Background Medical students at our institution undertake high fidelity simulation training in their third year. As students, they spend most of their time on the periphery, but in the simulated clinical setting, they are often placed directly into the centre of their community of practice as the “lead clinician.” Using the educational theory of legitimate peripheral participation (Lave and Wenger 1991), we investigated how our students interact with this new environment, and the impact on them of this new role.
Methodology We undertook 2 focus groups with year 3 students (six students in each). Questions were derived from a thematic analysis on a series of reflective essays written by a previous cohort of third years about their experiences in the simulation. Data was audio recorded and interpreted using the lens of symbolic interactionism.
Results The 6 themes elicited from the students’ reflective essays were: the simulation lab environment; immersion in the scenario; teamwork; professionalism; stress; and communication. Students put a strong emphasis on roles and clear delegation of tasks providing them with a positive attitude towards the scenario. Students felt consistently that scenarios with a clear structure/leadership, were much more realistic. They reported feeling helpless when they did not have a role, and related this to leadership. The presence of a leader who designated roles felt more “real”.
Conclusion and recommendations When put into the centre of their community of practice, medical students need a leader and clear roles to avoid feeling stressed. This may be due to previous hospital experiences with clearly defined and hierarchical structures. Students may benefit from an explicit explanation of any change in role. We conclude that whilst peripheral participation has a role in medical education, students seem to assign more value to active, central participation in simulated clinical settings.
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