Presented By: Ryan Hunton, University of Kentucky
Co-Authors: Patrick Palmieri, A.T. Still University

Purpose 
The purpose of this study was to describe the role of high-fidelity clinical simulation (HFCS) in teaching and assessing clinical reasoning. It aimed to describe the strengths and challenges of using HFCS as well as the potential opportunities and barriers to using HFCS. 

Methods 
A qualitative descriptive design was used to describe the role of HFCS. The principal investigator collected perspectives of clinical educators from North America and Europe through semi-structured interviews. Data from the interviews was analyzed through a manifest content analysis. Categories, which emerged from the data, were applied to the research questions. 

Results 
Eleven (11) clinical educators from physician, nursing, physician associate, and paramedic professions in North America and Europe participated. Educators identified the following strengths of HFCS: (1) spectrum of possible scenarios, (2) engagement and immersion in real-life situations, (3) debriefing as self-reflection and peer learning, (4) clinical errors in safe space, and (5) building emotional intelligence. Challenges included: (1) lack of validated assessment tools, (2) lack of translation data, and (3) threats to psychological safety. Potential opportunities for HFCS included: (1) integration into curriculum, (2) integration into hospitals, and (3) increasing technology. Barriers included (1) various monetary and non-monetary costs and (2) culture, including lack of faculty development opportunities. Themes from this research included: (1) HFCS plays a unique and important role in clinical reasoning education; (2) its use should be driven based on learner level and learning objectives; (3) its use will likely continue to grow in educational and clinical institutions; and, (4) there is much work to be done in overcoming challenges and barriers. 

Conclusion 
This diverse set of inter-professional clinical educators identified several unique strengths of HFCS which define its unique and important role in clinical reasoning pedagogy and assessment. There is potential for the expansion of HFCS into educational and clinical settings. However, fundamental barriers and challenges may limit its use.