Learner engagement matters, particularly in simulation-based education. Indeed, it has been argued that instructional design only matters in the service of engaging learners in a simulation encounter. Yet despite its purported importance, our understanding of what engagement is, how to define it, how to measure it, and how to assess it is limited. The current study presents the results of a critical narrative review of literature outside of health sciences education, with the aim of summarizing existing knowledge in these areas and providing a research agenda to guide future scholarship on learner engagement in healthcare simulation. Building on this existing knowledge base, we provide a working definition for engagement and provide an outline for future research programs that will help us better understand how health professions’ learners experience engagement in the simulated setting. With this in hand, additional research questions can be addressed including: how do simulation instructional design features (fidelity, range of task difficulty, feedback, etc.) affect engagement? What is the relationship between engagement and simulation learning outcomes? And how is engagement related to or distinct from related variables like cognitive load, motivation, and self-regulated learning?
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While fidelity is widely believed to be essential to simulation instructional design, the empirical data supporting the relationship between high fidelity and the subsequent transfer of learning is tenuous at best (Hamstra et al. 2014). As a result, some authors have advocated abandoning the concept of fidelity entirely while others have suggested a complete conceptual overhaul of what we consider it to be (Dieckmann et al. 2007; Cook et al. 2011; Norman et al. 2012; Grierson 2014). It may be, however, that part of the controversy surrounding fidelity stems from our incomplete understanding of the variables theoretically postulated to mediate its effect—variables such as engagement. If we believe that fidelity matters for learning insofar as it increases engagement, but we do not understand what it means for a student to be engaged, do not have a consistent way to measure engagement, and lack clarity in how we approach engagement, then it should not be surprising that we have failed to demonstrate a consistent relationship between fidelity and learning.
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Padgett, J., Cristancho, S., Lingard, L. et al. Engagement: what is it good for? The role of learner engagement in healthcare simulation contexts. Adv in Health Sci Educ 24, 811–825 (2019). https://doi.org/10.1007/s10459-018-9865-7
- Healthcare Learners
- Instructional Design