Gersten Jonker

Simulation at the frontier of the ZPD   97 4 I don’t stress out easily, but on the other hand I have certain expectations of myself. So it is stressful in some way if you cannot live up to those. (P7) I wouldn’t call it fear, but perhaps that’s the best way to describe it. . . . Somebody could die just because I intervene in the wrong way. (P6) Urgent situations in which the course of action was not evident triggered feelings in the students of incompetence and “lack of control” in which their initial confidence faded, the self-image of a doctor crumbled, and the limits of their competence were exposed. When I knewmore, or felt in control, I felt a little bit ahead in my medical training. When not [feeling in control], I went back to being a medical student. (P11) There were short moments when I knew what to do. Those felt like being a resident doctor. But as soon as I thought “help!” it was more like, “I’m a medical student. I don’t know!” (P8) Often, this feeling of uncertainty reverted to one of certainty if themanikin had a cardiac arrest. Students explained that the protocolled approach of basic life support provided “firm ground”; the students often experienced a paradoxical sense of relief or even of being in their “comfort zone” executing “standard procedures.” If the patient is deteriorating, it places you on firm ground. At least you can do something. (P3) When the patient had to be resuscitated, I thought: “Shit! . . .but let’s do it!” You kind of know how to make a start, which is comforting. . . . Comforting, because you know where you stand. (P11) Students’ perceptions of their own performance varied from“outright failure” to a “bare pass.” Most students had expected to perform poorly in this pretest and did not really mind as there were no consequences to “failing” the formative test. I’m just not ready [for such clinical situations]. 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) I’m rather perfectionist by nature, so it is annoying to fail. Regardless of what you do. On the other hand, it’s a relief, knowing you’re not expected to be perfect. (P11)