Gersten Jonker

Simulation at the frontier of the ZPD   75 4 I felt like crawling into a corner. . . . I was like, “Oh dear, I am sending her all over the shop!” (P6) There were brief moments when I knew what to do. Those felt like being a resident doctor. But as soon as I thought “help!” I was more like, “I’m a medical student. I don’t know!” (P8) Often, the student’s uncertainty reverted to confidence when the patient had a cardiac arrest. Havingaprotocolledbasic life support algorithmtoexecuteprovided the students a paradoxical sense of relief during this specific clinical deterioration. (However, none of the students mastered the advanced life support algorithm satisfactorily.) If the patient arrests, it places you on firm ground. At least you can do something. (P3) Self-assessment of performance varied from “outright failure” to a “bare pass.” Most students expected not to perform well and did not mind because the pretest was formative. The students’ perceptions were in accordance with the test results: Most students scored low on all 3 scenarios. I can’t really say I felt angry or like a very big failure because I didn’t expect to perform much better than I did. (P6) Despite the expectation of failure and the formative nature of the pretest, all students regarded their performance level as “a shocking revelation” and “disappointing”. It was so bizarre that I didn’t notice the patient was basically bleeding out. It was so obvious! . . . It’s just a shocking revelation. Because at that moment, I realized I am far from knowing enough [to manage] such a situation. (P6) It was very intense. I was confronted with my incompetence, and the realness of the simulation, and the demanding nature of emergency situations. It truly was a mirror. (P3) Students were aware of faculty witnessing their performance through the one-way mirror but generally did not mind that staff were assessing their performance. During moments of uncertainty, students became slightly more aware of the one-way mirror: I am being watched. I must do something! (P3)