Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Self-Reported Emotions in Simulation-Based Learning

Active Participants vs. Observers

Rogers, Timothy, MD; Andler, Carly, MD; O'Brien, Bridget, PhD; van Schaik, Sandrijn, MD, PhD

doi: 10.1097/SIH.0000000000000354
Empirical Investigations

Introduction Experiential learning through active participation is thought to be a key benefit of simulation-based education. Recent research has challenged this assumption, suggesting that active participants learn just as well as observers. Studies report that active participants experience stress and anxiety during simulation, which may hamper learning by active participants. We undertook the current study to examine whether active participation results in different emotional arousal than observing during simulation. We hypothesized that participants in active roles experience higher levels of negative emotions than those observing and looked for evidence that this may impact learning.

Methods Pediatric residents participate in simulations, rotating through active and observer roles, as part of their standard curriculum. We assessed both positive and negative emotional arousal with the Positive and Negative Affect Scale immediately after each simulation and assessed learning through multiple-choice questions. We used repeated measures analysis of variance to examine potential interactions between Positive and Negative Affect Scale scores and role in simulation. To explore differences in learning, we examined whether knowledge retention differed between the groups.

Results Residents had higher levels of both positive and negative emotional arousal in active roles compared with observing roles. We could not detect a difference in learning between the roles.

Conclusions The increase in both positive and negative emotions among active participants compared with observers may have important implications for simulation design and participant learning. Future studies should be powered to detect differences in learning and examine the impact of contributing factors such as learner level and context.

From the Department of Pediatrics (T.R.), Kaiser Permanente Oakland Medical Center, Oakland; Kanbar Center for Simulation and Clinical Skills (C.A.), and Departments of Medicine (B.O.) and Pediatrics (S.V.S.), Division of Pediatric Critical Care, University of California San Francisco, San Francisco, CA.

Reprints: Timothy Rogers, MD, Pediatric Hospitalists 12th Flr, 275 W Macarthur Blvd, Oakland CA 94611 (e-mail:

The authors declare no conflict of interest.

T.R. was a fellow in pediatric critical care medicine at the University of California San Francisco during time of study.

Online date: January 2, 2019

© 2019 Society for Simulation in Healthcare