High-Fidelity Simulation Pre-Briefing with Digital Quizzes: Using
INACSL Standards for Improving Effectiveness
Nazanin Sheykhmohammadi
, Aryobarzan Atashpendar
and Denis Zampunieris
Faculty of Science, Technology, and Medicine (FSTM), University of Luxembourg, Esch-sur-Alzette, Luxembourg
Pre-Briefing, High-Fidelity Simulation, Medical Education, Digital Quiz.
High-fidelity simulations enable medical students to gain experience in typical scenarios through the use of
computerized manikins, though their learning outcomes and performance greatly depend on their preparation.
To that end, a pre-briefing phase is typically set up to teach the students the necessary information, including
both the theory and the technical workings of the manikin. Our work explores a digital-first approach to
pre-briefing, where the learners are provided quizzes through a mobile application, which allows them to
identify gaps in their knowledge and reinforce their retention through repetitive testing in their own time.
Additionally, demonstrative videos of the manikin are offered to complement their learning. The quiz-based
approach to pre-briefing has been tested with a university class of medical students to prepare them for a basic
life support simulation. We discuss our findings in terms of how the digital quizzes were perceived by students
and evaluate our pre-briefing method against a set of best practices established by ”The International Nursing
Association for Clinical Simulation and Learning” (INACSL). Finally, recommendations to improve the quiz-
based approach are outlined for future case studies.
Lack of practice is a common complaint in medical
education, but simulation is increasingly employed
as a novel approach to address this concern. Re-
search has shown that simulation-based education im-
proves skill performance, knowledge, and patient out-
comes (Zeng et al., 2023). High-fidelity patient sim-
ulation is an advanced teaching method that utilizes a
computerized manikin to simulate real-life scenarios.
It helps students integrate their knowledge and skills
based on their clinical decisions. It has also been used
for problem-solving and clinical reasoning abilities in
educational training (Wong et al., 2023).
High-fidelity simulation involves three phases, re-
ferred to by different terms in various sources, such as
pre-briefing, simulation, and debriefing (Tong et al.,
2022a). Alternatively, they may be defined as prepa-
ration, participation and debriefing, with preparation
being composed of a pre-briefing and a briefing (Tong
et al., 2022b). In some contexts, the three stages
are pre-briefing, clinical case scenarios, and debrief-
ing (Duque et al., 2023).
This research solely focuses on the initial ”pre-
briefing” phase, which refers to ”the activities PRIOR
to the start of the simulation including the prepa-
ration and briefing aspects” according to ”The In-
ternational Nursing Association for Clinical Simula-
tion and Learning” (INACSL) definition (McDermott
et al., 2021). Students expect to develop their skills
during the simulation, but the class time dedicated to
the simulation can be limited. As the students need
to be adequately prepared for these time-constrained
simulations, the pre-briefing can equip them with
the necessary knowledge to successfully perform the
simulation (Tong et al., 2022b). While the debrief-
ing phase has been widely studied and practiced, the
significance of pre-briefing has recently been high-
lighted in studies by showing that its combination
with the participation and debriefing phases helps stu-
dents ”anticipate priorities, recognize and respond to
changes in the condition, and reflect on prioritization
choices” (Penn et al., 2023).
Traditionally, preparation for simulations involved
conventional methods such as lectures, textbook read-
ings, and skills practice. Newly, alternative strategies
involve web-based modules, mental rehearsal, and the
development of cognitive aids or care plans. Further-
more, facilitating self-assessment through quizzes,
self-reflections, or competency rubrics may allow
learners to identify knowledge or skill gaps before
engaging in simulations and to foster self-regulated
learning (Tyerman et al., 2019).
Sheykhmohammadi, N., Atashpendar, A. and Zampunieris, D.
High-Fidelity Simulation Pre-Briefing with Digital Quizzes: Using INACSL Standards for Improving Effectiveness.
