Building Competency with
Blended Learning:
Integrating Simulation into
Continuing Education
Julianne Perretta MSEd, RRT-NPS
The Johns Hopkins Medicine Simulation Center
Baltimore, MD
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Define Continuing Education
Motivations for Learning
Competency Assessment vs. Education
Learning Styles (VARK) Questionnaire
Adult Learner Characteristics (Knowles)
Best Practices in Simulation Education
Objectives
At the end of this session learners will be able to:
 Determine the goals of continuing education in
health care
 Differentiate between competency assessment and
education and how that affects simulation design
 Review key elements of adult learners
 Identify different learning styles and how different
forms of simulation can address each
 Initiate simulation design based on some best
practices in Simulation Education
Continuing Education
 Health Professions Education: A Bridge to
Quality (Institute of Medicine, 2003)
1.
2.
3.
4.
5.
Provide patient centered care
Work in interdisciplinary teams
Employ evidence-based practice
Apply quality improvement
Utilize informatics
Continuing Education
“Features, such as opportunities to reflect on
learning and apply it to practice, and
interpersonal interaction, have been
identified as characteristics of CME that
are most likely to result in practice
enhancement”
-Allen, p. 234
Motivations for Learning
Why are you here today?
Motivations for Learning
1.
2.
3.
4.
5.
6.
Social Relationships
External Expectations
Social Welfare
Professional Advancement
Escape/Stimulation
Cognitive Interest
Morstain and Smart (1974), noted in Learning in adulthood.
Competency Assessment vs.
Education
 Sometimes what we call “education” is
really assessment, and what we call
assessment is not that, either.
 What happens when we assess the quality of
someone’s work, and they don’t pass?????
Competency Assessment vs.
Education
 “Fail”
 What do you do when
you find a knowledge
deficit? A skills deficit?
 How do you remediate?
 Reteach
 Reassess
 Performance Plan
 What do you do with
them in the meantime?
Competency Assessment vs.
Education
 eLearning
 Pre Assessment (study/practice)
 New to simulation
 Nervous performers
 Post Assessment (remediation)
 Specific goals based on performance
 Score-based
 Knowledge deficit
 Decision-making deficit
 Unlimited time access
Competency Assessment vs.
Education
 Skills deficit
 Partial Task Trainers
 I.O. Leg
 IV arm
 Central Line Trainer
 Intubation head
 Virtual Reality
Adult Learners:
 Are more independent and self-directed
 Want to feel accepted, respected and supported
when learning
 Want to feel a partnership with their instructor
 Have a wealth of experience they draw from
when learning
 Want to feel they can immediately use what
they are learning (problem-centered)
 Have many different motivations for learning
Malcolm Knowles, Andragogy, 1968, 1980.
Simulation & the Adult Learner
 Work independently or with a group; use
debrief to direct learning
 Create a environment of respect, support, and
safety during simulations
 Dialogue between trainer and learner
 Build on previous experience and create new
experiences
 Scenarios that are directly applicable to job
 Goal oriented learning
Learning Styles
 How a person approaches learning tasks
 “Manner in which…learners most
efficiently and effectively perceive, process,
store and recall what they are attempting to
learn” (James and Blank, 1993, pp. 47-48).
 Helps you identify your strengths and
weaknesses as learners
Learning Styles
How do you learn best?
 VARK
 Multiple Intelligences(Multiple Intelligences
Questionnaire:
http://www.thirteen.org/edonline/concept2class/mi
/index.html)
 Learning Styles Inventory (Learning Styles
Inventory Questionnaire: http://www.rrcconline.com/%7Epsych/LSInventory.html)
Learning Styles
How do you learn best?
 Visual
 Aural
 Read/write
 Kinesthetic
http://www.vark-learn.com/english/page.asp?p=questionnaire
Learning Styles
How do you learn best?
 Visual
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Charts
graphs
flow charts (arrows, circles, hierarchies)
algorithms
Learning Styles
How do you learn best?
 Aural
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Lectures
Tutorials
Tapes
Group discussion
Email
Speaking
Webchat
“Talking Things Through”
Learning Styles
How do you learn best?
 Read/write
 Text-based input and output
 List-makers
Learning Styles
How do you learn best?
 Kinesthetic
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Practice
Hands-on
Examples
Simulations
Learning Styles
 V schematics, algorithms in debriefs
 A Debrief discussions
 Interactive online (with feedback)
 May be better at telling you the answers than doing them
 R handout and ppt debriefings
 Readings on evidence-based new info.
