Research by HPEd faculty and PhD alums examine factors that explain levels of online participation and interest during distance debriefings.

Ever wonder how engaged a person on the other end of a group Zoom call is? And how that engagement affects the group discussion?  

Researchers in the healthcare simulation space were wondering the same, specifically, the factors that can affect engagement in online virtual debriefing, or “distance debriefing.” 

In the paper, “Perspectives of engagement in distance debriefings” published in the journal Advances in Simulation, IHP Health Professions Education professor Janice Palaganas and two of the program’s first PhD graduates – Dr. Cynthia Mosher and Dr. Alex Morton – break down the experiences and perceptions of both educators and learners and explain some of the factors that influence engagement in online distance debriefing. 

“The impetus for our research was the sudden thrust of simulation education into the distance setting,” said Mosher, who serves as an assistant director in the Department of Clinical Skills at Alfaisal University College of Medicine, where the IHP has begun a new master’s degree. “With no guidelines to carry in-person simulation and debriefing to online, educators and learners found themselves trying to do at a distance what they have always done in person. While many aspects carried over well, some concerns arose regarding the engagement of learners in the distance setting.” 

“I'd say our body of literature that we've contributed over the last three years has definitely been the most rigorous that exists out there right now,” said Palaganas, the paper’s senior author.  

At the center of the research was this question: what factors influence engagement in healthcare simulation online distance debriefings? They typically took place after participants participated in either a procedural simulation – like learning how to perform CPR – or team training where students were managing the care of a patient.  

The authors conducted 14 interviews – six faculty and eight students – from the eastern United States, Toronto, Canada, and Riyadh, Saudi Arabia. The participants were intentionally recruited from different geographic locations, cultures, age groups, and technology experiences. 

“The interviews we conducted with them helped us appreciate many aspects of the distance setting that both educators and learners need in place to effectively engage and be engaged,” said Mosher. 

The authors outlined ten themes - among the most notable:  

The Simulation Effect 

One of the most significant findings was that previous literature on this topic didn’t factor in how one’s experience in simulation factored into the debriefing that followed.  

“If you had a really great experience in distance simulation, then the likelihood increases that your distance debriefing is more engaging, or it could be a bust if your simulation was a bust,” said Palaganas, who began looking into online debriefings before the pandemic. “So, there was this effect from the previous experience leading on. It’s kind of like in-person meetings as well. If you couldn't find parking, and you're aggravated about that, you come into the conversation either not engaged or checked out.” 

Internal-External factors of engagement  

Researchers found an educator’s perception of what's occurring in the online environment triggers the actions that they would take based off of those assumptions, which then influences the entire conversation. 

For example, if a student turned off the video, the educator might perceive that as the student not being interested. That in turn causes the educator to either tell the student to turn the video back on, which changes the dynamic of the conversation, or the educator over-interacts by putting the spotlight in that student, which might make the student wonder if they are in trouble.  

“These internal-external cycles can spiral down very quickly,” said Palaganas. “It’s about being aware of your own assumptions, and how you get in the way of yourself during a distance debriefing. We constantly interact throughout the entire conversation in ways that you also do in person, but there are many more assumptions that happen in the online environment.” 

Camera on does not equal engagement and camera off does not equal disengagement 

“Many participants felt everyone should have their camera on so their presence would be visual, and their engagement more easily appreciated,” the authors write. “As well, many felt having the camera off indicated disengagement and disinterest. However, some felt that having the camera off does not necessarily mean they are less or not engaged.” 

False engagement is a thing 

Just because a participant has their camera on doesn’t mean they are full engaged; one educator described it as “false engagement.” 

“They’re like doing something else and they’re just they're on camera just to be there,” the study quotes one participant. 

“I can bobble (nod) my head, but I might not be fully paying attention,” said another participant.  

Tools can help but they can also hurt 

While web conference tools like screenshare, whiteboard, hand raise, and polls, were helpful, chat was seen by some as controversial. 

“Some learners felt it contributed to disengaged outcomes, such as people paying more attention to chat than to the person speaking, when it becomes a side conversation between participants, that discussion in chat has no flow, that it is distracting, and that the side conversations in chat can be missed or fall out of relevance because the discussion has proceeded to another topic,” write the authors. “Nonetheless, chat was found by some to be of benefit in small doses and particular uses and for some was the engagement tool of choice.” 

The study was highlighted at the recent annual meeting of Society for Simulation in Healthcare and the article selected as an "Article of Influence 2021-2022" by SSH, a significant honor in this industry.  

More research is on the way because online distance debriefings aren’t going anywhere. The Healthcare Distance Simulation Collaboration, founded in 2020, surveyed 618 respondents from 32 countries: 82% of respondents indicated long-term plans to continue using distance simulation beyond the pandemic. 

Palaganas and Mosher point to the future and a key takeaway.  

“To move the field of distance simulation forward, it is pertinent to understand the challenges the distance setting presents,” said Mosher.  

Added Palaganas, “The key takeaway is being aware of how the assumptions you make in the online environment influences the way you teach, and every educator that is doing this really needs to understand that.” 

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