Editorial
The Relationship Between Emotions and Learning
Vicki R. LeBlanc, PhD
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Department of Innovation in Medical Education, Faculty of
Medicine, University of Ottawa, and University of Ottawa
Skills and Simulation Centre, Ottawa, Ontario, Canada.
Reprints: Vicki R. LeBlanc, PhD, Department of Innovation
in Medical Education, University of Ottawa, 850 Peter
Morand Cres, Room 102, Ottawa, Ontario, Canada, K1G 5Z3
(e‐mail: Vleblan3@uottawa.ca).
Copyright © 2019 Society for Simulation in Healthcare
DOI: 10.1097/SIH.0000000000000379
Vol. 14, Number 3, June 2019
Copyright © 2019 by the Society for Simulation in Healthcare. Unauthorized reproduction of this article is prohibited.
in Simulation-Based Education
I n this issue, Rogers et al1 present the results of a study looking at the interplay of
emotions and learning during simulation-based education. The role of emotions
in learning, particularly simulation, has been of growing interest to educators. Med-
ical education involves significant emotional experiences for the learners, and these
emotions can have important effects on the cognitive and learning processes of indi-
viduals. Given that stress has been associated not only with greater memory consol-
idation (process of solidifying transient memory traces into long-term memory) but
also with greater biases and inaccuracies in what is recalled, simulation educators are
increasingly concerned with understanding and quantifying stress for learners during
simulations.2 The goal of this editorial is to highlight possible directions for future
research building on the work of Rogers et al.1 I first present arguments for looking
at the role of appraisals as well as motivation when studying emotions. Second, I dis-
cuss the potential importance of individual roles as potential modifiers of emotional
responses during team-based simulation sessions. Finally, I discuss the possible ben-
efits of physiological and behavioral measures in the study of emotions.
Addressing the concerns of educators regarding stress reactions during
simulation-based education, Rogers et al1 investigated whether participants in simu-
lations had greater emotional responses than observers. As a secondary outcome
measure, they examined the relationship between emotional arousal and learning.
They found that participants, as expected, reported greater negative arousal than
the observers. However, they also found that the participants reported greater posi-
tive arousal than the observers, a finding that is more unexpected. Finally, they did
not find any relationship between emotional arousal or role (participants vs ob-
server) and scores on a measure of learning.
This study represents the early stages of an important research agenda for the
field of simulation-based education: how does the construction of our simulation
sessions affect the emotional experience of our learners, and how do these emo-
tional experiences affect their learning? As discussed by Rogers et al,1 the results
of this study raise more questions than answers, as would be expected from any
early inquiry into a topic. Although readers might be tempted to interpret these re-
sults as indicating that emotions do not influence learning, there are other factors
potentially at play that could influence the results. The relationship between types
of simulation experiences, emotional experiences, and subsequent learning is a com-
plex one that merits further inquiry. Hereinafter, I describe some possible venues for
future inquiry.
As highlighted by Rogers et al,1 participants in their simulation sessions experi-
enced the co-existence of greater negative and positive emotions compared with the
observers. This supports findings from the broader emotions domain that emotions
can co-exist, with each emotion having a unique—and sometimes opposing effect -
on cognitive processes.3 In their study, Rogers et al1 use the circumplex model of
emotions4 to frame the emotional reactions of the learners. A commonly used
model, the circumplex model's strength is that it parses out various emotions into
two dimensions thought to be at the core of an emotional experience: arousal and
valence. Dimensional models of emotion describe affective states as arising from
overlapping neurophysiological systems thought to act in predictable ways on
cognitive processes. Over the years, there has been some evidence in support of
dimensional models of emotions.5–7
137
 However, dimensional models such as the circumplex
model have also been critiqued for being too simplistic to fully
capture the complex relationship between emotions and cog-
nitive processes.8 To better characterize the relationship be-
tween emotions and cognition, discrete models of emotions
have been put forward. Distinct emotions are thought to orga-
nize behavior and physiology in a predictable fashion to allow
the individual to deal with specific emotion-evoking events.9
In contradiction to dimensional models, discrete approaches
argue that emotions of the same valence and arousal can have
different effects on cognition. For example, fear and anger,
though both negatively valenced high arousal emotions, differ
in terms of certainty and power appraisals. Fear is associated
with appraisals of low certainty and low power over a situation.
