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In the past decade medical education has witnessed a significant increase in the use of simulation-based technology to facilitate learning of technical/procedural and behavioural skills in a medical context. Contributing factors include changes in healthcare delivery, technological advances, an increased focus on patient outcomes and safety, reduced patient availability for learning opportunities and a paradigm shift to outcomes-based education, with its requirements for assessment and demonstration of competence.1 Scenarios written for simulation-based resuscitation courses often follow a generic narrative structure in which a simulated patient's condition deteriorates from baseline and then improves with appropriate treatment. In non-military simulation practice, the patient usually survives the critical incident. What is less well understood is how well simulated-based teaching methodologies prepare medical students and newly qualified doctors (interns) to manage unexpected and potentially distressing events. We assert that scenarios including unexpected events may not be congruent with ‘normative’ simulated patient outcome expectations. We report observations from a simulated Not For Resuscitation (NFR) …
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