DOI: 10.5220/0012682500003693
Paper published under CC license (CC BY-NC-ND 4.0)
In Proceedings of the 16th International Conference on Computer Supported Education (CSEDU 2024) - Volume 1, pages 412-419
ISBN: 978-989-758-697-2; ISSN: 2184-5026
Proceedings Copyright © 2024 by SCITEPRESS – Science and Technology Publications, Lda.
Recent studies and reviews (Silva et al., 2022; Ty-
erman et al., 2019) have highlighted alternative meth-
ods that have been used either alone or in combina-
tion with traditional methods. These include video-
based resources for pretraining, such as healthcare
professionals role modeling patient care, informative
reviews of concepts, and demonstrations of scenar-
ios developed by expert nurses in the role modeling
capacity. Other resources include web-based guides,
discussion forums, team building and communica-
tion exercises, and so on. In particular, the INACSL
also recommends some preparation activities such as:
”Assigned readings or audiovisual materials, Review
of the patient health record/patient report, Observa-
tion of a model of a simulated case, Completion of a
pretest or quiz (McDermott et al., 2021).
Implementing a pre-briefing session through
videotaping has been shown to be effective (Wheeler
and Kuehn, 2023). Moreover, quizzes containing
higher-order thinking questions can be an effective
tool to prepare learners for simulation-based learning
experiences, as they can prompt critical thinking and
motivate students to study relevant literature for the
answers. In this context, simulation experts may set a
minimum threshold on the score to obtain on the pre-
quizzes such that the students are eligible to partake
in the corresponding simulations (Leigh and Steuben,
The goal of practice through quizzes is to invoke a
testing effect (Roediger III and Karpicke, 2006; Fer-
nandez and Jamet, 2017; Van Gog and Sweller, 2015),
which has been shown to improve the long-term re-
tention of students compared to the act of restudy-
ing (Eisenkraemer et al., 2013). Additionally, the in-
direct effects of testing can further help the student
with their learning: firstly, they can apply their theo-
retical knowledge to questions and consequently as-
sess their current understanding without the aid of a
teacher, which has been shown to also break their
false, confident perception that they already master
the topics without practice. Secondly, they can im-
prove their future restudying efforts (Arnold and Mc-
Dermott, 2013; Izawa, 1971) by knowing which se-
lect topics to focus on.
The testing effect is also dependent on several
factors which determine its efficacy. Firstly, harder
questions require a greater retrieval effort by the stu-
dent, which in turn can improve the resulting testing
effect (Greving and Richter, 2018; Rowland, 2014).
One approach is to rely on free-form (recall) ques-
tions (Eisenkraemer et al., 2013; Greving and Richter,
2018; Van Gog and Sweller, 2015; Cranney et al.,
2009), which are considered harder than multiple-
choice questions due to the latter’s passive recogni-
tion nature, i.e., simply having to recognize the cor-
rect answer as opposed to remembering and produc-
ing it from memory.
Next, testing needs to be performed regu-
larly (Eisenkraemer et al., 2013; Cranney et al.,
2009), as the student’s retention can decay overtime.
Lastly, students may also retain incorrect information
and weaken their retention when they answer ques-
tions wrongly (Eisenkraemer et al., 2013; Cranney
et al., 2009; Greving and Richter, 2018). To counter-
act this negative testing effect (Richland et al., 2009;
Arnold and McDermott, 2013; Barber et al., 2011;
Butler and Winne, 1995; Eisenkraemer et al., 2013;
Cranney et al., 2009; Van Gog and Sweller, 2015;
Roediger III and Karpicke, 2006; Fernandez and
Jamet, 2017), it is important to provide immediate
feedback to the learner by not only informing them
of the correct answer but also by providing an expla-
nation such that they understand why they had orig-
inally answered incorrectly. Feedback can thus not
only prevent a negative testing effect, but even further
reinforce the student’s learning and retention (Hattie
and Timperley, 2007; Azevedo and Bernard, 1995).
