Awareness of the knowing–doing gap in arrhythmia management: a clerkship-embedded multicomponent simulation package

Background Outcomes-based curricula increasingly emphasize participatory clerkships promoting learning through preparation, practice, feedback, and reflection. Acute arrhythmia care is thought to exemplify the ‘knowing–doing gap', requiring conversion of exam-oriented knowledge into time-critical, integrated performance. Objective We evaluate learners' awareness of a knowing–doing gap through a clerkship-embedded, multicomponent arrhythmia simulation package. Methods We retrospectively analyzed routinely collected program-evaluation data from fifth-year medical students. The simulation package included pre-session self-study. Each student then managed one of five standardized 15-min scenarios as a treating physician using a high-fidelity simulator with a confederate nurse and simulated patient. The scenario was conducted under structured peer observation and was followed by multi-source feedback and physician-facilitated debriefing. Post-session free-text questionnaires were analyzed using qualitative content analysis. Results Of 190 eligible students, 170 (89.5%) completed the package and 164 (96.5%) returned questionnaires. Knowing–doing gap awareness was identified in 83 learners (50.6%). The most common aspect was difficulty in translating knowledge into action under time pressure. Learners also recognized the need for generative decision-making and competencies beyond factual knowledge, including patient explanation, team communication, and situational awareness. Acceptability of the simulation was high, , 25.6% somewhat satisfied, and 93.9% of correspondents supported similar training in other departments. Conclusion A standardized, clerkship-embedded arrhythmia simulation package helped to make the knowing–doing gap visible from multiple perspectives within a safe-to-fail environment supported by structured feedback and debriefing. The package was acceptable to learners and feasible to deliver within a routine cardiology clerkship.