-based learning environment in the context of conditional probability. The study group consisted of 44 prospective mathematics teachers of the Probability and Statistics Teaching course. The data were collected through three probability problems, a survey form for the simulation-based learning environment, and observations. The research was conducted within the scope of the Probability and Statistics Teaching course. In the lessons, conducted in a simulation-based learning environment with distance education, the prospective teachers were asked to solve the questions asked and send the solutions using smartphones. The different ways of thinking that emerged are put forward by the researcher. Then, simulations developed by the researcher were used for the problems, and the prospective teachers were asked to make observations and take notes on important issues. In the last stage, there was a class discussion about the related problems. After the simulation-based learning activities, the prospective teachers were asked to evaluate the learning environment. The data obtained were evaluated qualitatively, and the prospective teachers’ ways of thinking about problems, changing thoughts with the use of simulations, and their views on the learning environment are presented as direct quotations. The research findings revealed that the designed learning environment offers unique opportunities for prospective teachers to think about situations with mathematics content and to experience different methods of teaching and learning mathematics. The learning environment provided prospective teachers with the opportunity to understand and evaluate the contribution of simulations to problem-solving and the opportunities they provide for discussion, reflection, and collaboration in a meaningful context. It was concluded that simulations could become a powerful tool and an effective learning environment for learners.

Pedagogical Practices for Organizing Simulation-Based Healthcare Education

Despite the positive findings on the results of simulation-based health-care education, what truly makes it successful remains unclear. We do not know enough about when and how the simulation-based learning environment (SBLE) should be applied. Thus, the specific aim of this thematic-review study was to determine what the facilitators’ peda-gogical activities are in the simulation-based education process. For this purpose, the study reviewed 83 previous studies in which the ped-agogical practices were explained or examined. Based on the literature review, the pedagogical practices have been clearly linked to facilita-tors’ activities before, during, or after simulation. Most of the research has focused on facilitators’ activities during simulation-based educa-tion, especially during the debriefing phase. Some studies have exam-ined pre-simulation activities, but the research concentrating on facili-tators’ post-simulation activities is limited. All in all, this thematic lit-erature review provided insights on the successful pedagogical prac-tices for implementing the simulation-based health-care education process. To further develop simulation-based health-care education and to optimize the use of such a learning environment, scholars should describe facilitators’ and learners’ activities more accurately; and they should use more rigorous research methods to analyze the teaching and the learning activities. Furthermore, such knowledge should be synthesized and used to develop pedagogical models and methods for simulation-based healthcare education and to integrate them into various learning contexts.

Cognitive and Motivational Person Characteristics as Predictors of Diagnostic Performance: Combined Effects on Pre-Service Teachers\u2019 Diagnostic Task Selection and Accuracy

The acquisition of diagnostic competences is an essential goal of teacher education. Thus, evidence on how learning environments facilitate pre-service teachers’ acquisition of corresponding competences is important. In teacher education, approximations of practice (such as simulations) are discussed as being learning environments that can support learners in activating acquired knowledge in authentic situations. Simulated diagnostic interviews are recommended to foster teachers’ diagnostic competences.The conceptualization of diagnostic competences highlights the importance of cognitive and motivational characteristics. Motivational learning theories predict that the activation of acquired knowledge in learning situations may be influenced by motivational characteristics such as individual interest. Although teachers’ diagnostic competences constitute an increasing research focus, how cognitive and motivational characteristics interact when shaping the diagnostic process and accuracy in authentic learning situations remains an open question.To address this question, we report on data from 126 simulated diagnostic one-on-one interviews conducted by 63 pre-service secondary school mathematics teachers (students simulated by research assistants), studying the combined effects of interest and professional knowledge on the diagnostic process and accuracy. In addition to the main effect of content knowledge, interaction effects indicate that participants’ interest plays the role of a “door-opener” for the activation of knowledge during simulation-based learning. Thus, the results highlight the importance of both, cognitive and motivational characteristics. This implies that simulation-based learning environments should be designed to arouse participants’ interest to support their learning or to support less interested learners in activating relevant knowledge.

