Ordered Networked Analysis of Multimodal Data in Healthcare Simulations: Dissecting Team Communication Tactics

Ordered Networked Analysis of Multimodal Data in Healthcare Simulations: Dissecting Team Communication Tactics | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Ordered Networked Analysis of Multimodal Data in Healthcare Simulations: Dissecting Team Communication Tactics Linxuan Zhao, Vanessa Echeverria, Yuanru Tan, Lixiang Yan, Xinyu Li, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4916976/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract In highly immersive, team-based healthcare simulations, students must collaborate effectively to complete open-ended learning tasks. These often require students to move among multiple locations within the physical learning space, 1 requiring the development of effective communication tactics to manage complex team dynamics and multiple concurrent dialogue segments. Analysing such distributed team dialogue using only audio data poses significant challenges as it is hard to distinguish how teams temporarily break into smaller groups. This study investigates the integration of audio and spatial data to model embodied team communication tactics in highly-dynamic healthcare simulation scenarios. We employ ordered network analysis (ONA) to examine the order of communication behaviours across coded co-located dialogue segments of teams of nursing students. We also explore the potential of ONA to enhance teaching through a qualitative assessment of its usability with teachers. Results reveal that high-performing teams employ effective team tactics by prioritising primary tasks (i.e., deteriorating patients) and performing critical tasks timely and correctly, while low-performing teams struggle to develop prioritisation tactics (i.e., focus-ing on stable patients) and with team coordination. Interviews with teachers found high-level information in ONA networks interpretable but faced challenges with sequential details and contextualisation. This research offers insights into improving team-based learning and assessment in healthcare education. Teamwork Learning Analytics Simulation-based learning Ordered Network Analysis Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 20 Jan, 2026 Reviews received at journal 21 Nov, 2025 Reviewers agreed at journal 09 Oct, 2025 Reviews received at journal 14 May, 2025 Reviewers agreed at journal 09 Apr, 2025 Reviewers agreed at journal 24 Feb, 2025 Reviewers agreed at journal 10 Sep, 2024 Reviewers invited by journal 26 Aug, 2024 Editor assigned by journal 23 Aug, 2024 Submission checks completed at journal 23 Aug, 2024 First submitted to journal 15 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4916976","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":354137441,"identity":"2950ba44-b4dc-41f8-9dfc-06aa8f382915","order_by":0,"name":"Linxuan Zhao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYBACPmYYSwKIP4BZPEDMhlsLG7IWxhlEaYGzgFqYeYjSws57TJqn5g6D/Ozmh49tc2zy+PvPHmD4UHYYj8P4ko15jj1jYJxzzNg4d1tascSNvATGGefwaeExfMzDdpiBWSLBTDp32+HEhhs8Bsy8bXi1GBzm+XeYgU0i/Zu0JVDL/PNnDJj/4tdi+BhkJo9Ejpk0I1DLhgM5BsyM+LUYG87tO8wjIZFTbNi7LS1x440cg4M959JxauHnP2Mm8ebbYTn5GekbH/zcZpM47/wZwwc/yqxxaoEBHhTeAYLqR8EoGAWjYBTgBQBgcUwsEYV/xgAAAABJRU5ErkJggg==","orcid":"","institution":"Monash University","correspondingAuthor":true,"prefix":"","firstName":"Linxuan","middleName":"","lastName":"Zhao","suffix":""},{"id":354137443,"identity":"3244e358-7a62-44c6-9e6a-b11b575c6798","order_by":1,"name":"Vanessa Echeverria","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"Vanessa","middleName":"","lastName":"Echeverria","suffix":""},{"id":354137444,"identity":"4830c34b-aa9b-4f83-946c-72855128fe7a","order_by":2,"name":"Yuanru Tan","email":"","orcid":"","institution":"University of Wisconsin–Madison","correspondingAuthor":false,"prefix":"","firstName":"Yuanru","middleName":"","lastName":"Tan","suffix":""},{"id":354137446,"identity":"1d8a949d-5564-4ad2-9f67-af36fc90f9b5","order_by":3,"name":"Lixiang Yan","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"Lixiang","middleName":"","lastName":"Yan","suffix":""},{"id":354137447,"identity":"6e05c6a7-54b8-4b85-8e7b-2cab768650ec","order_by":4,"name":"Xinyu Li","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"Xinyu","middleName":"","lastName":"Li","suffix":""},{"id":354137448,"identity":"c9bef2fe-28e2-48bd-8c45-01f8539638f3","order_by":5,"name":"Riordan Alfredo","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"Riordan","middleName":"","lastName":"Alfredo","suffix":""},{"id":354137450,"identity":"6472b906-3afe-4cb5-8af2-1f3ccaf330cc","order_by":6,"name":"Samantha Dix","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"Samantha","middleName":"","lastName":"Dix","suffix":""},{"id":354137453,"identity":"676db784-a086-472e-8742-b7c8949eb18d","order_by":7,"name":"Hollie Jaggard","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"Hollie","middleName":"","lastName":"Jaggard","suffix":""},{"id":354137454,"identity":"d4897586-2ebb-40f4-a213-42d3d46514f2","order_by":8,"name":"Rosie Wotherspoon","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"Rosie","middleName":"","lastName":"Wotherspoon","suffix":""},{"id":354137457,"identity":"59f3e733-3392-45be-a303-0ad9da6c4e84","order_by":9,"name":"Abra Osborne","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"Abra","middleName":"","lastName":"Osborne","suffix":""},{"id":354137458,"identity":"9d5cd594-d611-4d44-8562-fbe5d8c22566","order_by":10,"name":"Rebecca Winter","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"Rebecca","middleName":"","lastName":"Winter","suffix":""},{"id":354137460,"identity":"adf121a2-3835-409e-9656-8f69bfcde4dd","order_by":11,"name":"David Williamson Shaffer","email":"","orcid":"","institution":"University