Abstract:

Context:
Vicarious learning holds potential for simulation-based learning scenarios. Although authenticity in simulation-based learning is linked to cognitive processes implicated in learning, evidence concerning the effect of mode of perspective and interactivity on perceived authenticity is insufficient. We previously found evidence for an effect of simulation format on perceived authenticity in patient-case-based simulation. We now analyzed the effect of participatory role in a common form of simulation – student roleplay – and examined perceived authenticity in interactive and noninteractive modes of participation. To complement our analysis of participants’ experience, we analyzed a performance measure to evaluate possible differences in learning gain between participatory roles.

Method:
To simulate anamnestic interviews with the task of diagnosing a patient via roleplay, we randomized 298 medical students to their participatory conditions of physician, patient and observer. Observers received instructions with an observer protocol. The simulation consisted of three interviews each based on a different patient case. Following the simulation, we measured perceived authenticity on three subscales: Realness, Involvement and Spatial Presence to compare authenticity perception across different participatory conditions.
We employed repeated measures Analysis of Variance to evaluate the effect of participatory role on authenticity ratings (Realness, Involvement, and Spatial Presence). To evaluate differences in learning gain, we assessed participants’ diagnostic accuracy (accordance with expert opinion) in a corresponding computer based interview simulation prior to and after the roleplay simulations.

Results:
The interaction between participatory role and authenticity subscale was statistically significant, F(4, 590) = 7.66, p < .001, η2 = .01, indicating that the effect of participatory role varied across subscales of authenticity. Post hoc pairwise comparison across participatory roles revealed a significant difference between ratings of Spatial Presence but not in ratings of Realness or Involvement. Both interactive roles (physician, patient) showed significantly higher ratings of Spatial Presence in comparison with the noninteractive role (observer): physician versus observer (p < .001), observer versus patient (p = .024). The difference between the two interactive roles was nonsignificant. An ANCOVA controlling for pretest performance found no difference in diagnostic accuracy at posttest between the three participatory conditions.

Discussion:
Our study provides evidence that perception of authenticity depends on mode of participation and that increased authenticity perception in interactive, first-person-perspective is specific to Spatial Presence. Noninteractive, third-person-participation may induce equally high perception of Realness and Involvement. We found no evidence for an effect of participatory role on learning gain and hence no disadvantage for noninteractive participation. This provides another piece of evidence for the potential of vicarious learning in simulation-based learning and the use of student roleplay as a commonly used format in particular.

Keywords:

Simulation-based learning, authenticity, roleplay, medical education.