Exploring the Boundaries of Deception in Simulation: A Mixed-Methods Study

Background: Deception can be defined as causing someone to accept a falsehood as true. Within simulation, a deception is an aspect of the environment for which there is no clear agreement or knowledge among facilitators and learners about its ground rules, boundaries, or existence. The psychological literature surrounding deception is mixed, and little simulation-specific research exists. Methods: This mixed-methods survey-based research explored attitudes for and against deception's use and facilitator perceptions of psychological risk and ethical harm. Subjects consisted of a random sample of members from three international simulation societies that included nurses, physicians, standardized patients, and educational specialists. The survey was designed and tested using an iterative process and distributed using SurveyMonkey™. Descriptive statistics and thematic analyses were performed. Results: Eighty-four (11%) of surveys were completed. Thirty-three percent of respondents currently use modification/deception, whereas 61 to 75% of respondents expressed psychological and ethical concerns. Thematic analysis yielded five themes: types of modification/deception, decision-making considerations and guardrails, never events (high risk), potential detriments, and potential benefits. Conclusions: The use of deception appears relatively prevalent in the simulation community, but significant concerns also exist. Careful consideration of all relevant factors is needed if deception is to be used responsibly.