Effect of the Fundamentals of Laparoscopic Surgery Curriculum on Skills of Operating Room Technology Students: An Interventional Study

Background: In a laparoscopic surgery team, a surgical technologist as a skillful assistant surgeon is responsible for camera navigation and peg transfer. Objectives: We assessed the effect of the fundamentals of laparoscopic surgery curriculum on improving the skills of surgical technology students in camera navigation, pattern cutting, and peg transfer. Methods: A study was conducted on 30 surgical technology students at the Iran University of Medical Sciences based on Kern's six-step model. After assessing the needs and defining the educational goals, the course content was determined. Afterward, students were trained in a simulation-based learning environment. Then, in the evaluation stage, using the standard task completion time (TCT) tool, their competence in performing the three skills was evaluated. The results of the first comprehensive attempt to perform each skill were recorded as the pretest, and the results of the sixth and 10th repetitions were recorded as the posttest. Data were analyzed using analysis of variance with duplicate data. Results: The TCT score improved in this study. The time of camera navigation decreased from 92.14 to 56.42 s, pattern cutting from 186.07 to 118.21 s, and peg transfer from 93.03 to 54.10 s. Conclusions: This study showed that the fundamentals of laparoscopic surgery curriculum improved the surgical technologists’ competence in performing triple skills essential for performing laparoscopic surgeries. Thus, this learning method could play an essential role in laparoscopic surgery.

A Design Methodology for a Computer-Supported Collaborative Skills Lab in Technical Translation Teaching

Aim/Purpose: The aim of this study is to adopt more systematically the collaborative learning dimension in the technical translation teaching at Master Degree level. In order to do so, a computer-supported skills lab approach is targeted. This approach is aimed at enhancing traditional courses on Computer-Assisted Translation (CAT) so that student competences and soft skills are enhanced. Background: In traditional CAT courses, laboratory sessions complement theoretical lessons, thus providing students mainly with tool-oriented operational knowledge, while nowadays more intertwined competences are required by the labor market. Moreover, this sector lacks skills labs which engage students in collaborative activities mimicking professional workflows, thus not exploiting team-based learning potential effectiveness. Methodology: In this paper, therefore, a design methodology to deploy and operate an enhanced skills lab as a remote Computer-Supported Collaborative Simulated Translation Bureau (CS2TB) is proposed and validated. The proposed methodology is based on a set of intertwined methodological frameworks that address: 1) student competences and educational requirements, 2) collaborative aspects, 3) regulatory policies as well as functional and interactional guidelines for the simulated fieldwork. The overall effectiveness of the proposed methodology has been assessed by using pre-post questionnaires to ascertain student feedback. The improvement in technology skills has been evaluated by collecting and examining student help requests as well as system error logs. Contribution: The CS2TB provides a technology-enhanced simulation-based learning environment whose aim is twofold: first, enriching traditional approaches with a Computer-Supported Collaborative Learning (CSCL) experience and, second, incorporating widely adopted approaches for the translation-teaching domain as the required grounding knowledge. Findings: Results demonstrate the effectiveness of CS2TB in improving students’ competences (specifically in the IT area but also in the technical translation area), students’ willingness to operate in a fieldwork-like context and cooperative learning efficacy. Recommendations for Practitioners: The educational implications of the proposed approach concern the development of a full range of competences and soft skills for students in the technical translation teaching at the higher education level, ranging from language and translation proficiency to the usage of IT platforms as well as personal and interpersonal interactional soft skills. Recommendation for Researchers: This study offers a wide overview of all the aspects entailed by the design, implementation, management, and evaluation of a skills lab for technical translation teaching. Researchers may benefit from the rigorous modelling approach as well as from the adopted assessment techniques. Moreover, the study stresses the pivotal role of a tight collaboration between language/translation teaching and computer engineering. Impact on Society: Higher education institutions that already have courses on computer-assisted translation may benefit from the proposed CS2TB approach, which allows them to design new thematic activities leveraging team-based learning, collaborative learning, and fieldwork-situated simulation. Moreover, the presented broad range of assessment approaches can be used to measure the impact of CS2TB on learning outcomes of the involved students. Future Research: Future research activities will be dedicated to examining the impact of a different set of enabling IT platforms on the collaborative learning perspective, to evaluate alternative scaffolding approaches (e.g., chatbots or augmented reality), and to increase simulation fidelity further, so that even more student competences can be fostered.

Promoting car mechatronics apprentices' diagnostic strategy with modeling examples: Development and evaluation of a simulation-based learning environment

Crucial for training automotive mechatronics technicians (AMTs) is enabling them to diagnose car malfunctions. AMTs are particularly successful when they base their diagnostic process on a mental model of the affected automotive system. Still, only few AMT apprentices master such diagnoses after their apprenticeship. Therefore, we created a simulation-based learning environment with modeling examples to teach AMT apprentices a diagnostic strategy that builds on mental models. Following design-based research guidelines, we formatively evaluated our learning and testing materials by expert judgments and a small study during the development of the learning environment. Finally, an evaluation study showed that the learning environment promoted apprentices' knowledge about the diagnostic strategy. However, they could not transfer their knowledge to diagnostic problem-solving. Overall, the apprentices evaluated the learning environment positively, except it was considered too long and repetitive. Reasons for the outcomes as well as possible further developments of the learning environment are discussed.