Anger is associated with high certainty and high power. As a
result of these appraisals, anger is associated with more opti-
mistic assessments of the future and lower risk perceptions
than is fear.10–12 Similar research has shown that sadness (eg,
negative-low arousal) is associated with more pessimistic as-
sessments of the future, but less aversion to taking risks.12
These data suggest that even when emotions overlap in valence
and/or arousal, they can have significantly different effects on
how individuals think and act.
In addition, emotions can have an impact on a learner's
motivation and efforts toward understanding of educational
materials, that is, their preparation, perseverance in the face
of challenges, and strategies toward learning.13 According to
Pekrun's control-value theory of emotions,14 achievement
emotions are emotions directly tied to achievement activities
(emotions experienced during an activity) and achievement
outcomes (emotions experienced as a result of success or fail-
ure outcomes). Different emotions will affect one's motivation
toward learning behaviors.
Positive emotions, such as enjoying a task, can lead to
greater interest and greater intrinsic motivation to engage in
the task for its own sake.15,16 Negative emotions (eg, boredom,
anxiety, anger) can decrease interest and intrinsic motivation
in a task. However, negative emotions can also increase extrin-
sic motivation (motivation to engage in a task as a means to an
end).17 For example, the fear of performing badly in front of
colleagues may result in greater extrinsic motivation, thereby
motivating learners to engage in behaviors to enhance their
learning. As such, both positive and negative emotions can en-
hance motivation to learn and, as a result, subsequent perfor-
mance.14 These effects may be different for specific emotions.
For example, Zhao18 observed that fear did not have any signif-
icant impact on motivation to learn but had a direct negative
effect on learning itself. In contrast, guilt and sadness were pos-
itively associated with motivation to learn but had no direct
effects on learning from errors. Another study suggests that
transient shame can lead to greater attention to feedback.19 In
contrast, deactivating positive emotions, such as relief, can have
a detrimental effect on learning motivation and behaviors.20
In a study of medical students' learning with a virtual patient
simulation program, relief was negatively associated with at-
tention to feedback.19 Together, these studies suggest that fu-
ture studies looking at the relationship between emotions and
learning from simulation sessions would benefit from consid-
ering the distinct emotions experienced by learners.
138 Emotions and Learning in Education
Copyright © 2019 by the Society for Simulation in Healthcare. Unauthorized reproduction of this article is prohibited.
Another aspect that merits further study would be to look
at the effects of specific roles while participating in simula-
tions. In their study, Rogers et al1 describe sessions in which
2 to 3 residents actively participated in the same scenario. In
such cases, one individual would likely assume the role of
leader with the others taking a more supporting role. As such,
the emotional responses of all active participants might not
be equivalent. In previous research by our group, we found
that different roles were associated with different stress re-
sponses.21 Therefore, further work could look at the effect
of different roles on participants' emotions as well as on sub-
sequent learning.
This study also looked at self-reported emotions. This is a
common approach, given financial and logistical challenges of
measuring physiological stress responses (eg, cortisol and
heart rate variability). As addressed by Rogers et al,1 this is also
a potentially contentious approach to measuring emotions.
Although the collection of cortisol samples often requires con-
straints that do not accommodate well with simulation-based
education sessions,22 recent development in the measurement
of heart rate variability has made data collection more straight-
forward and affordable.23 Where possible, adding physiological
measures to subsequent studies looking at stress responses
would allow for greater understanding of the relative contri-
butions of subjective (“feeling” stressed) and physiological re-
sponses. Although the physiological measurement of other
distinct emotions is not as reliable, great advances have been
done in facial and behavioral analyses.24
In conclusion, Rogers et al,1 in their study, begin to ad-
dress an important question for simulation-based education.
By further understanding the emotional responses of our
learners to simulation sessions, and the effects of these various
emotions on learning, educators will be better equipped to
create simulation-based curricula that will best prepare learners
for future clinical practice.
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