The results presented in this article draw attention to the fact that for the surveyed academics the aspects related to their work environment, the technical-administrative conditions as well as professional development are important when managing the teaching process in a simulated environment. All teachers agreed that the external aspects, such as the number of simulation session groups, additional equipment and interior design of the room are important in organizing this process. Paying attention to the equipment, teachers were also aware of the fact that their knowledge about that specific equipment is essential. As referred to another aspect included in “the technical-administrative conditions” scale - the costs of simulating classes - the surveyed academics were not sure about the difference between expenses involved in teaching classes in simulation conditions or in a clinic. They were not aware of the high costs of the former, which may be an important factor in planning the education process.
Proper organization of time and planning functional scenarios for simulation sessions were important for all surveyed participants. They also found the involvement of the simulated patients intrinsic in the implementation of simulation sessions and agreed that the effectiveness of the sessions depends on the teacher's and the student's preparation. They considered simulation as an essential complement to clinical teaching and a reliable method of teaching.
The surveyed participants agreed with the statement that work in simulation requires teachers’ preparation for classes, a thoughtful organization of the teaching plan, implementation of special methodologies and well-established technical-administrative conditions of the simulation setting. Since it is a complex process it requires appropriate decisions based on experience, available literature, and reliable research results.
The shortage of health professionals, including doctors in Poland, triggered a series of system-based changes in the undergraduate education system. The changes included implementing a new Higher Education Act and introducing new standards of education, i.e., medical simulation. The Polish government invested in a network of Simulation Centres based in Polish medical schools and required the application of the simulation methods for providing education to students of medical curricula. Included were: a transfer of minimum of 5% of clinical education into simulation conditions, employment of simulated patients to assist students’ professional skills acquisition in the patient-doctor communication and the implementation of the Objective Structured Clinical Examination (OSCE) aimed at the assessment of health care students' professional skills and competencies. The above mentioned system-based requirements raised the need to expand the pool of qualified faculty capable of carrying out simulation-enhanced educational process. To be able to establish an effective simulation environment, develop high standards for students learning with the use of medical simulation and hold the responsibility for teachers’ qualifications in that field, the authors of this study aimed to create a standardized tool, which could help to characterize the medical simulation environment as teachers’ workplace. In addition, the designed questionnaire enabled the assessment of the individual aspects that make up the simulation environment as an education environment.
Harden and Crosby (2000) [27] list twelve teacher roles that can be classified into six areas:
(1) Teacher as a provider of relevant information in the teaching process in lectures or a clinical context,
(2) Teacher as a role model performing his or her medical specialty,
(3) Teacher as a facilitator and mentor,
(4) Teacher as a student evaluator and curriculum,
(5) Teacher as a person planning and designing the curriculum and courses,
(6) Teacher as a source material organizer.
The authors point out that some teachers' roles are more focused on a person with medical knowledge, and some emphasize the role of an educator.
The effectiveness of the methods and methodology depends on the teacher’s knowledge and involvement [12]. It is the teacher who has the opportunity to decide on the type of a teaching method, curriculum design, implementation of educational objectives, and the legitimacy of applied tools. The conditions of the simulation environment that must be provided for the teaching to bring the expected outcomes can only occur with the participation of academic teachers, the majority of whom are regular clinicians. Their expertise in the field of patient care is precious; however, their availability is often limited due to clinical obligations. With medical simulation requiring a unique teaching methodology, concentration, and attentive evaluation of students’ skills and competencies, the educational load of medical simulation teachers is much higher. What is more, the knowledge of the academic teacher's role, the scope of his or her duties or expectations related to the implementation of the education process is critical in the process of matching the teachers’ tasks to the existing curriculum, the faculty evaluation, as well as designing programs for faculty development.
The authors of the study embraced the information mentioned above to look for the answer to their research question - what is the teachers’ perspective on their work in the medical simulation environment. The initial stage was based on the interviews, which revealed certain tendencies in the opinion of academics regarding working in simulated conditions. Then, further works aimed to design a more standardized tool - the Work in Simulation Healthcare questionnaire.
The construction of the WISH questionnaire proved to be effective for describing the perspectives of academic teachers on their work in simulated conditions. The questionnaire seems to fill up the niche in this particular research area, and to present the applicability of the new tool its construct was juxtaposed with the DREEM [1], JHLES [2], MSLES [3] and SSES [10] inventories. As demonstrated in Table 3, the new questionnaire addresses the same aspects of a general education environment as the above-mentioned well-established tools; however, the area of the study is narrowed, in that case, to simulation conditions. [Table 3. Comparison of the DREEM, JHLES, MSLES, SSES, WISH – near here]. Another unique feature of this tool is that the authors changed the source of information from the students to academic teachers. It also allows expanded evaluation of the educational environment by investigating both students’ and teachers’ preparedness to classes, as this mutually affects the perspectives of the learning and teaching processes.
