Why do they come? exploring rural healthcare workers’ engagement in simulation-based interprofessional education : a mixed methods case study

Abstract

Despite robust evidence supporting healthcare simulation as an effective continuing education strategy, a gap remains in the theoretical understanding of how simulation-based education succeeds, and whether practicing providers will choose to participate, especially in complex practice environments such as rural healthcare. This study addresses that gap by examining rural healthcare workers’ engagement in simulation-based interprofessional education (Sim-IPE) through the lens of Self-Determination Theory (SDT), a comprehensive framework for understanding human motivation. This mixed-methods case study explored the situational motivation, psychological safety, and lived experiences of rural emergency physicians, nurses, licensed practical nurses, and paramedics participating in Sim-IPE sessions across four rural emergency departments in Northeastern Nova Scotia. A convergent parallel mixed methods design was employed. Quantitative situational motivation was measured using the Situational Motivation Scale (SIMS), and qualitative data were collected through semi-structured interviews employing purposive maximum-variation sampling across professions, experience levels, and gender. Quantitative findings revealed a predominantly autonomous motivational profile, characterized by high Intrinsic Motivation (IM) (M: 20.8/ 28) and Identified Regulation (IR) (M: 25.9/28), low External Regulation (ER) (M: 11.6/28) and Amotivation (AM) (5.4/ 28), and a positive Self-Determination Index (M: 45.1/72). Reflexive thematic analysis identified individual motivation, team motivation, psychological safety and the rural context as key to understanding how participants experienced the Sim-IPE and why they chose to participate. SDT provided a robust theoretical framework to explain Sim-IPE participation and its sustainability through the satisfaction of basic psychological needs and support for autonomous learning. A joint display integrating SIMS scores, SDT constructs, and qualitative themes demonstrated that interprofessional design, embodied psychological safety, organizational supports, and expert facilitation were key conditions fostering autonomous motivation. The rural context emerged as a unique amplifier of motivational processes when paired with context-specific in-situ simulation design. This work extends SDT and health simulation scholarship by conceptualizing rural in-situ Sim-IPE as a distinctive motivational ecology in which place-based design and psychological safety function as core mechanisms that promote internalization and sustained engagement. It also links rural Sim-IPE to broader rural system issues, including provider wellness, retention, and opportunities to integrate CPD as a core health system function.