The remainder of this paper is organized as fol-
lows. In Section 2, we lay out the objectives of our
case study and highlight our methodology in Sec-
tion 3. Next, we describe the results in Section 4
and discuss our findings alongside recommendations
in Section 5. We conclude in Section 6 with the future
work planned for our next case study.
The literature generally lacks guidance on the proper
organization of simulation pre-briefings, with no con-
sistent approach to implementation. It is recom-
mended that researchers focus on pre-briefing to help
close those gaps (Wheeler and Kuehn, 2023).
A recent study (Sheykhmohammadi et al., 2023)
formulated recommendations for improving high-
fidelity simulation sessions using manikins in a uni-
versity setting, which were based on the challenges
and requirements faced by both the students and train-
ers. These include:
1. Scenario design and implementation
2. Before simulation (Pre-briefing)
3. During simulation
4. After simulation (Debriefing and feedback)
The necessary steps and frameworks for developing
valid and reliable scenarios were outlined for the
given manikin’s software. Given these findings, our
High-Fidelity Simulation Pre-Briefing with Digital Quizzes: Using INACSL Standards for Improving Effectiveness
research focuses on reforming the pre-briefing by re-
lying on purely digital means. In particular, we ex-
plore digital quizzes to prepare students for a specific
simulation scenario, which are intended to test their
knowledge such that they can identify gaps they need
to study up on further, as well as to reinforce their
retention through repetition of the quizzes.
The goal is to facilitate access to self-regulated
testing by providing the quizzes through a mobile ap-
plication which they can use in their own time, thus
allowing them to align their testing with their per-
sonal study schedule. Additionally, while the quizzes
are intended to include questions both about the the-
ory behind the upcoming simulation scenario, as well
as technical information such as how to work with
the manikin, the pre-briefing also relies on recorded
videos demonstrating the manikin’s functionality.
By applying our pre-briefing method to a univer-
sity class of students who were preparing for a high-
fidelity simulation, we aim to gauge both their inter-
est and motivation in using our approach, as well as
its effect on their simulation performance.
According to McDermott et al, Pre-briefing activi-
ties are designed to provide a ”psychologically safe
learning environment” for the simulation-based ex-
perience through two key components (McDermott
et al., 2021):
1. Preparation: the learners are aligned with a com-
mon mental model.
2. Briefing: the learners are conveyed essential
ground rules.
To that end, we relied on video-based resources and
digital quizzes to realize our pre-briefing approach.
Firstly, we chose the mobile quiz app BEACON
Q due to several features which can help the students
achieve an effective testing effect to improve both
their studying efforts and their retention: educators
can schedule quizzes for specific periods, which al-
lows each student to align their testing with their per-
sonal study timing before the simulation session.
It also supports replaying quizzes, which enables
the learner to regularly practice and reinforce their re-
tention. Furthermore, BEACON Q adjusts the diffi-
culty of questions to each user’s performance level,
e.g., by changing the format of multiple-choice ques-
tions to free-form, with the latter potentially resulting
in a stronger testing effect.
Finally, the application provides immediate feed-
back to the user, who not only has their answer eval-
uated, but who is also given explanations to further
describe the question and its possible answers, includ-
ing the distractors (wrong answers), which also helps
avoid a negative testing effect.
BEACON Q can thus cover the quizzing portion
of the pre-briefing. In particular, the dynamic ad-
justment of the quizzes’ difficulty is important, given
the best practice criterion ”The experience and knowl-
edge level of the simulation learner should be consid-
ered when planning the pre-briefing. (Miller et al.,
2021). BEACON Q accommodates the simulation
learner’s knowledge level over time as they replay
quizzes by collecting their performance data and ei-
ther rendering the same questions easier or harder de-
pending on their past attempts.
