Gersten Jonker

68   Chapter 4 the frontier of the ZPD, poor participant performance is likely, leading to a negative simulated patient outcome. How such a negative outcome affects the participant’s emotional state, learning, and motivation is not completely understood. Simulation can induce physiologically measurable levels of stress [11, 12]. Stress can alsomanifest at a mental level, imposing cognitive load and reducing a student’s mental resources for learning [13]. The distress that arises from failing tomanage a deteriorating patient likely adds to a student’s cognitive load [13]. It is safe to state that working with simulated critically ill patients is stressful [12, 14–16]. Management of critically ill simulated patients occurs at the ZPD’s frontier for most medical students and, to the greatest extent, for untrained students, such as those participating in a pretest. A pretest is an assessment of a student’s level of knowledge, skill, or competence before instruction and learning. Simulation pretesting can be a powerful tool to clarify the learning objectives of a course. A student can experience such a formative assessment as valuable and motivating [17–19]. However, pretesting that is too challenging and stressful and that results in poor performance could cause destructive friction and may demoralize the student. How to strike the right balance in simulation pretesting at the ZPD’s frontier is unknown. We undertook a study to answer the following question: How do untrained medical students experience the simulation of overly challenging cases? The aim of the study was to increase understanding of the psychosocial and educational impact of simulation at the edge of the ZPD. The goal was not only to gain knowledge about Vygotsky’s ZPD in the context of simulation but also to provide insight in the use and effect of highly challenging pretests. METHOD We designed a qualitative phenomenological study to explore students’lived experience of simulations at the ZPD’s edge. Phenomenology is a methodological approach within the interpretivist research paradigm that considers social reality to be formed by subjective human experiences and social contexts [20, 21]. It aims to understand the social reality of a phenomenon by collecting firsthand accounts of the phenomenon and describing the common meaning of those experiences [21–23]. Phenomenology holds that the presented reality of a phenomenon is constructed from the subjects’ conscious thoughts, feelings, and ideas about their experiences [22].