The impact on learning in healthcare simulation education using Transformative Agency through Double Stimulation (TADS)

Oral Presentation 5
Dr Andrew Spence, Prof Gerry Gormley, Dr Davina Carr

The impact on learning in healthcare simulation education using Transformative Agency through Double Stimulation (TADS)

Introduction
Simulation is being increasingly used in health profession education to develop clinical and behavioural skills. However, there is a tension between simulation being merely a _performative_ act against optimising the _transformation_ of students’ skills. Transformative Agency through Double Stimulation (TADS) [Sannino, 2015] is an approach shown to enhance skillsets in other walks of life, by repeating scenarios, such as in business. However, its’ use has rarely been explored within healthcare education.

Objectives
To investigate the effects of double simulation as a model of teaching in medical education informed by TADS, from an ethnographic perspective. Specifically, to establish the thoughts, feelings and attitudes of students undergoing repeat simulation

Methods
The TADS study was performed in InterSim Education Centre, Queen’s University Belfast, where, in groups of three, simulation naïve second year medical students undertook a scenario managing an acutely unwell patient. During debrief, students evaluated their performance and experiences, where they, aided by facilitators, collectively identified areas of improvement. Post-simulation the students underwent a second scenario followed by a further group debrief. Individual semi-structured interviews were then conducted. All debriefings and interviews were audio recorded and transcribed to facilitate thematic analysis, providing a rich ethnographic description of the TADs approach.

Outcomes
All participants greatly valued the experience, reporting significant benefit to their learning. During the first debriefing they described being “nervous but excited at the prospect of simulation training” before the first scenario. Reflecting, they identified areas to improve including “initial assessment of the unwell patient” and the “need for more organisation within the team”, as well as “improved communication and division of roles during the scenario”. Students’ performances improved during the second simulation, in tandem with being more relaxed and confident. The embodied experience of implementing their perceived improvements were positive takeaways. In individual interviews they commented that before the second simulation they “had less nerves which led to a calmer atmosphere”. They also functioned more efficiently by “reflecting on the first simulation, we understood increased organisation and communication would result in a better performance”. Participants valued the opportunity to undertake a second scenario, feeling it allowed them to immediately apply their knowledge gained during debriefing.

Conclusion
Our study showed the value of immediate repeated simulation to reinforce areas of improvement resulting in not only superior performance but also an enhanced experience. Our pedagogical model using TADS can be applied to other healthcare disciplines with use in interprofessional education.