To test our method of pre-briefing, we selected
third-year medical students at a university to conduct
a simulation session based on the BLS scenario, using
a high-fidelity manikin manufactured by MedVision
For the preparation phase, an initial quiz was pro-
vided through the BEACON Q app, with 13 questions
prepared based on research (Spinelli et al., 2021) and
the advice of a professional anesthesiologist who also
acted as the simulation teacher. The questions cov-
ered both theoretical and guideline-based knowledge
about the BLS scenario. To introduce the students to
the BEACON Q app, an explanatory session was or-
ganized two weeks before the planned simulation, af-
ter which they gained access to the quiz. Each student
was free to play the quiz on their given day and time
until the simulation session.
Next, for the briefing phase, we relied on a sec-
ond digital quiz which was prepared by the simula-
tion teacher and a high-fidelity simulation expert. The
quiz contained 11 questions covering the manikin’s
functionality, though several demonstrative videos
were also provided to the students through both the
second quiz, as well as their learning management
system Moodle. The second quiz became available
to play slightly later, specifically six days before the
simulation session. Playing both quizzes was a pre-
requisite to participating in the simulation session.
Following the pre-briefing and the simulation, we an-
alyzed the quiz results, questionnaire responses and
simulation performance of the students. Based on our
findings and in accordance with the INACSL (McDer-
mott et al., 2021) standards, we endeavored to formu-
late recommendations for optimizing the incorpora-
tion of video and quiz-based training to enhance our
pre-briefing process.
Manikin ”Leonardo” by MedVision Group:
CSEDU 2024 - 16th International Conference on Computer Supported Education
We present the results of the students’ performance
on the digital quizzes, followed by their questionnaire
4.1 Quizzes
Two quizzes were playable through the mobile quiz
app BEACON. The first quiz meant for the prepara-
tion step of the pre-briefing was available from 26
October to 2 November and contained 13 questions.
Each student could initiate their quiz attempt at any
time during that period, but they would be limited to
30 minutes to finish it once started. The average suc-
cess rate for this quiz was 85%, i.e., 85% of all stu-
dents’ answers to the 13 unique questions were cor-
rect. However, only 15% of the answers were fol-
lowed by feedback reviews, meaning instances where
a student would tap on a given choice, either correct
or a distractor, after submitting their answer to read
the additional explanations provided by their simula-
tion teacher.
Next, the second quiz meant for the briefing step
of the pre-briefing was available from 2 November
to 6 November and contained 11 questions, with the
quiz expiring shortly before the simulation session.
The students were granted more time to finish the sec-
ond quiz once started, specifically 50 minutes, due to
some of its questions requiring them to watch videos
before answering. Similar to the first quiz, the success
rate was high at 83%, though in this case there were
no feedback reviews whatsoever.
As a final note, the days on which the students
played each quiz were spread out, especially in the
second quiz’ case. However, the first quiz was played
more often on either the first day or the day after it
became available, and no students played it over the
weekend. On the other hand, the second quiz was
also played over the weekend, most likely due to the
simulation being on the following Monday.
4.2 Questionnaire
After the simulation session, students were invited to
fill out a questionnaire, shown in Figure 1, to cap-
ture their impressions of the BEACON Q quiz app, as
well as how prepared they felt for the simulation. The
questions were primarily designed based on expert in-
sights along with past research (Sharoff, 2015).
The average student answers to the choice-based
questions 1 9 are given in Table 1, which firstly in-
dicates that 89.66% of the 29 students had used the
BEACON Q app. Next, 86.21% of the students had
played the preparation quiz, with only 55.17% find-
ing it helpful in preparing them for the simulation.
Furthermore, the briefing quiz, which included in-
structional videos in its questions, was completed by
82.76% of the students, though only 31.03% found
it useful. In the same context, their learning man-
agement system Moodle revealed that only 7 students
had viewed the instructional videos which were made
available outside of the mobile quiz app.
