Immersive simulation requires a significant financial and human investment. It involves a complex technical environment (cameras, high-fidelity manikin, healthcare equipment, simulation and control rooms) and educational process (clinical scenario, briefing, simulation activity, debriefing). Facilitators ensure the quality of these training sessions, but their role often remains in the shadow of the technological device. Furthermore, the scientific literature deals with the practice of debriefing (Jaffrelot & Pelaccia, 2016; Johnston et al., 2017; Policard, 2018) and with the design of the scenario (Dieckmann et al., 2007). From a social science perspective, we propose an original analysis of the managing of the simulation-based experience, a phase where facilitators are, strictly speaking, major actors.
Our pragmatic analysis of the facilitator’s actions is firstly based on an ethnography of immersive simulation sessions (proposed for several health professions) in a School of Health Sciences in French-speaking Switzerland. Secondly, we observed the meetings of a working group, whose mission is to support the implementation of a simulation teaching program. We finally conducted interviews with various educators involved in simulation.
Managing a simulation-based experience is a complex and active role: facilitators interact with and on the technical environment and the educational process. They direct participants’ actions when these deviate from the established scenario or when the simulation does not progress quickly enough for the time allowed. They also give a personality to the manikin to make it "more human". Moreover, they regularly work to circumvent the technical and relational limitations of the machines that could defeat the simulation: for example, they provide oral cues to compensate for the missing visual cues that participants face during the simulation.
Facilitators’ actions, which could not be replaced by technology, help to fill the limits of the manikin and to recompose the care practice in a simulated environment (Johnson, 2007; Hindmarsch et al., 2014). They raise questions about the theoretical framework of simulation, formulated in terms of 'realism' and 'fidelity' (Horcik & Durand, 2015), and about the standardisation of simulation practices: is a scenario facilitated by different educators always the same scenario? Does the discrepancy between the almost inert and stereotyped body of the manikin and the experienced and singular voice of the facilitator disturb the simulation experience? The notion of socio-material assemblage (Denis & Pontille, 2018) allows us to consider the distribution of roles and agency during the simulation experience, including the vulnerability of this assemblage and of the objects that make it up (Hennion, 2019): facilitators intervene to remedy sometimes a programming defect in the manikins, which are very complicated to use, and sometimes one of the breakdowns that punctuate simulation sessions, to the point that they are mentioned in the briefing. Our results show that beyond the sophistication of the manikin, the smooth running of the simulation is above all ensured by the educators, who take care to produce an experience that is certainly unstable but educationally effective.
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