Positive emotions, such as enjoying a task, can lead to increased interest and motivation6. But not all tasks are enjoyable. Negative emotions, such as stress, can enhance engagement in learning17. Let's give an example of dental trauma that students dread: a 1-year-old child presents to the pediatric ward of the hospital following a fall. A primary tooth is severely fractured and needs to be extracted. The students take no pleasure in performing this type of procedure because of the crying, the agitation, the young age of the patient. But this type of fear can increase the student's extrinsic motivation17 because he/she will want to deal with this stressful situation when it arises in his/her professional life in the dental office. Emotions influence perseverance in learning18. The relationship between emotions and cognition is linked to social learning theories1.
Emotions are specific to each student and their personality19. In simulation, the behavior of the mannequin was modulated according to the interactions with the learner. For this reason, not all sessions were identical. In the course of their professional activities, they will be confronted with difficult patients, for example anxious, critical, unfriendly, aggressive or uncooperative patients20. The behavior and feelings of each learner are modulated by their self-efficacy1. The more it increases, the better it will perform. The objective is to increase self-efficacy and self-confidence by exposing the student to the simulation situation before clinical practice.
The simulated situation should be as realistic as possible. The main obstacle to pediatric simulation is the pediatric patient. One of the limitations of our study seems to be the mannequin and its appearance which could have reduced the emotional involvement of the learners. Our results showed that there was almost no difference between the emotions experienced in simulation and in clinical practice. The use of standardized patients is also an effective teaching tool for pedodontic simulation, with proven positive effects on clinical practice21. Virtual simulation is a solution for training in other aspects of dentistry, such as clinical reasoning or knowledge of pediatric behavior management22.
Pediatric dentistry is a difficult specialty that is not well appreciated by students. Training in pediatric dentistry should focus on improving students' self-confidence, especially in emotionally challenging settings23. Previous work has shown that postgraduate pedodontic students have high to very high levels of emotional intelligence (EI), with no difference between men and women24. EI has been defined as "a form of intelligence that involves the ability to monitor one's own and others' feelings and emotions, distinguish between them, and use this information to guide one's thinking and actions." 25. EI can contribute to better learning and should be included throughout undergraduate education. Simulation training could improve EI and empathy in undergraduates up to the level of postgraduates. In pediatric dentistry, patients' perception of the dentist is important and conditions their cooperation, motivation for oral hygiene, and fear24,26. Empathy was correlated with decreased dental fear and improved treatment success and cooperation in pediatrics24. Several authors have linked EI to clinical decision making, highlighting the role of emotions in patient management27. A practitioner's emotions can enhance or degrade his or her judgment and decision making. Clinical practice requires clinicians to actively manage their own emotions27.
Do participants in a simulation have stronger emotional reactions than observers? Roger et al. showed a difference between emotional arousal and role in the simulation (participants or observers) but without consequences for scores on a learning measure28. According to social-cognitive theories of learning, students can learn by observing others perform professional tasks1, which is essential for the learners who observe the simulation and participate in the debriefing. Sharing their feelings during the debriefing allows students to look back on the positives and negatives, identify what may constitute good practices, and thus learn from each other by forming a community of practice.