Gersten Jonker

80   Chapter 4 Implications We found that simulations of challenging stressful acute care situations, without guidance during scenarios and despite poor participant performance and simulation patient outcome, do not demoralize participants but rather lead to positive, instructive, and motivating experiences, when conducted in safe, formative, developmental circumstances. Our findings imply that simulations at the far edge of the ZPD may be used safely to motivate learners. This finding contrasts with current opinion on simulation learning [10] and has practical significance by providing preliminary data on simulating beyond traditional borders. Limitations Our study had several limitations. We conducted an explorative study in the specific context of pretested students at the start of a final year focused on acute care. The study did not control for the extent to which the far edge of the students’ ZPD was reached, nor did it include control groups of participants with variable levels of competence or intrinsic motivation. Also, the study reached theoretical sufficiency, i.e. there was no need for additional constituent or core themes to categorize new data, with a relatively small number of interviews, which could be attributable to participants all being part of the same elective track. Lived experiences could have been more divergent in a random sample of students. Future studies could investigate the phenomenon in other groups, including students with less focus on acute care and graduating students. Another limitation is that we did not measure a longer-term learning effect. Participants stated that the simulation was a valuable learning experience, but we did not test for educational effectiveness. By providing a precise description of the context, we aimed to improve the transferability of our data and provide generalizable insights regarding the ZPD in the context of simulation. Better comprehension of the psychosocial and educational impact of exposing inexperienced learners to activities far outside of their comfort zones may support the responsible and effective use of simulation at the ZPD’s frontier, such as in pre-assessment. Further research could investigate the effects of teacher support and instructional design on students’ experiences of crossing the ZPD border in simulation [2, 6].