The contribution of instructor presence to social evaluation anxiety, immersion and performance within simulation-based learning environments: a within-subject randomised cross-over trial with paramedic students


instructor presence
paramedic education
social evaluation anxiety

How to Cite

Mills B, Carter OB, Ross NP, Quick JK, Rudd CJ, Reid DN. The contribution of instructor presence to social evaluation anxiety, immersion and performance within simulation-based learning environments: a within-subject randomised cross-over trial with paramedic students. Australasian Journal of Paramedicine [Internet]. 2016May1 [cited 2023Jan.31];13(2). Available from:



Previous research suggests removing instructors from simulation-based learning environments is popular with students who report greater task immersion and decreased anxiety. However, the specific impact of social evaluation anxiety on students’ immersion and performance remains equivocal.


N=31 paramedic students completed two simulation-based clinical scenarios in random order, one in the presence of an instructor and one without. Students’ distraction and time-to-completion were quantified via review of head-mounted video cameras, anxiety via continuous heart-rate (HR), and performance via two expert assessors reviewing video footage using a structured clinical assessment checklist. One-on-one, in-depth interviews followed with 12 randomly selected students.


Students completed scenarios 1.8 minutes quicker when instructors were ‘absent’ compared to ‘present’ (6.6 vs. 8.4 min, p<.001), approximately half of this additional time was spent interacting with instructors (61.4 sec, SD=33.4). Peak HR was higher in the instructor ‘present’ than ‘absent’ group (121 vs. 116 bpm, p=.035), but no between-group difference was found for average HR (98 vs. 100 bpm, p=.407). Interview data suggested students felt greater stress in the presence of instructors. No statistical difference was evident between students’ performance scores in the instructor ‘absent’ versus ‘present’ conditions (71.6% vs. 69.4% respectively, p=.314).


Students were more immersed, reported being less stressed and distracted, and were significantly quicker at completing clinical tasks with instructors absent, with no detriment to performance. Removing instructors during simulation-based training is likely to enhance students’ immersion and potentially decrease social evaluation anxiety, but immediate performance is unlikely to improve.


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