Table 1 The integration of seven key elements underpinning the simulation design, development and analysis of the study

1. Learner

Research study featuring final-year BSc (Hons) physiotherapy students from one university in the UK. All students undertook active roles within a uni-professional simulation scenario and debrief featuring a video-reflexive interview.

2. Facilitator

Facilitator and researcher roles were identified. Skills set established and formal training acquired within specialist areas of simulation scenario design, educational theory, debriefing, human factors and patient safety.

3. Theories and educational practices

The methodological design was informed by social constructivism [47, 48] and socio-material (complexity) theoretical perspectives [49–51, 60]. The scenario and video-reflexive interview embraced social constructivist theories including Vygotsky’s [70] zone of proximal development, situated and authentic learning [72]. Educational practices within the existing physiotherapy curriculum included blended learning [17], flipped classroom [71], scaffolding [73] with increasing levels of complexity of scenarios and the provision of opportunities for deliberate practice prior to practice (clinical) placements.

4. Learning design characteristics

Learning objectives were in line with a social constructivism principles [48]. The instructional medium included high (equipment, environmental and psychological)-fidelity simulation, featuring a human patient simulator. The modality was an immersive clinical simulation scenario featuring an acutely deteriorating medical in-patient. The simulation scenario has been outlined in Table 2. The instructional method included self-directed learning. A high degree of realism was achieved through the use of authentic artefacts (equipment and environment) and scenario design. Antecedent, reality, conceptual and cues incorporated into the scenario were included [74, 75]. Fiction cues were avoided, and responses to intervention were realistic in terms of physiological responses and timing. The scenario was designed to replicate the complexity of an emergency on-call physiotherapy situation and piloted to minimise cognitive overload [19–21].

5. Pre-brief and debrief

Pre-brief information was provided in advance of the study through the participant information sheet in respect to the focus, style format, duration and use of assistive technology and discussed in person on the day of the study. Information was also detailed relating to the debrief procedures in writing and discussed verbally during the pre-brief (format, style, anticipated duration and use of video-recording technology required to undertake the video-reflexive interview).

6. Linked learning activities

At the end of the video-reflexive interview (debrief), the linked learning activities were discussed with study participants. Participants were provided with a copy of their own video footage (scenario and video-reflexive interview), which they could combine with further written reflexive evidence for their personal e-portfolios. Further opportunities were available for the study participants to transform learning from the simulated scenario to practise during their forthcoming (final, elective) practice-based placement.

7. Outcomes

This study focused on exploring the experiences of pre-registration physiotherapy students’ experiences of managing a deteriorating simulated patient, the ability of the students to independently recognise errors, perceived elements of prior learning that may influence their performance and the value that pre-registration physiotherapy students attributed to the cardio-respiratory simulation-based learning experience. Video and thematic analysis was undertaken to explore knowledge, skills (technical and non-technical), attitudes, behaviours, clinical decisions and reasoning, elicited when managing an acutely deteriorating patient. A priori themes were integrated within the thematic video analysis from the acute illness management rubric [57] CSP framework [38] and non-technical skills for a surgeon’s observational behaviour tool [58].