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‘It is a different type of learning’. A survey-based study on how simulation educators see and construct observer roles
  1. Stephanie O’Regan1,2,
  2. Elizabeth Molloy3,
  3. Leonie Watterson1,
  4. Debra Nestel2
  1. 1 Sydney Clinical Skills and Simulation Centre, Northern Sydney Local Health District, St. Leonards, NSW, Australia
  2. 2 Monash Institute for Health and Clinical Education, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
  3. 3 Department of Medical Education, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Stephanie O’Regan, Sydney Clinical Skills and Simulation Centre, Level 6 Kolling Building, Royal North Shore Hospital, Northern Sydney Local Health District, Reserve Road, St. Leonards, NSW 2065, Australia; Stephanie.oregan{at}


Background Simulation is reported as an appropriate replacement for a significant number of clinical hours in pregraduate programmes. To increase access for learners, educators have looked to understanding and improving learning in observer roles. Studies report equivalent learning outcomes and less stress in observer roles. However, reports on the prevalence, use and perceived value of observer roles from the educator’s perspective are lacking.

Methods An exploratory survey for Australian and New Zealand (ANZ) simulation educators based on literature findings was developed and piloted with a small sample (n=10) of like subjects for language, clarity, skip logic and completion time. The final survey comprised 36 questions. Quantitative data were analysed using Pearson’s chi-squared test, Welch’s ANOVA and exploratory factor analysis. Select qualitative data were analysed using content analysis and summarised with frequency counts and categorisation.

Results Two hundred and sixty-seven surveys were completed, with 221 meeting criteria for analysis. The observer role is widely used in ANZ and most learners experience both hands-on and observer roles. The location of observers is dependent upon several factors including facility design, learner immersion, scenario design and observer involvement. Verbal briefings and/or other guides are provided to 89% of observers to direct their focus and 98% participate in the debrief. Educators value observer roles but tend to believe the best learning is hands-on.

Conclusions The learning in observer roles is less valued by educators than hands-on roles. Focused observation provides opportunities for noticing and attributing meaning, an essential skill for clinical practice. Learning spaces require consideration of scenario design and learning objectives. Scenario design should include objectives for observer roles and incorporate the observer into all phases of simulation. Attention to these areas will help promote the value of the different type of learning available in observer roles.

  • Simulation based education
  • Simulation based learning
  • Simulation faculty
  • Simulation in healthcare

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  • Twitter Debra Nestel @DebraNestel.

  • Contributors SO devised the study, drafted the survey, conducted analysis and wrote the manuscript (80%). EM and LW advised on and reviewed the study design, reviewed the survey, advised on and reviewed the analysis and contributed to the writing of manuscript (both 5%). DN supervised the study design, reviewed the survey, advised on and reviewed the analysis and contributed to the writing of manuscript (10%).

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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