Does Simulation Enhance or Inhibit the Development of Self-Knowledge?
Simulation has been widely adopted in medical education. Traditionally, the design of simulation activities was through a hierarchical approach where experts within a specialty contributed to the development of content and assessment processes. Whilst this has proved to be a reliable method, the effectiveness from the perspective of students has rarely been examined. The Ward Simulation Exercise (WSE) was delivered in the final six months of the undergraduate medical curriculum at the University of Dundee. It was designed to assess the capabilities of medical students to prioritise competing demands and work collaboratively within a simulated environment. Students were observed by two assessors (normally consultants), who determined whether the student had met the required standard or not. The University of Dundee WSE was unique – no comparable assessment could be identified in the literature. This thesis examined whether the WSE enhanced or inhibited the development of student self-knowledge. In the context of this thesis, self-knowledge can be considered as the aggregation of wisdom derived from internal and external stimuli that informs a substantial comprehension of one’s character, values, abilities, aptitudes, attitudes and emotions (Cassam, 2014). The literature (which varied in rigour and quality and was not extensive) reported that simulations predominantly assessed a singular skill and that student voice was rarely appreciated within this process. There was scant evidence that the medical profession engaged with the concept of student self-knowledge. WSE assessment data from 2010, 2012 and 2014 were analysed using a mixed methods approach. The qualitative aspects utilised Grounded Theory and Cluster Analysis to better understand the lived experience of students and determine the reliability of the assessment from the student perspective. The students’ perspective was contrasted with that of the assessors. In total, 412 data sets (87%) from the first run of the WSE and 127 data sets (89%) from the second run met the inclusion criteria. In all years the WSE was a reliable form of assessment. The professional role of an assessor and their gender influenced whether they felt a student had met the required standard or not. Analysis identified where the opinion of students differed from that of assessors. Recurring themes related to the submissive role that students experienced during the WSE and the hierarchical nature of the assessment. This thesis is one of the first research studies to examine student self-knowledge within medical education. The medical profession arguably needs to be more inclusive of students within curriculum design and assessment. Empowering students could challenge hierarchical practices and address an expectation for a more transactional approach to education. This could allow students to develop self-knowledge appropriate to their stage of professional development.
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