Gersten Jonker

Simulation at the frontier of the ZPD   73 4 I was astounded, finding myself giving orders or instructions to a nurse and pressing the defibrillator button. I couldn’t stop thinking about this experience the rest of the day. (Participant [P]2) All students believed they could encounter similar situations as newly qualified doctors. They perceived the manikin almost as a person, eliciting in some a desire to “rescue the patient” and “comfort him.” Despite the high level of realism, all students were continuously aware of being in a simulation: I was kind of assuming the manikin was going to crash. So I was thinking about the diagnosis: What could it be? And what could then go wrong? (P11) Emotional response The main emotion students experienced during the simulation was universally described as stress. Many students also experienced a sense of responsibility and a feeling of failure. Stress The amount of stress varied from person to person. In most cases, feelings of stress were related to the uncertainty about diagnosis or treatment options. Although some noticed palpitations and sweating, most students were not aware of a physical stress response but did experience stress mentally. Students described feelings of being frozen in place or time: The pulse oximeter made a penetrating, beeping sound. It felt like time stood still. . . . If you don’t know what to do, then every second is painful and feels like a minute. (P3) Many felt overwhelmed, had difficulty structuring their thoughts, struggled to prioritize or forgot what they intended to do: When I saw on the monitor that it wasn’t going well, thoughts were racing through my mind. “It could be this, or this, or this.” (P6) But then I realized I’m reading the sheet with CPR instructions, but I’m not processing them. (P8) A significant contributor to stress was students’ perception of their performance: