Context: Much ado about - what, exactly?

Abstract

Introduction

Simulation-based learning is an example of learning in context in which clinical contexts are recreated in controlled settings to facilitate deliberate practice. While widely regarded as effective, unanswered questions exist about what elements of the clinical context must be recreated in simulated settings to promote authenticity. Moreover, the degree of authenticity (or fidelity) required for optimal learning is not known, with current thinking often deemphasizing the importance of physical realism. We therefore sought to explore contextual influences on performance in a ‘context-rich’ clinical setting: paramedicine.

Methods

We followed constructivist grounded theory principles and recruited currently practicing paramedics to participate in one-on-one, semi-structured interviews. We asked the participants to describe a recent experience in which they attempted to resuscitate a victim of sudden cardiac arrest and asked them how to recreate their experiences in simulated settings.

Results

Fourteen paramedics provided a total of seventeen interviews, each describing a distinct cardiac arrest event, yielding over ten hours of audio data for analysis. We iteratively identified three major interrelated themes describing contextual influences: the event – its physical characteristics, circumstances and people present; the conceptual response – the cognitive processes and challenges encountered; and the emotional response – the degree of emotional engagement in the management of the resuscitation. We also identified a major theme related to how to simulate these events. Collectively, our results suggest a complex and dynamic interplay between the physical, conceptual and emotional domains of context.

Conclusion

In contrast to other conceptualizations of context and fidelity, our results suggest that conceptual and emotional responses occur as a result of physical features in the practice environment, arguing in favour of physical authenticity in simulation.