Instruction and guidance in healthcare simulation: a scoping review

Introduction
There is growing evidence that instruction and guidance during simulation engagement can enhance explicit and subtle procedural knowledge and skills, medical knowledge, situation awareness and organization, and observation and reflection. However, instruction and guidance to scaffold learners during simulation engagement receive limited attention in published peer-reviewed literature, simulation practice guidelines and instructional design practices. This scoping review aimed to identify specific instruction or guidance strategies used to scaffold learners during simulation engagement, who or what provided support and guidance, who received instruction or guidance, and for what reasons.

Methods
Guided by Reiser and Tabak’s perspectives on scaffolding, we conducted a scoping review following JBI Guidance. Included databases were PubMed, CINAHL, Embase, PsycINFO and Web of Science. No date boundary was set. All languages were eligible. Hand searching included six healthcare simulation journals, yielding 9232 articles at the start. Using Covidence, two reviewers independently screened all articles (title and abstract, full-text). Two independent reviewers extracted every third article. The content analysis enabled categorization and frequency counts.

Results
Ninety articles were included. A human or computer tutor or a combination of human and computer tutors provides instruction and guidance. Strategies employed by human tutors were verbal guidance, checklists, collaboration scripts, encouragement, modelling, physical guidance and prescribed instructional strategies (e.g., rapid cycle deliberate practice). Strategies employed by computer tutors were audio prompts, visualization, modelling, step-by-step guides, intelligent tutoring systems and pause buttons. Most studies focused on pre-licensure and immediate post-graduate learners but continuing professional development learners were also represented. The most common reason for including instruction and guidance was to enhance learning without specific language regarding how or what aspects of learning were intended to be enhanced.

Conclusion
Although less prominent than pre- and post-simulation instructional strategies (e.g., pre-briefing, debriefing), there is a growing body of literature describing instruction and guidance for scaffolding learners during simulation engagements. Implications for practice, professional guidelines and terminology are discussed.