In the field of health professions education, acquiring technical skills involves three stages: 1) receiving instructions, 2) engaging in practice, and 3) receiving feedback. Simulation serves as a valuable tool that encompasses all three stages, enhancing the effectiveness of health professions education. This work focuses on feedback, which can be categorized as intrinsic (perceived by the learner through their senses) or augmented (provided by an external perspective). Augmented feedback can take the form of knowledge of results (information regarding the outcome) or knowledge of performance (information about the actions leading to the outcome). The overall objective of this work was to evaluate the perceived efficacy of these types of feedback in learning technical skills using a simulation, specifically an intraosseous access simulator, among advanced care paramedics. The primary focus of this article and the initial step towards achieving the aforementioned objective of this work was to determine the possible knowledge of results and knowledge of performance that paramedic facilitators could offer to advanced care paramedics during the use of an existing intraosseous access simulator. This research was conducted following the design-based research framework, employing a combination of design thinking and Delphi methods to generate a comprehensive list of augmented feedback, in both the form of knowledge of results and knowledge of performance, that can be provided to advanced care paramedics while learning intraosseous access skills through a simulator. The design thinking session was carried out to generate an initial inventory of augmented feedback, which was then refined through two rounds of Delphi consensus-building with paramedic experts. This process resulted in an eight-step list of feedback for knowledge of results and knowledge of performance that can be delivered to advanced care paramedics by paramedic facilitators using an intraosseous access simulator.
