Realism, authenticity, and learning in healthcare simulations: rules of relevance and irrelevance as interactive achievements

Because simulators offer the possibility of functioning as authentic representations of real-world tasks, these tools are regarded as efficient for developing expertise. The users’ experience of realism is recognised as crucial, and is often regarded as an effect of the similarity between reality and the simulator itself. In this study, it is argued that simulation as a realistic and relevant activity cannot be predesigned but emerges in the interaction between the participants, the simulator, and the context. The study draws on interaction analysis of video data from medical training. The aim is to contrast the use of two different simulators to explore the requirements needed to establish and maintain simulations as authentic representations of clinical practice. Irrespective of the realism of the simulator, glitches in the understanding of the simulation as work-related activity appear and are bridged by participants. This regularly involves an orientation to the relevant similarities with work and, simultaneously, the ruling out of irrelevant dissimilarities. In doing so, the participants rely on established professional practices to construe the situation. Moreover, the realism of the simulation is maintained through the participants’ mutual orientation to the moral order of good clinical practice and a proper simulation. It is concluded that the design of simulation activities needs to account for the possibilities of participants understanding the specific conditions of the simulation and the work practices that the simulation represents. Learning to simulate is thus something that needs further attention in its own right.     

EFFECTING EDUCATIONAL CHANGE ‐‐ SOME NOTES ON THE REFORM OF PRIMARY SCHOOL MATHEMATICS TEACHING∗

The claim that a belief in the compatibility of teaching with marriage acts as an incentive to women to choose this career received some support from the findings of the study described. The majority of the respondents also saw their work role as subsidiary to their domestic role, with the domestic demands being accorded first priority. Part‐time teaching opportunities were welcomed, with almost two‐thirds of the ex‐teachers hoping to return on a part‐time basis. Opinions on the use of nursery provision varied considerably; those respondents exhibiting the greatest willingness to return to teaching expressed significantly greater approval of nurseries. A considerable range of opinions emerged on wives and mothers going out to work, despite the fact that the husbands were extremely tolerant on this matter. Inter‐generational differences may provide one source of such variations; investigation of socio‐economic background and initial reasons for entering teaching as other possible sources proved inconclusive. The majority of the respondents were following or intending to follow the career pattern described by Gavron, though some did so with reluctance.