Education that empowers? A critical realist evaluation of a novel incivility-focused immersive simulation

Background When we experience incivility, or rudeness, our performance suffers, negatively impacting patient safety. Immersive simulation-based education (SBE) has been under-explored as an educational strategy that may empower individuals to challenge incivility. Psychological empowerment was conceptualised by Spreitzer as four cognitive domains (meaning, competence, self-determination, and impact) that influence motivation and an active orientation towards work. We aimed to explore the mechanisms underlying the influence of incivility-based immersive SBE on the experiences of medical registrars when facing workplace incivility. Methods We situated this study within a critical realist paradigm, a philosophical stance which aims to provide explanatory power to understanding the mechanisms that drive social reality. We conducted semi-structured interviews with 11 medical registrars at least four months after an incivility-based immersive simulation scenario. Interviews focused on participants’ experiences and reflections of workplace incivility, and the potential impact of their simulation experience. Data were analysed using template analysis, utilising Spreitzer’s theory of psychological empowerment as the guiding framework. Results Incivility-based SBE stimulated powerful reflection relating to the cognitive domains of psychological empowerment. Meaning encompassed a sense that civility was important, with subthemes of awareness and advocacy across boundaries. Competence referred to having the skills to manage incivility, with subthemes of mindful response, self-regulation and perspective taking. Self-determination related to having autonomy when experiencing incivility, with subthemes of identity formation and risk assessment. Impact was conceptualised as socio-structural mediators of transfer to practice, with subthemes of socio-political support, participatory culture, and systems. Conclusions We highlight the role of immersive SBE as a powerful tool to explore workplace incivility. SBE may influence behavioural change through provoking reflection related to psychological empowerment. We explore SBE as an influencer of the nuanced risk assessment that occurs when individuals face incivility. This framework of psychological empowerment has utility in designing effective SBE focused on relational aspects of work.