Hierarchical and smoothed topographic path planning for large-scale virtual simulation environments

Virtual simulation systems ought to make the most of agents’ realistic behaviors so that users feel immersed in virtual scenarios that mimic the real-world environment. Usually used for training and instruction purposes, agent-based simulations have additional requirements to be considered by the Artificial Intelligence solutions often explored in the development of computer games. To provide a valuable impression of how the simulated agents navigate in the real-world terrain, one of the key requirements indicates that topographic terrain characteristics need to be considered in the path planning tasks. It means that important aspects of the agents’ navigation capabilities have to be properly handled by the used pathfinding algorithms. This problem is even more challenging when large-scale terrain scenarios are considered in state-of-the-art simulation systems as the path planning may be too time-consuming when handling terrain representations with large search spaces. To approach the challenge of computing safe and realistic path solutions for agents inserted in simulation-based learning environments, this work discusses a hierarchical pathfinding algorithm named HPATheta*, showing how to compute terrain relief-aware smoothed paths in reasonable computing time when dealing with path planning in large-scale real-world virtual terrains. Using different simulated real-world virtual terrains, the proposal is validated by performing an extensive experimental campaign with the use of large-scale virtual terrain representations. The experimental results indicate that the proposed approach is able to efficiently address the targeted problem, showing better results compared to other similar path planning algorithms.

132 Faculty Procedural Skills in Academic Emergency Medicine: A Multisite Survey

Emergency physicians must be competent to perform numerous procedures. It is unclear if clinical practice alone is sufficient to maintain procedural skills, particularly for academic faculty who supervise trainees. Formal assessment of procedural skills beyond training is uncommon. There is a paucity of literature on faculty skills attrition or their preferences for skills maintenance. The faculty procedural skills (FPS) survey sought to determine faculty attitudes, beliefs and experience with procedures to inform programming aimed at skills maintenance. This was a multisite, cross-sectional study of emergency medicine (EM) and pediatric EM (PEM) physician faculty at five large US academic EM departments. Subjects were board certified or board eligible in EM or PEM and provided both clinical care and supervision of trainees. Subjects completed the FPS survey online which consisted of three sections: (1) respondent characteristics and experience performing and supervising EM procedures; (2) degree of confidence performing critical procedures; and (3) attitudes about skills attrition and learning preferences. Internal consistency of each survey section was calculated using Cronbach’s alpha. Items related to beliefs and attitudes were graded on a 5-point scale (strongly disagree to strongly agree), with higher values representing greater agreement. Response agreement (with 95% confidence interval [CI]) was calculated by combining “strongly disagree” with “disagree” and “strongly agree” with “agree” responses. A total of 186 faculty completed the survey (44% response rate). Scale reliability was good (Cronbach’s alpha performance = 0.82; supervision = 0.86; confidence = 0.85). All respondents agreed that ongoing procedural skills training is important for the clinical practice of EM. The majority of respondents agreed: that faculty should have opportunities to retrain for uncommon procedures (98%, 95% CI: ±2%); that skills attrition is a concerning problem (91%, 95% CI: ± 4.1%); that skills attrition is a patient safety issue (89%, 95% CI: ± 4.5%); that attrition was more likely in academic settings (93%, 95% CI: ± 3.7%); that faculty should be required to demonstrate procedural competence (83%, 95% CI: ± 5.4%). The majority of respondents (73%, 95% CI: ± 6.4%) personally experienced procedural skill attrition and a similar number (68%, 95% CI: ± 6.7%) observed it in peers. The most preferred method for skills maintenance was simulation (83%, 95% CI: ± 5.4%). The most preferred learning environment was in groups with peers (89%, 95% CI: ± 4.5%). A majority of faculty reported skills attrition, both personally and observed in peers. Respondents also overwhelmingly agreed they should be competent to perform procedures for which they are credentialed. These findings raise questions about the need for technical skill competency assessments for continued clinical practice. Faculty preferred simulation-based learning and peer environments for skills maintenance. Further study is needed to determine the attitudes, beliefs, and experiences of non-academic emergency physicians with procedural skills attrition.

Does a simulation-based learning programme assist with the development of speech-language pathology students' clinical skills in stuttering management?

