Gersten Jonker

Simulation at the frontier of the ZPD   79 4 importance of teaching students how to prevent cardiac arrest by recognizing and treating deteriorating patients, which we chose as an objective of our transitional year [26]. The students’emotional response to the stressful simulationwas regulated by awareness of the practice setting. Previous research has suggested that when participants expect a life-threatening event or negative outcome to occur, their level of stress is reduced during a simulation [38]. Students’ anticipation of poor performance was another stress modifier. The pretest worked as an eye-opener that explicated the level of performance that would be required for graduation. It motivated the students to exploit learning opportunities during the year: Pre-assessment can drive learning. The beneficial effect of a pretest on subsequent learning has recently been demonstrated in surgical skill acquisition [39]. The educational effect of the pretest is rooted in the close alignment between simulated cases and the learning objectives tested [10, 40–42], in this case the entrustable professional activities of a final year focused on acute care [26]. Because of the pretest, students started their final year with a clear view of the learning objectives [27]. Their choice for this specific final year elective program and their interest in acute care moderated their response to the pretest. Finally, the developmental atmosphere in the simulation center created a safe learning environment and helped make the test a motivating experience. In general, positive emotions can improve cognitive processing and increase motivation [43]. Previous research highlighted that learning and using stress-coping strategies in simulation training and assessment helped students turn negative emotions into positive ones [14–16]. In addition, feedback in the form of debriefing is crucial for the educational effectiveness of simulation [10, 40, 42] because it improves the transfer of learning after simulation [44]. Debriefing helps to restore tranquility, thereby reducing extraneous cognitive load and providing space for learning [43]. Venting emotions is a good starting point for a debriefing session to increase the students’ tranquility before they focus on medical and crew resource management aspects of their performance. In the simulations, students took on the role of doctor, but this self-image crumbled when they experienced feelings of incompetence. The resultant disappointment subverts students’ common belief that doctors should be in control even in complex situations, which influences emotional and behavioral responses to challenging clinical situations [37]. The response to complex situations could be a topic for the debriefing to help students be reflective about their expectations of being in control.