Gersten Jonker

Simulation at the frontier of the ZPD   67 4 INTRODUCTION Vygotsky's Zone of proximal development (ZPD) [1] is a widely cited concept in education. It refers to “the distance between the actual developmental level as determined by independent problem solving and the level of potential development under adequate guidance”[1]. The ZPD is the variable space between what a learner has mastered and what they are not yet able to do and is determined by what an individual can sufficiently perceive as doable when assisted [2]. The ZPD does not simply refer to the amount of support a learner needs when acquiring a new skill but also to the steps needed to transition to the next developmental stage of capability. While Vygotsky related the ZPD specifically to the age-related cognitive child development stages, the concept has been applied widely in all educational settings. In higher education the ZPD has been linked to the concepts of constructive and destructive friction between teaching and learning [3]. A student’s comfort zone is where he or she can perform tasks independently. When students are presented with teaching activities that invite them to leave this comfort zone – that is, when they can only complete an activity when they receive expert guidance – constructive friction is generated [4, 5]. Destructive friction occurs when the gap between the comfort zone and the task is so large that the student cannot complete the activity (even with support) or when the gap is too small (instruction is redundant and might even hamper completion of the activity) [3, 4]. Medical students who perform physicians’ tasks are completing activities in their ZPD if guidance is provided. Complex medical responsibilities may be too difficult for the student to take on, leading to destructive friction, and can be viewed as activities at the far edge, or frontier, of the ZPD. Acute care activities, e.g. resuscitation of critically ill patients, exemplify how inexperienced learners may have to confront the ZPD frontier in a very visible fashion in medical education. Medical students can be trained for such high-acuity events and assessed with simulated clinical immersion [6, 7]. Simulation training and assessment can be used at different stages of the medical educational continuum [7–9], but to be educationally effective, the difficulty of the simulation task should be tailored to the developmental level of the participants [10], pushing them beyond their current level of mastery, into the ZPD, to guide development in constructive friction. Simulation scenarios that are too demanding, i.e. at the far edge of the ZPD, cause destructive friction, and may be a waste of learning opportunities and resources. Moreover, at