As for the students’ impression of our quiz-based
pre-briefing approach for improving how they notice,
interpret and respond during the simulation session,
50.00% found it helpful. Regarding what they had
taken away from both the pre-briefing and the simu-
lation session itself, 20.69% thought they were bet-
ter prepared for the future, while 15.52% felt more
confident in themselves. Only 6.90% thought their
skills had improved simulation, while 29.31% be-
lieved that they had gained the opportunity to reflect
on their actions. Additionally, 25.86% of the partici-
pants thought they had learned lessons from both their
own errors, as well as from their colleagues during the
simulation. Lastly, there were no students who felt
highly anxious about the simulation, with most hav-
ing low levels of anxiety.
Figure 1: Post-simulation questionnaire.
Regarding the last, free-form question of the ques-
tionnaire, 18 students had provided additional com-
ments, with 6 of them expressing that the quizzes
were not helpful, with comments such as ”I do not
think the quizzes were helpful in preparing us for the
simulation”. Their main concerns were about the con-
tent of the quizzes, though 1 student strongly opposed
the mandatory nature of the pre-briefing quizzes.
Next, 5 students suggested that the quizzes could
be beneficial if the quality of the content, pictures and
High-Fidelity Simulation Pre-Briefing with Digital Quizzes: Using INACSL Standards for Improving Effectiveness
Table 1: Post-simulation questionnaire results for the
choice-based questions.
Question Title Results
1. Mobile Quiz App Usage 89.66%
2. Completion of Preparation Quiz 86.21%
3. Helpfulness of Preparation Quiz Very helpful and Somewhat helpful: 55.17%
Slightly helpful and Not helpful: 44.83%
4. Completion of Briefing with Instructional Videos 82.76%
5. Helpfulness of Briefing for Simulation Preparation Very helpful and Somewhat helpful: 31.03%
Slightly helpful and Not helpful: 68.97%
6. Overall Effectiveness of Quiz-Based Pre-Briefing 50.00%
7. Feelings After Simulation (Reflecting) More confident: 15.52%, Better prepared: 20.69%,
Overall skills improved: 6.90%, Reflected on own actions: 29.31%,
Learned from errors and colleagues: 25.86%
8. If did not review preparatory material Yes: 0.00%, No: 50.00%, Not sure: 50.00%
9. Anxiety Level for Simulation Experience (No Review) Low: 100.00%, Medium: 0.00%, High: 0.00%
Anxiety Level for Simulation Experience (Review) Low: 55.17%, Medium: 37.93%, High: 6.90%
videos were improved. For instance, one student men-
tioned ”Clearer instructions, the photos taken for the
quiz on the mobile app were not taken optimally”. On
the other hand, 2 students found the quizzes helpful,
with one noting ”The pre-briefing quiz and the videos
were very helpful for today; I felt prepared before the
simulation [...]”.
Finally, 5 students mentioned that they would like
to have a debriefing session, although this is beyond
the scope of this research and questionnaire. For ex-
ample, one student commented ”Immediate feedback
will be great, so we can know what we did wrong.”,
i.e., they wanted their simulation teacher or an expert
to be present such that they could immediately give
the students individual feedback after the simulation.
Following our initial case study, we discuss rec-
ommendations for organizing a pre-briefing phase
based on our own quiz-based approach. Afterwards,
we evaluate our method against the INACSL stan-
dards (McDermott et al., 2021).
5.1 Recommendations
For our quiz-based method of pre-briefing, some key
areas can benefit from enhancements.
Primarily, there is the impression that the two
quizzes which were offered as part of the pre-briefing
did not cover enough content-wise: the students’ suc-
cess rate for them was significantly high (> 80%) and
in the questionnaires, they had not only noted that
the quizzes were not particularly helpful in preparing
them for the simulation, but some of the additional
comments explicitly stated that the quizzes did not
cover enough and that they were too simple. This
is a point which can easily be amended, as the stu-
dents did not necessarily have qualms with the mobile
quiz app itself, but rather the content of the quizzes.
Hence, the pre-briefing quizzes should be extended
with additional questions to go into more depth when
it comes to both the theory of the simulation scenario,
as well as the technical know-how required for inter-
acting with the manikin.
