Students' Use of Mindfulness During Full-Scale Immersive Simulation Training: A Qualitative Analysis

Background: This qualitative secondary analysis explored how medical students used mindfulness strategies during a high-stress, multi-day military simulation. Mindfulness training has been increasingly incorporated into medical education to enhance stress management, emotional regulation and performance under pressure, but its application in high-intensity simulation environments remains underexplored. Methods: Ninety-six medical students completed a single open-ended survey question following the simulation exercise. Responses were analysed using a phenomenologically informed thematic approach to identify patterns in how students applied mindfulness strategies during the event. Results: Three key themes emerged from the analysis: (1) increased leadership capabilities, (2) enhanced physical and emotional resilience and (3) improved team cohesion. Students reported using mindfulness to manage stress, sustain focus and support both personal and team performance during the exercise. Conclusions: These findings provide preliminary evidence that brief, low-burden mindfulness strategies can help learners manage stress and maintain performance in high-intensity simulation settings. Future research should employ more robust qualitative methods and incorporate objective performance measures to better understand these effects and inform broader implementation within medical education.