We read the abstract by Leonard et al. [1] highlighting the use of high-fidelity simulation to increase medical students’ confidence in the management of paediatric emergencies with a degree of relatability. We too recognize the impact limited training opportunities have on learners’ preparedness for clinical practice and have responded to an illustration of this by developing a simulation for the management of iatrogenic bleeding during bronchoscopy, a rare but potentially fatal event.

The authors’ intervention was scheduled for medical students’ penultimate week of paediatric placement, demonstrating consideration of participants’ psychological safety and ensuring they acquire knowledge before progressing to performance. The challenge point framework suggests that, as educators, we must strike the balance between challenge and performance to optimize participants’ learning, and a baseline level of knowledge will influence the degree of challenge faced by participants [2].

Bleeding during bronchoscopy is considered a high acuity, low occurrence (HALO) event, for which simulation training has been shown to be an effective educational tool [3]. In contrast to the above study, we considered it crucial to involve all members of the bronchoscopy team, including the bronchoscopy nurses, as effective management of this emergency does not rely solely on the actions of an individual but those of the team. Interprofessional simulation, where two or more learners from different professions collaborate in a safe learning space, enhances overall communication and teamwork, ultimately leading to safe and effective patient care [4]. Early introduction of interprofessional education to undergraduate curricula gives participants a greater appreciation of professional roles and improves multidisciplinary team working in the real clinical environment [5]. We would encourage Leonard et al. to consider this approach when developing their intervention and explore the possibility of offering this simulation opportunity to other healthcare students to improve overall collaboration. Without the involvement of the whole team, can it really be deemed high-fidelity?

Furthermore, we are interested in the authors’ positivist paradigm. Conducting research in the clinical setting requires pragmatism, and we appreciate the limitation of resources. However, when evaluating preparedness, we prefer to take a constructivist stance. We are of the view that preparedness is achieved through a social, active and contextual learning process that is unique to each individual and is not a quantifiable measurement. To truly understand the learning taking place in any educational intervention, we must be thoughtful about the outcomes being measured and how these will be evaluated. Self-reported confidence, gathered quantitatively, provides little insight into how the learning was achieved. For this simulation, utilizing the debrief as a focus group for data collection would enrich the quantitative data and provide a greater understanding of the intervention’s effectiveness in improving the participants’ preparedness. This will assist with the ongoing development of the educational intervention, ensuring optimal use of resources and enhancing the sustainability of the programme. Introducing an interprofessional element to the simulation would provide data from different perspectives and raise the credibility of the study.

Limited training opportunities are an ever-present issue in clinical education, and we commend Leonard et al. for raising this educational challenge and their willingness to address it.