Organization of the educational environment is an important factor influencing the level of realization of the assumed educational goals. Medical simulation is a special kind of educational environment. Due to legislative changes concerning the standards of education in medical faculties, it has become a popular and necessary method of effective implementation of the contents of the curriculum. Simulated environment, defined in the standard of education as simulated clinical conditions, optimally used, brings with it a great educational potential. The full use of the resources of this type of environment consists of, among others, the attitude of the student and teacher to work with simulation methods. In this paper, therefore, an attempt has been made to examine the perspectives of students and academic teachers in the context of the conditions associated with the implementation of the curriculum using a simulated environment (7).
Medical simulation is certainly a specific educational environment, which should meet specific requirements in order for the educational activities to produce the expected results. Researchers attempt to define the role of simulation in medical education (8, 9). Reynolds et al. (2008) present research aimed at assessing the impact of medical simulation-based teaching on students' knowledge and satisfaction with the teaching process. They conducted research in connection with the course of Obstetrics and Gynaecology. The results of these studies presented by them indicate that classes based on medical simulation increase students' satisfaction with the teaching process (10).
Undoubtedly, a strong point of organizing the learning process in a simulation environment is the possibility of implementing specific content while maintaining patient safety. The student has the ability to undertake activities and procedures in a repetitive manner, without exposing the potential patient to risk. At the same time, the simulation environment is a reflection of the conditions that will most likely be found in the work environment in the future. This translates into the process of using the acquired knowledge and skills. Healthcare professions require not only technical skills or knowledge of specific medical procedures. It also requires future physicians and nurses to have non-technical skills, make decisions, work in a team, communicate with patients of different ages and needs (11). Classes conducted by students in simulated conditions provide an opportunity to practice and acquire these skills which are necessary for future work.
Despite the benefits of using medical simulation in teaching, it also has its limitations. Bokken et al. (2008) attempted to identify the strengths and weaknesses of the real and simulated patient in pre-diploma education. Their research shows that each type of patient has its own advantages and disadvantages from the perspective of teachers, students and patients themselves. At the same time, researchers stress the need to deepen the knowledge on the role of patients in medical education (12).
Hssain et al. (2012) stresses the need to know how to use simulation techniques in order to ensure their proper use in the teaching process and the need to use medical simulation at an appropriate stage of the educational process. Researchers emphasize that the effectiveness of simulation methods is influenced by their combined use with traditional methods. Therefore, this issue should be consciously planned by educators. Other limitations on the use of simulated methods include the high costs associated with the use of simulated methods in the educational process (13). Not every unit that educates students in medical faculties has the financial and accommodation capacity to use the method of medical simulation in teaching.
The Questionnaire for Evaluation of Satisfaction of Simulation Training Student in Simulation Questionnaire (QuESST) is a summary of aspects related to simulation experience and organization of the simulation environment as an educational environment. Standards for this method were calculated based on quartiles. The questionnaire takes into account, among others, the content related to the attitude, involvement and preparation of academic teachers for classes, organization of classes and the level of realism of classes. Students may also assess how engaging the classes are for them in simulated conditions, to what extent they give them the opportunity to learn practical skills and to what extent they improve students' communication skills. The QuESST questionnaire therefore takes into account a wide spectrum of the organization of simulation classes, as well as the content related to the opinion on academic teacher and self-evaluation of students in the context of simulation classes.
Very interesting correlations were obtained by using a correlation analysis between the overall result of the QuESST questionnaire and the overall result and the individual scales of the DREEM questionnaire. Both the overall results of the QuESST and DREEM tools, as well as the overall result of QuESST and the results of individual DREEM scales correlated significantly with each other statistically. These correlations mean that the increase in the overall score of the QuESST questionnaire was linked to the increase in the overall score and the results of the individual scales of the DREEM questionnaire. The assessment of the educational environment was therefore related to the assessment of the simulation conditions by the students. The assessment of the educational environment could be based on the students' satisfaction with the experience with simulation. The QuESST method seemed to confirm this relationship in a good way. High correlations between the QuESST authoring tool and the existing DREEM tool may suggest a high psychometric value of QuESST.
The described educational environment seems to be very important. It is a kind of basis for the development of conditions in which learning will be organized using simulation methods (14, 1, 15). A well-organized general educational environment can be the first step in the further planning of education in simulated conditions.
The simulation environment requires appropriate preparation of teaching conditions, appropriate embedding in the curriculum and organization from the administrative point of view, high level of content, appropriate attitude of persons leading to the content, ability to interact with students, ability to design scenarios and course of classes (16). Even a small inconvenience on the part of technical equipment may disturb the course of classes and their realism.
Proper design and construction of the educational environment seems to be important from the perspective of optimizing the learning process. This is particularly important from the perspective of the teaching process in medical faculties, where students often have to face real-life situations in a hospital or clinic. Adaptation of the DREEM tool seems to be important for the proper assessment of the educational environment. Additionally, in order to specifically capture the conditions of the simulation environment as an educational environment, it seemed necessary to construct an appropriate tool. The QuESST tool seems to capture well the aspects related to the educational process in the simulation. The proper design of the educational process allows for the realization of the content of the teaching process and the achievement of the assumed educational goals. It is also needed to undertake further work on strengthening the construction and psychometric values of the QuESST tool.