Furthermore, greater care should be taken when
preparing the demonstrative pictures and videos of
the manikin to be included both in the quizzes and
on their learning management system, such as paying
attention to the angle and lighting.
Next, it is important that the students also mas-
ter essential skills such as team-based communica-
tion (Livne, 2019), with the latter’s lack being noted
while observing the students trying to work together
to operate the manikin. For example, these team-
based skills would include how to efficiently dis-
tribute the tasks among the group members, as well
as assigning a leader at the start of the simulation to
ensure someone is managing the team as a whole and
keeping track of the required steps and guidelines.
Lastly, certain students opposed the fact that the
digital quizzes were considered prerequisites to par-
ticipating in the simulation session. We similarly be-
lieve this to not be the right approach, as the quizzes
should be offered as an additional learning aid, i.e.,
the students themselves should be free to plan their
preparation for the simulation based on all the re-
sources we provide them during the pre-briefing.
The reason for a less restrictive approach is that
intrinsic motivation (Cranney et al., 2009; Rodrigues
et al., 2021) to test yourself can reinforce the testing
effect, as opposed to extrinsic motivation, e.g., where
the teacher forces their students to test themselves
through quizzes. The purpose of testing is to improve
the student’s long-term retention and to enhance their
future restudying efforts, not to actually teach them
the material. Rather, it is important that the students
still study in addition to testing themselves.
As a result, we propose that the pre-briefing
should not be mainly based on quizzes, but rather on
a set of resources, such as written guides and demon-
strative videos, which the students would firstly study
before moving on to the quizzes to practice their
knowledge. This would form a loop, where the stu-
dents would go back and forth between studying their
material and testing what they have retained through
CSEDU 2024 - 16th International Conference on Computer Supported Education
the quizzes until they feel confident enough in being
prepared for the simulation.
5.2 INACSL Standards
INACSL has established a set of standards for simula-
tion under the title ”Healthcare Simulation Standards
of Best Practice” (HSSOBP), which cover aspects
such as ”professional development, ”simulation de-
sign,” ” interprofessional education,” ”debriefing pro-
cess” and ”learning and performance evaluation” (Vi-
olato et al., 2023). In particular, pre-briefing (Penn
et al., 2023; Miller et al., 2021) was included as one
of the standards (McDermott et al., 2021), based on
which we have created a checklist for evaluating our
method, as shown in Figure 2. A high-fidelity simu-
lation expert, who was responsible for managing the
simulation session, was asked to fill out the form. We
believe this following set of recommendations to be
particularly useful, as a recent review (Barlow et al.,
2024) noted that few studies clearly articulate how
their methods aligned with these standards.
Figure 2: Pre-briefing evaluation checklist based on the IN-
ACSL standards (McDermott et al., 2021).
Based on the expert’s feedback and our analysis
of the case study results, we have compiled improve-
ments for our pre-briefing method according to each
criterion in the INACSL standards (McDermott et al.,
Criterion 1: for our case study, the simula-
tion manager was an experienced anesthesiolo-
gist who, in collaboration with a medical infor-
matics researcher, implemented the pre-briefing
(videos, quizzes). However, we recommend in-
volving more experts, particularly ones who spe-
cialize in high-fidelity simulation, e-learning and
psychology, such that they can set up a compre-
hensive set of quizzes and resources to prepare the
students for the simulation.
Criterion 2: meeting the learning objectives be-
comes a difficult task when only using digital
quizzes and videos. Rather, we think it is still
necessary to rely on traditional methods, such as
written learning material, to teach the required
knowledge to the students during the pre-briefing.
Quizzes can help the learners in re-orienting their
studying efforts and improving their retention, as
has been shown with the testing effect (Arnold
and McDermott, 2013; Izawa, 1971), but they are
not a substitute for other resources such as lec-
tures meant to teach the content as a first step.
Digitization can facilitate access to the learning
material, e.g., with the help of a mobile quiz app,
but the content itself should not be reduced in the
process by purely relying on quizzes, which are
not an ideal teaching medium.
