NHS Blood and Transplant
Neurodiversity Global
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Scenario 03

The learner who performs well when active but loses the sequence while observing

Attention regulation, transitions and the observer role in 1:3 simulation

Persona

Name
Leanne Brooks
Age
27
Role
Learner in simulation-based training
Disclosure
Leanne has told her trainer she has ADHD. She says she learns best when she is actively doing the task and struggles during long pauses or unstructured waiting time.
Context
Highly engaged when active. Asks good questions, remembers practical details and brings energy to the group. Performance becomes less reliable during delays or while watching others.
Record
Performs well during active practice. Has been reminded once not to jump ahead during simulations. No formal concern raised before this session.

Scenario

The session uses a 1:3 rotation. Each learner takes a turn as the active learner in simulation while the other two observe. There is no specific observer task — they are asked to "watch and learn". Leanne performs strongly in her active turn. While she is observing the next learner, she loses track of where the sequence is up to. When her second turn begins, she restarts from the wrong point and misses the required check. The trainer says: "You're rushing again. We've covered this." Leanne says:

"I was fine when I was doing it. When we stopped and watched someone else, I lost where we were."

What happened after

The trainer tells the manager: "She knows what to do, but she is careless when it is her turn again." Leanne tells the manager: "When I'm doing it, I'm fine. When I'm watching, my brain skips ahead and I lose the restart point." The manager has to address the missed check and look at how the observer role is structured in the 1:3 rotation.

Now, in your groups

Discuss in your group

  1. 01

    What is the visible issue?

  2. 02

    What might ADHD be affecting here?

  3. 03

    What is the safety-critical concern?

  4. 04

    What could change about the observer role, transitions or restart instructions?

  5. 05

    How should the manager hold Leanne accountable without creating shame?

Stretch the discussion

What if there was no disclosure?

If Leanne had not disclosed, what would you still notice? Strong active performance, weaker performance after observing, lost restart point, missed check on second turn. Where does the process actually drop — and is the observer role designed well for any learner?

Capture your thinking

Group output

Use this to note what your group lands on. One person can capture for the share-back, then save to send it to the facilitator review.