of Wisconsin–Madison","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"Williamson","lastName":"Shaffer","suffix":""},{"id":354137461,"identity":"407c9bfd-4533-4524-a9ae-114aa9eb5757","order_by":12,"name":"Dragan Gašević","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"Dragan","middleName":"","lastName":"Gašević","suffix":""},{"id":354137466,"identity":"4b4d6ffb-2173-4a49-8a5f-96da0963fb59","order_by":13,"name":"Roberto Martinez-Maldonado","email":"","orcid":"","institution":"Monash University","correspondingAuthor":false,"prefix":"","firstName":"Roberto","middleName":"","lastName":"Martinez-Maldonado","suffix":""}],"badges":[],"createdAt":"2024-08-15 04:18:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4916976/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4916976/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":65148262,"identity":"3b7801f6-3029-4440-a170-fa71ce357ac9","added_by":"auto","created_at":"2024-09-24 06:42:11","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":733665,"visible":true,"origin":"","legend":"","description":"","filename":"IJAIEDAIED2023ONAextensionLinxuan4.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4916976/v1_covered_172c5ced-5a5f-4729-8c4c-ce521641091f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Ordered Networked Analysis of Multimodal Data in Healthcare Simulations: Dissecting Team Communication Tactics","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-artificial-intelligence-in-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aied","sideBox":"Learn more about [International Journal of Artificial Intelligence in Education](http://link.springer.com/journal/40593)","snPcode":"40593","submissionUrl":"https://submission.nature.com/new-submission/40593/3","title":"International Journal of Artificial Intelligence in Education","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Teamwork, Learning Analytics, Simulation-based learning, Ordered Network Analysis","lastPublishedDoi":"10.21203/rs.3.rs-4916976/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4916976/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"In highly immersive, team-based healthcare simulations, students must collaborate effectively to complete open-ended learning tasks. These often require students to move among multiple locations within the physical learning space, 1 requiring the development of effective communication tactics to manage complex team dynamics and multiple concurrent dialogue segments. Analysing such distributed team dialogue using only audio data poses significant challenges as it is hard to distinguish how teams temporarily break into smaller groups. This study investigates the integration of audio and spatial data to model embodied team communication tactics in highly-dynamic healthcare simulation scenarios. We employ ordered network analysis (ONA) to examine the order of communication behaviours across coded co-located dialogue segments of teams of nursing students. We also explore the potential of ONA to enhance teaching through a qualitative assessment of its usability with teachers. Results reveal that high-performing teams employ effective team tactics by prioritising primary tasks (i.e., deteriorating patients) and performing critical tasks timely and correctly, while low-performing teams struggle to develop prioritisation tactics (i.e., focus-ing on stable patients) and with team coordination. Interviews with teachers found high-level information in ONA networks interpretable but faced challenges with sequential details and contextualisation. This research offers insights into improving team-based learning and assessment in healthcare education.","manuscriptTitle":"Ordered Networked Analysis of Multimodal Data in Healthcare Simulations: Dissecting Team Communication Tactics","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-24 06:34:00","doi":"10.21203/rs.3.rs-4916976/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-20T05:48:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-22T02:25:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"51421430408454123971936340665853834023","date":"2025-10-09T17:49:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-14T13:59:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6050879441855294313813951658583046134","date":"2025-04-09T14:44:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260782478124116557045919648396423928823","date":"2025-02-24T19:05:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311937785067578057655405437507728077917","date":"2024-09-10T18:44:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-26T16:12:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-23T13:37:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-23T13:35:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Artificial Intelligence in Education","date":"2024-08-15T04:16:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-artificial-intelligence-in-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aied","sideBox":"Learn more about [International Journal of Artificial Intelligence in Education](http://link.springer.com/journal/40593)","snPcode":"40593","submissionUrl":"https://submission.nature.com/new-submission/40593/3","title":"International Journal of Artificial Intelligence in Education","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"d979c817-b70d-4886-8410-b83fcfeef851","owner":[],"postedDate":"September 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-05T18:09:57+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-24 06:34:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4916976","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4916976","identity":"rs-4916976","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}