Gersten Jonker

74   Chapter 4 I don’t stress out easily, but on the other hand I do have certain expectations of myself. So it is stressful in a sense of not being able to live up to those expectations. (P7) The level of stress increased when the patient deteriorated: I was sweating more, had a real adrenaline rush. It made me double my efforts, but once the patient deteriorated, I started to feel a little claustrophobic in that room. (P2) The constant awareness of being in a simulated environment eased feelings of stress. The atmosphere at the simulation center helped to reduce tension: I was pleasantly surprised to find out that I stayed calm and was still able to think. . . . I knew it was a manikin, and a disastrous situation was going to be created. I did realize something is going to happen that won’t necessarily be my fault; I just need to solve it to my best ability. (P10) Students emphasized that although the experience was stressful, they still enjoyed the simulation. It felt gratifying to solve a puzzle, experience a unique learning opportunity, and realize they were able to handle complex medical situations to a certain degree: Besides knowingwhere I should be at the end of medical school, it gives me a sort of confidence, knowing I am capable of helping out in an emergency situation until the real team arrives. (P9) Sense of responsibility and failure The students’ perception of role was fluid during the scenarios. Most students initially felt like junior doctors, finding it exciting and novel to give directions to the nurse: I felt like a real doctor in the simulation. This was one of the few times I felt completely responsible for a patient. I realized this immediately. And it felt quite good. (P2) Often, this initial feeling of confidence faded upon encountering urgent situations in which the course of action was not evident. Students experienced a significant degree of incompetence, and their self-image changed from junior doctor to medical student. Also, they felt they were being unprofessional when giving unclear instructions or retracting orders: