Is simulation always a safe learning environment? Anxiety and social anxiety symptoms in first-year medical students during simulated patient encounters

BACKGROUND: Interpersonal contact is essential for health professions. Simulation with actors in a safe, protected environment followed by feedback from teachers and simulated patients can positively impact anxiety symptoms related to social anxiety, which this project focuses on. OBJECTIVES: To assess social anxiety in medical students and their relationship with practical simulations during the first year, determining the prevalence of social anxiety; and to qualitatively analyze students' narratives about simulations with simulated patients. METHODS: Self-administered questionnaires measured social anxiety (LSAS - Liebowitz Social Anxiety Scale) and trait anxiety weeks before the experience, and monthly on simulation days, assessing LSAS and state anxiety. Free narratives on expectations (before) and experiences (on simulation day) were collected. RESULTS: The mean baseline LSAS was 56.66 ± 26.71; mean trait anxiety was 49.03 ± 12.05. Expectations showed high motivation and recognition of the learning potential and personal development through simulations, but also anxiety, nervousness, self-doubt, and insecurity. On simulation days, 80 students gave 107 responses; mean LSAS was 51.95 ± 28.49, not significantly different from baseline (p=0.30). Mean state anxiety was 48.93 ± 10.75. Among 21 students with repeated responses, no significant change was found in state anxiety (p=0.66) or LSAS (p=0.09) over time. Qualitative analysis highlighted anxiety and performance insecurity, but also ambivalence, with reports of fear alongside pleasure and gratitude. Students saw simulations as opportunities for self-reflection and growth in a safe space to learn from mistakes. CONCLUSION: High anxiety linked to simulations is a concern and should be addressed in simulation planning to ensure a psychologically safe learning environment. Social anxiety may hinder clinical performance and should be addressed in health professions education.