Table 3
Comparison of the DREEM, JHLES, MSLES, SSES, WISH
| DREEM | JHLES | MSLES | SSES | WISH |
PURPOSE | To measure the educational environment and climate of health professions/ medical schools professions to permit evaluation of their responses to the challenges of changing mandates and missions | To measure students’ perceptions of the learning environment that would capture the richness and variety of each student’s relational, academic and institutional engagement in medical school | To measure students’ perceptions of their learning environment to plan appropriate interventions in the educational program and to assess their impact on students’ academic performance | To measure and compare differences in satisfaction levels between nursing students exposed to medium and high fidelity human patient simulation manikins | To characterize the medical simulation environment as a type of working environment |
Date of creation | 1996 | 2011–2012 | 1976 | 2009–2010 | 2019 |
Number of respondents | First intervention 1996: 42 Dundee University medical students; In total between 1996–1997: 721 students of medicine and nursing program | 377 medical students | 93 medical students | 344 nursing students | 32 teachers of the medical program |
Number of items | 58 | 28 | 50 | 18 | 30 |
Aspects of the learning environment | GENERAL LEARNING ENVIRONMENT AND CLIMATE | GENERAL LEARNING ENVIRONMENT AS A WHOLE | GENERAL LEARNING ENVIRONMENT | SIMULATION LEARNING EXPERIENCE | SIMULATION LEARNING ENVIRONMENT |
Applicable to: type of school/profile/level of education | medical schools and other health training settings/ undergraduate | medical school/ undergraduate | medical school/ undergraduate/ basic science years | nursing school/ undergraduate | medical school/ undergraduate |
Curriculum | • S’s perception of the learning process/curriculum | • S’s perception of the curriculum | • S’s perception of the meaningful learning experience – curriculum • S’s perception of the degree to which LE fosters interest and activity in medicine - Breadth of interest • S’s perception of the organization of the learning process • S’s perception of the flexibility – the pattern of school control imposed on the students | • S’s assessment of the simulation experience • S’s perception of the extent to whish SE helped to integrate knowledge with | • T's perception of the extent to which SE allows the successful implementation of the curriculum |
Interactions with the academic community | • S’s perception of teachers/ teaching skills and interactions with students | • S’s perception of teachers | • S’s perception of the interaction with faculty and staff | • S’s assessment of the teacher’s support – hints, discussion, feedback | • T’s perception of the students and their preparation to classes |
• S's perception of the social self | • S’s perception of other students • S's perception of the administration | • S’s perception of peer-relations |
Sense of the learning climate | • S’s perception of the learning atmosphere • S’s perception of academic self | • S’s sense of the learning climate/ fair and understandable • S’s sense of inclusion and safety • S’s sense of the institutional ethos | • S’s perception of the emotional climate, sense of stress • S’s perception of the extent to which the school supports them by caring or providing assistance | • S’s perception of the extent to which simulation experience helped them to recognize their clinical strengths and weaknesses • S's assessment of their development and self-reflection | • T's perception of the extent to which SE/SM affects both teachers and students' emotions towards teaching/learning, e.g., sense of stress |
Facilities | n/a | • S's perception of the facilities/workspaces | n/a | S's perception of the simulation experience about the medium- and high-fidelity human patient simulation manikins | • T’s assessment of simulation conditions (realism)/ technical problems • T’s perception of the costs of SE |
Other | n/a | n/a | n/a | S’s perception of debriefing skills of the faculty | • T's assessment of their methodological qualifications to teach with MS and the ability to operate the simulation equipment |
Limitations | • Does not examine the simulation environment as a learning/teaching environment | • Conducted at a single institution • Does not explore the simulation environment as a learning/teaching environment | • Does not explore the simulation environment as a learning/teaching environment | • Is limited to examine simulation experience not a comprehensive aspect of the simulation environment as a learning/teaching environment | • Created and validated at a single institution • A small number of participants |
S-students; T-teachers |
The authors of the presented study project have found no other tools in the available literature that would specifically identify the factors helping to describe golden standards for setting up effective simulation environment and allow the academics to provide their viewpoint on these issues. The WISH questionnaire was designed to identify these factors and to understand the perspectives of academic teachers on working in a simulation environment. The presented research results highlight the areas which most of the surveyed participants found relevant when working in a simulation environment. The authors of that research project consider the results of their survey useful and potentially applicable worldwide when deciding on the process of organizing and teaching simulation-based curriculum.