title: A simulated night shift in the emergency room increases students' self-efficacy independent of role taking over during simulation.
abstract: BACKGROUND
  Junior doctors do not feel well prepared when they start into postgraduate training. High self-efficacy however is linked to better clinical performance and may thus improve patient care. What factors affect self-efficacy is currently unknown. We conducted a simulated night shift in an emergency room (ER) with final-year medical students to identify factors contributing to their self-efficacy and thus inform simulation training in the ER.
  
  
  METHODS
  We simulated a night in the ER using best educational practice including multi-source feedback, simulated patients and vicarious learning with 30 participants. Students underwent 7 prototypic cases in groups of 5 in different roles (leader, member and observer). Feeling of preparedness was measured at baseline and 5 days after the event. After every case students recorded their confidence dependent of their role during simulation and evaluated the case.
  
  
  RESULTS
  Thirty students participated, 18 (60 %) completed all surveys. At baseline students feel unconfident (Mean -0.34). Feeling of preparedness increases significantly at follow up (Mean 0.66, p = 0.001, d = 1.86). Confidence after simulation is independent of the role during simulation (F(2,52) = 0.123, p = 0.884). Observers in a simulation can estimate leader's confidence independent of their own (r = 0.188, p = 0.32) while team members cannot (r = 0.61, p < 0.001).
  
  
  CONCLUSIONS
  Simulation improves self-efficacy. The improvement of self-efficacy is independent of the role taken during simulation. As a consequence, groups can include observers as participants without impairing their increase in self-efficacy, providing a convenient way for educators to increase simulation efficiency. Different roles can furthermore be included into multi-source peer-feedback.
authors.affiliation: Lernzentrum (Skills Lab), Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. fabian.stroben@charite.de.|Department of Gynecology and Obstretics CCM & CVK, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. fabian.stroben@charite.de.
authors.forename: Fabian
authors.initials: F
authors.lastname: Stroben
authors.affiliation: Lernzentrum (Skills Lab), Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.|Department of Gynecology and Obstretics CCM & CVK, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Therese
authors.initials: T
authors.lastname: Schröder
authors.affiliation: Lernzentrum (Skills Lab), Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.|Department of Emergency Medicine at Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Katja A
authors.initials: KA
authors.lastname: Dannenberg
authors.affiliation: Department of Gynecology and Obstretics CCM & CVK, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Anke
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Universitäres Notfallzentrum, Inselspital Bern, 3010, Bern, Switzerland.
authors.forename: Aristomenis
authors.initials: A
authors.lastname: Exadaktylos
authors.affiliation: Universitäres Notfallzentrum, Inselspital Bern, 3010, Bern, Switzerland.
authors.forename: Wolf E
authors.initials: WE
authors.lastname: Hautz
mesh_terms: D001291:Attitude of Health Personnel; D019985:Benchmarking; D002983:Clinical Competence / Q000592:standards; D003198:Computer Simulation; D004504:Education, Medical, Undergraduate / Q000379:methods* / Q000592:standards; D004636:Emergency Service, Hospital; D005260:Female; D000068156:Formative Feedback; D005858:Germany; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D007858:Learning; D008297:Male; D016544:Patient Simulation; D012381:Role Playing; D020377:Self Efficacy; D013337:Students, Medical / Q000523:psychology*
keywords: Emergency medicine; High-fidelity simulation; Medical education; Self-assessment; Self-efficacy; Simulation-based education; Undergraduate education