Gersten Jonker

Simulation at the frontier of the ZPD   77 4 From now on, when situations like these occur, I’ll perceive them differently. I’ll try to engage more with what’s happening at the time. (P11) It is very informative to know what’s expected of me once I qualify. . . . It [the level expected of a qualified junior doctor] is a sort of guideline, outlining the gaps in my knowledge. It demonstrates what I should study in greater depth or what I should pay attention to during my clerkships. (P9) Essence Students experienced difficulties in managing simulated acute care situations, leading to a significant amount of stress fueled by uncertainty about medical management, deterioration of critically ill simulated patients, and disappointment about their performance. Their stress manifested itself mainly mentally, impeding cognitive function. Students reported that awareness of the practice setting, anticipation of poor performance, debriefing, a safe learning environment, and the prospect of training opportunities regulated their emotional responses to stress. These stress-regulating factors turned stressful simulation into a motivating educational experience. DISCUSSION Our study explored the psychosocial and educational impact of simulation at the frontier of the ZPD in medical students after a residency-level pretest of acute care competence at the start of the students’ final year. Our main finding is that, in a formative pre-assessment setting, simulation at the far edge of the ZPD causes constructive friction leading to an experience that generates a motivation to learn. This finding contrasts with the current opinion that the difficulty of the simulation task should be tailored closely to the developmental level of the participant [10] to avoid destructive friction and demoralization. The ZPD spans the difference between an individual’s current level of capabilities and the level of functioning needed in the next stage of development [2]. The ZPD comprises maturing functions relevant for the next level of capability, activities that cannot be carried out independently but that can be taught or carried out with direction, generally from a teacher [2]. We exposed students to activities from their next stage of development, that of a junior physician, without providing teacher support or direction. The students’ inability to sufficiently manage the activities indicates that these activities were at the far edge of their ZPD. In addition, students perceived shifts between doctor