Criterion 3: although we designed preparation
quiz questions based on research. However, based
on the students’ post-simulation feedback, the
pre-briefing quizzes would benefit from more in-
depth questions specifically in terms of the theory.
To that end, the content of the quizzes needs to be
better aligned with the student’s curriculum, such
that the questions do not appear as simple repeti-
tions of topics they have already studied recently.
Rather, the quizzes should also fill any gaps in
knowledge in terms of concepts not typically cov-
ered in their lectures and similarly allow the stu-
dents to test themselves with practical questions.
Criterion 4: to aid the learning experience, more
general resources regarding psychology should
also be provided to the students, rather than only
covering the simulation scenario’s topics.
Criterion 5: a diverse set of formats for the pre-
briefing material can be useful, as each student
has their preferences when it comes to how they
study. As such, while digital quizzes and audio-
visual material may seem helpful for some, tradi-
tional methods such as written guides should also
be offered to support a broader range of learning
Criterion 6: based on the students’ own com-
plaints from our case study, we recommend of-
fering the pre-briefing resources, including in dif-
ferent formats as previously noted, though with-
High-Fidelity Simulation Pre-Briefing with Digital Quizzes: Using INACSL Standards for Improving Effectiveness
out imposing a requirement that they must com-
plete a certain set of tasks before being allowed
to participate in the simulation. The simulation
itself is what the students are to be evaluated on,
meaning how they prepare themselves during the
pre-briefing should not matter to the teacher. Pro-
viding the students with the learning material,
while still giving them the freedom to organize
their preparation can best suit each student’s self-
regulated learning.
Criterion 7: as per our observations and results,
we need to apply all steps in the current Criterion
in the following study. We highly recommend
preparing a comprehensive document covering all
aspects, especially students’ roles and team-based
communication, in any suitable format.
Criterion 8: we found that teaching the modalities
of the high-fidelity manikin was difficult through
the digital quizzes. Instead, we would suggest
not only written tutorials explaining the manikin’s
functionality but also a virtual simulation room
tour before the actual session. The latter would
not only help the students get a hands-on expe-
rience with the general controls and monitoring
displays of the manikin, but it could also reduce
their anxiety by familiarizing them with the envi-
Criterion 9: an issue we faced with our case study
was the limited amount of time we could dedicate
to each simulation group. This lack of time not
only made the students feel pressured to quickly
learn how to handle the manikin before being able
to start with the basic life support scenario, but it
also did not allow the simulation teacher to offer
individual feedback to each student after the ses-
sion. While debriefing was not the focus of our
work, it is still an important aspect in reinforcing
the students’ learning outcomes. As a result, we
recommend allocating more hours for simulation
in the curriculum to allow teachers much time to
manage all phases of the simulation session and
cover all aspects of this criterion.
Pre-briefing can greatly help in preparing students for
high-fidelity simulations with manikins. Our work
proposed a testing-based approach through the us-
age of digital quizzes whose difficulties are adapted
to each learner’s skill level, as well as demonstrative
videos. Our case study revealed that this testing fo-
cus is not enough, as the students still require learning
material such as written guides and lectures to acquire
the required knowledge. Testing can improve their re-
tention and help them identify topics they have not
mastered yet, but it cannot teach the underlying con-
tent effectively. Based on our findings and based on
the INACSL pre-briefing criteria, we proposed several
improvements for our method to achieve comprehen-
sive pre-briefing.
For future work, we intend to implement the pro-
posed improvements and conduct additional simu-
lations using our pre-briefing approach. Given the
importance of debriefing, we are developing a plan
to provide students with automatic and personalized
debriefing reports by integrating proactive comput-
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ter simulations.
The researchers would like to express their gratitude
to the participants for their contribution to this study
and are grateful to the medical teaching team for their
support and guidance.
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High-Fidelity Simulation Pre-Briefing with Digital Quizzes: Using INACSL Standards for Improving Effectiveness