Simulation-based learning can be used in university programmes to provide speech-language pathology students with essential clinical experiences. However, limited research has explored the use of simulation to support students' development of skills in clinical practice with people who stutter. (1) To evaluate students' clinical skills in managing stuttering within a simulation-based learning programme; (2) to develop an assessment tool, the Standardised Patient Interview Rating Scale for Stuttering (SPIRS-Stuttering); and (3) to conduct a preliminary investigation of its validity in measuring students' performance. Speech-language pathology students (n = 114) participated in a simulation-based stuttering programme in addition to academic coursework in fluency disorders. Students' clinical skills were assessed over two simulation sessions using the SPIRS-Stuttering tool, adapted from an earlier iteration of the SPIRS tool. Content validity, intra-rater reliability and internal consistency of the SPIRS-Stuttering tool were also explored. Students demonstrated a statistically significant improvement in stuttering clinical skills between sessions 1 and 4 of the simulation-based stuttering programme. Good content validity was achieved for the SPIRS-Stuttering tool with a low level of intra-rater reliability and variable internal consistency. This study identified that students' clinical skills in stuttering improved during participation in a simulation-based programme undertaken in conjunction with an academic course on fluency disorders. The results of this study support the inclusion of this learning modality in university programme curricula. Whilst the SPIRS-Stuttering tool enabled assessment of speech-language pathology students' clinical skills in stuttering management, further exploration of reliability is required. What is already known on this subject Within speech-language pathology, simulation-based learning is a teaching approach used in university clinical programme curricula. Simulation-based learning is used as an opportunity for students to gain specific clinical skills, particularly if clinical experiences are readily not available. Research in speech-language pathology has revealed that students value simulation because it provides a safe learning environment. What this study adds to existing knowledge There are fewer opportunities for students to gain clinical experience in the management of stuttering in adults. This study explored students' clinical skill development within a stuttering simulation-based learning programme. Additionally, it detailed the development and preliminary investigation of validity of the SPIRS-Stuttering, an assessment tool used in a simulation-based learning environment. What are the potential or actual clinical implications of this work? Students' clinical skills in the assessment and management of stuttering in adults, as measured by the SPIRS-Stuttering, improved during participation in the stuttering simulation-based learning programme. Further investigation of validity of the SPIRS-Stuttering tool is required to confidently measure students' performance. The stuttering simulation-based learning programme can be used to provide students with an opportunity to develop their clinical skills in stuttering, a practice area in speech-language pathology that is not always available to students.

Organizing for collaboration in simulation-based environments: An affordance perspective

Extant research has identified the significance of technological affordances in computer-supported learning environments. However, until recently, there is scarcely empirical research on affordances for organizing collaboration in these learning environments. To address this gap, this study empirically examines affordances for organizing collaboration in a simulation-based learning environment. We focus, in particular on understanding how the organizing affordances of the learning environment are perceived and employed by the learners during a simulation-based learning task. The study was executed among 177 undergraduate higher education (HE) business students from 10 universities in Belgium, China, Estonia, New Zealand, the USA, Austria, and Finland. The data were obtained from the students’ reflective essays, and analyzed with a qualitative content analytical approach. The results of our analyses yield in four types of organizing affordances: (1) organizing the division of work, (2) managing information and resources, (3) managing tasks, and (4) strategizing. Each type of organizing affordance was required in the joint learning task. The study offers an advanced understanding of affordances for organizing and of their use/nonuse in simulation-based learning environments. The findings of this study have theoretical and empirical implications and can contribute to both the development of pedagogic and educational practices as well as the design of learning tasks and environments.

Teaching the dynamics of the growth of a business venture through transparent simulations

Achieving rapid and sustainable growth is essential for business ventures to succeed. This being so, future entrepreneurs need to understand and manage the dynamics of business growth. Simulation-based learning environments (SBLEs) have been proposed as effective tools to help learners improve their understanding of complex business problems. However, previous research has found that learners tend to underestimate dynamic complexity. Transparent simulations allow entrepreneurship learners to explore the dynamic complexity of business ventures while accessing the model structure and growth behaviour. Previous studies have addressed some aspects of model transparency and produced inconclusive results regarding their impact on learning effectiveness. This study explores the learning and performance effects of using transparent simulations to teach the dynamics of the growth of a business venture. One such simulation experiment used a system dynamics model that represented the development of an energy service company (ESCO) venture under varying conditions of simulator transparency. Students who were subjected to the more transparent strategy achieved higher performance and demonstrated better comprehension of the business dynamics. However, our findings indicate that the effect to be gained from making only the simulator model more visible is more limited. The structural debriefing (focused on the critical variables and relations) was determinant in improving students’ learning regarding the stocks and flows structure in the prospects pipeline. Only after participating in the behavioural debriefing (focused on the relation between model structure, patterns of actions, and system behaviour), were the students able to appreciate the dynamics of the business feedback loops. The research suggests that educators who use complex business simulations should complement model transparency with structural and behavioural debriefings.