Qualitative analysis
The main themes that emerged from the observation analysis were related to stress, the ease and difficulties of the students to act as expected during the exercise, and the reported and observed benefits.The qualitative data allowed interpretation of the quantitative results on the major results. First, concerning the improved performance of the intervention group during the exam, the observation data showed an improvement in performance from one formative session to another during the training, including increased fluidity of the student and higher satisfaction expressed by the evaluator during the end-of-session debriefing. A plateau effect in the acquisition of knowledge and skills was reported by several students and trainers after the fourth session. The students were not only trained by the exercise, i.e., how to properly conduct the exchange with the patient, but also by the feedback during the individual debriefing (what are the points to be addressed according to the scoring grid, how to ensure points, memory aid tips), which constituted a favorable context to pass the exam. On the other hand, qualitative data allowed the interpretation of non-positive results as well. One of the formative sessions (n°3/4) was dedicated to an exercise concerning the announcement of a diagnosis. This particularly unsettled the students. The ease, knowledge, and skills accumulated in previous sessions declined, the stress increased, and the evaluations were weak. Finally, concerning stress during the formative sessions, several students informally reported being stressed by being alone for the first time (for the majority) in front of a patient (even simulated) and by being evaluated during the exercise, particularly by a referent teacher. "Score" and "validation" were major aspects in all debriefings. However, the repetition of the exercise, the better knowledge of assessment processes, and the debriefings were perceived as benefits. Debriefings were times of benevolent reassurance for the student and involved (no standardization) anchoring of the exercise in the professional future, a systematic review of the evaluation grid, and discussion with the evaluator. Overall, we observed good acceptability by the students, as well as by the doctors involved in the exercise, which created a favorable atmosphere for learning.