The Effects of Reflective Pauses on Performance in Simulation Training

Joy Y Lee*, Jeroen Donkers, Halszka Jarodzka, Géraldine Sellenraad, Tjitske J E Faber, Jeroen J G van Merriënboer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


INTRODUCTION: The reflective pause, taking a pause during performance to reflect, is an important practice in simulation-based learning. However, for novice learners, it is a highly complex self-regulatory skill that cannot stand alone without guidance. Using educational theories, we propose how to design cognitive and metacognitive aids to guide learners with the reflective pause and investigate its effects on performance in a simulation training environment.

METHODS: These effects are examined in four aspects of performance: cognitive load, primary performance, secondary performance, and encapsulation. Medical students (N = 72) performed tasks in simulation training for emergency medicine, under 2 conditions: reflection condition (n = 36) where reflection was prompted and guided, and control condition (n = 36) without such reflection.

RESULTS: The effects of reflective pauses emerged for 2 aspects of performance: cognitive load decreased and secondary performance improved. However, primary performance and encapsulation did not show significant difference.

CONCLUSIONS: The results demonstrate that reflective pauses with cognitive and metacognitive aids implemented can enhance some aspects of performance. We suggest that to secure these effects, feedback during reflection and an adaptation period should be provided.

Original languageEnglish
Pages (from-to)82-89
Number of pages8
JournalSimulation in Healthcare: journal of the society for simulation in healthcare
Issue number2
Early online date21 Apr 2023
Publication statusPublished - 1 Apr 2024


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