Simulation-based teaching methods have become ubiquitous across educational programs in many professions. Cannon-Bowers and Bowers (2009) refer to these methods as “synthetic learning environments”, as they are characterized by technology-enabled instructional environments that are actively based on representations of some relevant real-life processes or activities through simulation, games, or virtual worlds.

Simulations provide a safe environment to train on risky operations that can be difficult to get sufficient practice on in real life (Chernikova et al., 2020). The simulated environment allows the instructor¹ to manipulate events and use recorded data (audio, video, or action logs) for educational purposes. Simulations can also be flexible, efficient, and cost-effective, as they can have low transition costs when accessing and changing between different scenarios, as opposed to more rigid environments for on-the-job training (Kim et al., 2021).²

In this article, we compare simulation-based training in three fields, asking how instructors in bachelor programs for professional education use and evaluate the role of technology in simulation-based teaching methods. To answer this question, we conducted a survey targeting instructors’ bachelor-level educational programs in nautical studies, biomedical laboratory science (BLS), and nursing studies in Norway, Sweden, and Denmark. Empirical insights about how instructors in different fields use and evaluate these technology-intensive and often costly pedagogical practices can be conducive for further qualitative analysis, theoretical developments, and cross-disciplinary learning. In this article, we focus our comparison on practices between, and not national differences within, professions.

Below we provide a brief introduction to simulation-based teaching methods in the three different professional education programs. Materials and methods are described, before we present data on instructors’ choice of technology, their frequency of use, opinions about what makes a good simulation exercise, and their assessments of current use and available technologies. The findings show distinct practices and important similarities, which are highlighted in the subsequent discussion. In conclusion, we suggest paths for further exploring our findings.

Our empirical data stems from a survey targeting instructors teaching simulation-based methods across three bachelor-level studies in Norway, Sweden, and Denmark.

The survey questionnaire was organized into four sections. The first focused on the instructor’s background. The following two focused on design choices in different phases of the simulation activity, from planning to the execution and follow-up with students. In this section, we identified ten simulation modalities and asked the respondents to report which they used and how often (seven categories from daily to do not use, here presented as four categories for readability). The final section asked instructors to evaluate different claims about the use of simulation as a teaching method and factors influencing instructors’ choices regarding such methods. We asked respondents to report these questions using a Likert scale from 1 to 5 (the most negative sentiment, to a very little extent, or similar, was given the value 1).

Initially, the survey was designed in Norwegian by a cross-disciplinary group of researchers and practitioners with knowledge about simulation to ensure valid terminology and questions that worked across the fields. Next, the instrument was piloted by an instructor from each of the respective fields. The ten forms of simulation technology identified in the survey were defined through group discussions, with the instructors piloting the survey also being asked if the listed options were adequate. Identifying categories that were meaningful across professions was a challenging part of the design. The final survey was translated to Danish, Swedish, and English. Our translations were quality-checked by native speakers with relevant thematic competence. In the analysis, the four datasets (one from each language) were merged and exported to SPSS. In addition to various descriptive analyses on the dataset, we performed a Kruskal-Wallis test (KW test). Here, we compared the respondents’ professional field (dependent variable) with their attitudes toward technology use (independent variable). The null hypothesis was that there would be no group-level differences between respondents’ professional backgrounds and their responses to the specific variables being tested. The significance level for the rejection of the null hypothesis was set at 0.05. A post hoc, pairwise comparison of professional fields explored how responses differed in cases where the null hypothesis was rejected in favor of the alternative (at least one group being significantly different from the others regarding the dependent variable).

The survey included questions aimed at evaluating whether the instructors were content with the technology they currently had available to do simulations. When asked whether “the simulation technology makes it possible for us to realize the learning activities that we want in simulation”, instructors across the three fields are content overall (mean score of 3.74/SD 1.104). Moreover, when asked to evaluate the claim “I often find myself in a situation where I want a technology other than the one available to be able to reach defined learning outcomes” (1 = to a very small extent), the mean score was 2.16 (SD 1.096). This indicates they are overall satisfied with their options. Instructors from nautical studies appear more content with the available technology than instructors from nursing studies and BLS instructors (with the latter being the least positive in their assessments).

Besides asking how much time different instructors spend on simulation-based methods, we also asked for their assessment about whether they spend too much time on simulation.

Figure 4 shows that most respondents disagreed with this statement. Both nautical and nursing studies strongly disagree (1), while BLS has a median of 2.

In this study we are concerned with two aspects of simulation-based training: as a way of doing instruction (technique), and as a set of tools to accomplish the job (technologies). Gaba (2004) underscored this important distinction in order to avoid reducing simulation-based training to mere technology. As a way of doing pedagogy, a technique, our survey shows that respondents draw on a myriad of technologies to facilitate simulation-based training for students. There are both interesting similarities and salient differences between the three fields.

A key concern relates to the simulation modalities and their use frequencies. The results suggest noticeable contrasts between the three fields, raising questions about potential differences in pedagogical assumptions across these professional educations. Our results show a clear difference in frequency of use: nautical studies and BLS instructors take their students into simulation exercises more often than nursing study instructors do.

