Using the Zone 01 Proximal Development As a Conceptual Framework to Create a Unique High-Fidelity Simulation Program in Undergraduate Anesthesia Education Applegarth, Oliver
High-Fidelity Patient Simulation (HPS) has become an important component of medical education, and its role in undergraduate anesthesia education in no exception. While there is an ever-increasing body of work looking at its uses and the outcomes it creates, little analysis exists examining at the epistemological assumptions that drive this powerful learning tool. We have attempted to reconsider the pedagogical foundation upon which simulation is utilized at the undergraduate level and have asked ourselves whether there exists some current educational theories that could better inform HPS . To this end we have drawn on the work of Lev Vygotsky, specifically with respect to the zone of proximal development (ZPD). From these conceptual ideas has grown a unique style of simulation that is not rigid in its delivery, but rather one that becomes adaptable to the needs of the individual student and can support the individualized level of development that each student brings to the simulator. Collaborative development in this environment is a key. It is one thing to theorize, but we have attempted to move from the conceptual into reality. One key element we have incorporated arises from work looking at situational awareness in a simulated environment, in which the simulator can be frozen. We have termed our program "freeze-action" simulation, a unique simulation environment for delivery to the undergraduate anesthesia clerkship at the University of British Columbia. This program utilizes "freeze-Action" simulation initiated by the learners themselves. The freezes are thought of as individual moments of potential learning initiated at the discretion of the learner and they are used to explore educational opportunities surrounding the "freeze" based on the needs of each student. We have aligned the medical student with a peer learner, an "expert" anesthesia resident and adjuvant learning materials to help navigate this novice learner through perioperative resuscitative scenarios that are designed to operate above their current developmental level. It is hoped that ultimately through researching this unique environment we can obtain data on all students individual zone of proximal development, the role that the "expert" plays in expanding this ZPD, and how this environment can be harnessed to maximize the educational efficiency on HPS. Understanding the ZPD could lead to modifications to medical curriculum that improve development and alter all student's ZPD in a positive fashion. It is believed that our "freeze-action" simulation environment could be a major contributor to this developmental process.
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