Abstract
The manuscripts that comprise this dissertation collectively investigate clinical simulation-based assessment in respiratory therapy education. Clinical simulation, characterized by debriefing that engages learners in self- and collaborative peer-assessment in addition to formative instructor assessment, is a well-established set of practices in respiratory therapy education. Contextual factors within the profession of respiratory therapy in Canada, in particular its regulatory environment, are prompting a move from using formative debriefing sessions that support learning in simulation, to employing high-stakes testing intended to assess entry-to-practice competencies. There exists a need for the profession to consider how environmental factors, including externally derived requirements, may ultimately impact the effectiveness of simulation-based learning environments.
It is proposed that several important social elements of the clinical simulation-based learning environment, including trust, ontological security, and fidelity, may be at risk in the face of the evolving assessment practices in health professions education. As an at once undertheorized yet highly technologically enhanced and connected approach to learning, a shift towards socio-cultural perspectives on clinical simulation assessment, research, and practice is needed to better understand the social phenomena inherent in clinical simulation. This shift can benefit from the adoption of networked learning theory to encourage deeper understanding of the interrelationships that exist among sociomaterial dimensions of clinical simulation.
The findings of a qualitative case study are presented, examining the experiences of respiratory therapy students in clinical simulation learning environments where comparable instructional designs are characterized by differences between two important assessment approaches used in the field: formative debriefing for learning and summative debriefing for high-stakes testing. The findings indicate that social aspects of participants’ experiences in clinical simulation are characterized by: their comfort levels, their senses of ontological security, and their degrees of immersion in the simulation. Each of these experiential dimensions were impacted in some manner by the assessment design, a phenomenon that was further modulated by individuals’ self-reflexive capacity. These phenomena appear to coalesce to impact learners’ perceptions of their own performance in the clinical simulation context, which was also related to the approach to assessment built into in the instructional design.