The two fields that most frequently adopt simulation-based training rely on different technological modalities. Nautical study instructors most often use advanced simulators, while BLS instructors rely on laboratories and areas of skill training, in addition to objects or instruments for skills training. More in-depth studies are needed to explore what this difference in modality signifies. Our study shows that BLS instructors give less weight to the dimension of social realism in simulation training than the two other fields. A question for future research is how choices about technological modality relate to pedagogical ideas regarding the role of skills training or more complex scenarios, respectively.

Nursing draws on all the listed modalities, but instructors use simulations less frequently than in nautical studies and BLS. An obvious factor that may account for this difference is the larger cohort of students in nursing compared to nautical studies and BLS. Consequently, simulation-based training in nursing studies may require more resources and time to conduct. Still, when our respondents are asked to evaluate how various factors like time, teacher resources, and material conditions affect their abilities to optimize teaching, they are quite positive across the board (3.82–3.96). Moreover, the median score for nursing instructors was higher (5) than for the other two fields. This is somewhat surprising given the observed differences in use-frequency (and considering differences in class size). Use patterns in nursing education might therefore involve a bootstrapping type of situation, where instructors consider the current level of simulation-based training feasible given the size of student groups and available resources. Further analysis of the practical implications of these differences is needed in order to better understand the underlying pedagogical assumptions and drivers. Another possible explanation for differences in use-frequency is that nursing studies have considerably more work practice in the curriculum, compared to the other two fields. According to this logic, we should see differences between countries depending on if they integrate the practice period in the bachelor. Our data does not support this inference, and further studies that specifically look at the role of integrated practice are encouraged.

Another notable result is the vast use of different forms of simulations across the three professional fields. Of the ten simulation modalities listed in our survey, eight were used in all three education programs. An intriguing exception was AR and VR, which had no reported users in BLS and were rarely used by instructors from nautical and nursing studies. Instructors do not seem to experience this as a problem, as indicated by their responses to the question of whether they are satisfied with current technological options. Alternatively, instructors do not have sufficient knowledge about VR and AR as simulation technologies to know what they are missing out on. These results show that instructors from all three fields generally appear to be content with the pedagogical opportunities afforded by their simulation technology and the available options for technology.

In general, instructors do not agree with the statement that they spend too much time on simulation and appear to value it as a teaching method. Here, instructors from both nursing and nautical studies strongly disagree (median score 1), which suggests that they would like to spend more time simulating. Our results also suggest that instructors from all three professions consider successful simulation exercises to substantially reproduce both the technical and interactional aspects of the real-world environments where students will conduct their work. Particularly interesting is the degree to which instructors emphasize the significance of stories and anecdotes in creating a meaningful experiential context for their students.

Our sample of instructors appears confident in their ability to conduct simulation-based teaching. The survey included three different statements asking them to evaluate their competence in simulation-based methods: two asking instructors to evaluate their own and colleagues’ competence in simulation as a teaching method, and one asking about their expertise in utilizing the simulation technology. These statements are interesting to examine together. Among nautical instructors, all three statements were scored as equally important. BLS instructors have the most confidence in their colleagues’ competence (4), followed by their own competence in the teaching methods (3.5) and the least confidence in their knowledge of the technology (3). Most notable is the score among the nursing study instructors. Nursing instructors report high confidence in their own and colleagues’ competencies about the teaching method (5), with a remarkably lower confidence in their own expertise about simulation technology (3). These results suggest that high confidence in competence for simulation-based teaching is not primarily due to confidence in mastery of the simulation technology, but other factors. Further studies are needed to explore the observed difference between nautical studies and nursing instructors. A place to start might be the observed differences in use-frequency and gender composition in the two fields.

Comparing three distinct professional fields in this manner introduces both strengths and weaknesses to the present study. One limitation pertains to the population under study, as the available time and resources necessitated distinct recruitment strategies across the fields. Although control over the entire nursing population was unattainable, clear selection criteria were employed to address this limitation. Also, surveying across three professional fields with different terminologies led to compromises in question design. Moreover, our comparative angle required a pragmatic stance, leading us to consolidate important nuances, like those between skills-based and scenario-based training forms, into a single category of simulation. This choice originates from an acknowledgment that in-depth qualitative inquiry is needed into how the various disciplines define what these concepts entail, as well as how they use the various modalities for these forms of training. However, these cross-disciplinary comprises are also a strength as they enabled a unique perspective and an empirical base for further study, both empirical and theoretical.

This article provides an empirical state of the art on the use and evaluation of technology facilitated simulation-based teaching methods among Scandinavian instructors in three professional fields. Our findings reveal a general positive sentiment toward simulation technology, as most instructors are quite happy with their existing options and their ability to employ them effectively. However, the three fields differ in terms of use-frequency and choice of technological modality. While this study incorporates relevant variables to potentially account for these discrepancies, more research is needed to give a satisfactory explanation of why these differences exist. For instance, how do these observed differences relate to epistemic views about methods, professional practice, and technology as mediating tools for training? Exploring these findings further, in dialogue with both in-depth qualitative studies of practice and the simulation literature, might further elaborate on how synthetic learning environments are operationalized in different professional environments. This endeavor has the potential not only to shed light on similarities and distinct approaches taken but also to stimulate cross-disciplinary debate about the proper role of technology in simulation-based training.

The research is funded by the Norwegian Research Council #316212. Thanks to all participants as well as to our wider project team for productive feedback on the design and interpretation of the results.