Effects of reflection-through-action on collaborative clinical reasoning skills in an emergency dental simulation
- 1Department of Learning Health Sciences, School of Information Victor Vaughan, University of Michigan Medical School
- 2Department of Neurology, University of Michigan Medical School
- 3University of Michigan School of Dentistry
Abstract
Background Simulation-based training is a central component of healthcare education. However, most current instructional designs emphasize post-simulation debriefing, while reflection during the simulation itself, termed reflection-through-action, remains understudied. Prior empirical evidence suggests that structured reflective pauses may enhance learners’ metacognitive regulation and diagnostic and intervention clinical reasoning, though whether these learning gains transfer to subsequent, novel clinical scenarios is unknown. This study examined whether reflection-through-action during an initial emergency simulation enhances the translation of technical skills and collaborative clinical reasoning practices in a subsequent emergency simulation among dental students. Methods In this mixed-methods study, 110 dental students were randomized into teams and completed two sequential medical emergency simulations. Six experimental teams received structured reflection-through-action during the first simulation, consisting of a guided pause with written prompts and a structured PARSE (Pause–Analyze–Reflect–Strategize–Execute) debrief, while six control teams completed the simulation without reflective pauses. Outcomes accounted for prior knowledge and team familiarity and included expert-rated technical and non-technical performance, self-reported learning confidence, and behavioral process-level analyses using Epistemic Network Analysis (ENA) of team conversations during the second simulation. Results Controlling for prior knowledge and team familiarity, no differences were seen in expert-rated technical or non-technical performance or in self-reported learning confidence between groups. However, ENA revealed important structural differences in the collaborative clinical reasoning displayed during the second simulation. Learners who engaged in reflective pauses demonstrated stronger connections between suggesting/requesting action, planning interventions, and intervening actions, indicating a greater connection between diagnostic reasoning and treatment management. In contrast, control teams showed weaker connections between planning and action, with conversations emphasizing procedural explanations, disconnected suggestions, and unfocused patient history questions. Conclusion A structured reflective pause did not produce immediate differences on traditional performance metrics but revealed meaningful changes in collaborative clinical reasoning including how teams organized diagnostic, planning, and action during a subsequent emergency simulation. These findings suggest that reflective pauses reshape the structure of a team’s clinical reasoning and support near (contextually similar) and proximal (temporal) learning transfer. ENA offers a more sensitive and analytic approach than traditional performance-based outcomes for detecting differences in team-based collaborative clinical reasoning.
Related
- Unlocking the power of reflection: how simulation debriefing shapes clinical decision-making and competence in nursing students
- Clinical expertise and cognitive reflection predict fewer misconceptions in Bayesian diagnostic reasoning
- inproTeamED - clinical reasoning in the emergency department as an individual and interprofessional process: a qualitative analysis.
- Self-Reflection Resilience-Recovery Activity Promotion Training for Emergency Medical Service Clinicians: A Randomized Controlled Pilot Trial of a Novel Digital Intervention
- Where did it go? How Information Management Practices Impact Rigor and Reproducibility in Collaborative Clinical and Translational Research
BibTeX
@article{glowski2026effects,
title = {{Effects of reflection-through-action on collaborative clinical reasoning skills in an emergency dental simulation}},
author = {Lauren Glowski and Nikolas Grotewold and Sarah Tomaka and Theodora E. Danciu and Vitaliy Popov},
journal = {Advances in Simulation},
year = {2026},
month = jul,
doi = {10.1186/s41077-026-00463-6},
url = {https://doi.org/10.1186/s41077-026-00463-6},
note = {CC BY},
}
RIS
TY - JOUR
TI - Effects of reflection-through-action on collaborative clinical reasoning skills in an emergency dental simulation
AU - Lauren Glowski
AU - Nikolas Grotewold
AU - Sarah Tomaka
AU - Theodora E. Danciu
AU - Vitaliy Popov
PY - 2026
DA - 2026/07/01
JO - Advances in Simulation
DO - 10.1186/s41077-026-00463-6
UR - https://doi.org/10.1186/s41077-026-00463-6
AB - Background Simulation-based training is a central component of healthcare education. However, most current instructional designs emphasize post-simulation debriefing, while reflection during the simulation itself, termed reflection-through-action, remains understudied. Prior empirical evidence suggests that structured reflective pauses may enhance learners’ metacognitive regulation and diagnostic and intervention clinical reasoning, though whether these learning gains transfer to subsequent, novel clinical scenarios is unknown. This study examined whether reflection-through-action during an initial emergency simulation enhances the translation of technical skills and collaborative clinical reasoning practices in a subsequent emergency simulation among dental students. Methods In this mixed-methods study, 110 dental students were randomized into teams and completed two sequential medical emergency simulations. Six experimental teams received structured reflection-through-action during the first simulation, consisting of a guided pause with written prompts and a structured PARSE (Pause–Analyze–Reflect–Strategize–Execute) debrief, while six control teams completed the simulation without reflective pauses. Outcomes accounted for prior knowledge and team familiarity and included expert-rated technical and non-technical performance, self-reported learning confidence, and behavioral process-level analyses using Epistemic Network Analysis (ENA) of team conversations during the second simulation. Results Controlling for prior knowledge and team familiarity, no differences were seen in expert-rated technical or non-technical performance or in self-reported learning confidence between groups. However, ENA revealed important structural differences in the collaborative clinical reasoning displayed during the second simulation. Learners who engaged in reflective pauses demonstrated stronger connections between suggesting/requesting action, planning interventions, and intervening actions, indicating a greater connection between diagnostic reasoning and treatment management. In contrast, control teams showed weaker connections between planning and action, with conversations emphasizing procedural explanations, disconnected suggestions, and unfocused patient history questions. Conclusion A structured reflective pause did not produce immediate differences on traditional performance metrics but revealed meaningful changes in collaborative clinical reasoning including how teams organized diagnostic, planning, and action during a subsequent emergency simulation. These findings suggest that reflective pauses reshape the structure of a team’s clinical reasoning and support near (contextually similar) and proximal (temporal) learning transfer. ENA offers a more sensitive and analytic approach than traditional performance-based outcomes for detecting differences in team-based collaborative clinical reasoning.
SN - 2059-0628
ER -