 K Simulation, hands-on debriefing
 Can include eSimulation as well
Best Practices in Simulation
Education
 Experiential Learning (Kolb)
 Contextual Learning (Kneebone)
 Situated Learning/Peripheral Participation
(Lave & Wenger)
 Self-Efficacy and Competency (Maibach et al,
Miller)
 Deliberate Practice (Ericcson)
 Feedback (Van de Ridder)
 Mastery Learning (Bloom)
Hunt et al, 2008
Best Practices in Simulation
Education
Experiential Learning
(Kolb)
1. Direct encounter with
the phenomenon being
studied rather than
merely thinking about
the encounter, or only
considering the
possibility of doing
something about it
2. Education that occurs
as a direct participation
in the events of life
Best Practices in Simulation
Education
Contextual Learning (Kneebone)
 For learning to be most effective, it must
occur within a context parallel to how
individuals will apply the knowledge in
their own professional practice
Best Practices in Simulation
Education
 Same equipment as in unit
 Groups bring specific equipment
 BLS training for med students includes how
to function with new BLS skills in hospital
setting
Best Practices in Simulation
Education
Situated Learning/Peripheral Participation (Lave &
Wenger)
 Learning through real-life participation
 Learners observe actions while working side-byside with a skilled person (content expert)
 Begin participating in observed tasks, bringing
them from periphery to participation
Best Practices in Simulation
Education
Self-Efficacy and Competency (Maibach et al)
 A person’s belief in their capability to organize
and execute a course of action to produce given
attainments
 4 levels of Competence:
1.Unconsciously incompetent
2.Consciously incompetent
3.Consciously competent
4.Unconsciously competent
Best Practices in Simulation
Education
Self-Efficacy and Competency (Maibach et al)
 Framework for assessing clinical competency
(Miller)
1.Knowledge (knows)
2.Competence (knows how)
3.Performance (shows how)
4.Action (does)
Best Practices in Simulation
Education
 Hybrid simulations to practice very specific
skills
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Neonatal Chest Tube Management
Patient death
ECMO
NP
Aspirate
Best Practices in Simulation
Education
Deliberate Practice (Ericcson)
 Training activities that promote consistent
improvements in expert performance domains
 Repetitive performance in a focused domain
 Rigorous skills assessment (specific formative
feedback)
 Progressively improved performance in a
controlled setting
Best Practices in Simulation
Education
Feedback
• “Specific information about the comparison
between a trainee’s observed performance and a
standard, given with an intent to improve the
trainee’s performance” (Van de Ridder)
Best Practices in Simulation
Education
 Build debrief tools based on agreed upon
standards
 Debrief should be based on simulation
objectives
Best Practices in Simulation
Education
Mastery Learning (Bloom)
 Aptitude is the length of time it takes a person to
learn not how "bright" a person is, i.e., everyone
can learn given the right circumstances
 Goal: all learners to achieve the target outcome
with little/no variability; amount of time to
achieve will vary based on the learners
Best Practices in Simulation
Education
• eLearning
• Practice makes Perfect PERMANENT
• AHA BLS course
Putting it all Together
 Continuing education in healthcare should
include:
 Opportunities to reflect on learning
 Opportunities to apply learning to practice
 Interpersonal interaction
Putting it all Together
 Competency assessment looks for level of
knowledge/skills and identifies deficits.
Focus is not on new learning.
 Should include avenues for remediation and
opportunities for student study/practice
prior
Putting it all Together
 Adult learners:
 Are problem-centered
 Have a wealth of experience to draw from
 Have many different motivations for learning
Putting it all Together
 Different learning styles mean people are
most comfortable in a particular way.
 Build simulations and debriefings to meet
these styles
Putting it all Together
 Key learning theories to consider when
building a simulation are:
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Experiential Learning
Contextual Learning
Situated Learning/ Peripheral Participation
Deliberate Practice
Feedback
Mastery Learning
Resources
Allen, M., Curran, V. Ferrier, D. Ho, K., Kirby, F., Allen, J. et al (2004).
Interactive on-line continuing medical education: Physician’s
perceptions and experiences. The Journal of Continuing Education in
the Health Professions 24 (4): 227-236.
Hunt, E.A., Fiedor-Hamilton, M., Eppich, W. (2008). Resuscitation
education: Narrowing the gap between evidence-based resuscitation
guidelines and performance using best educational practices. Pediatric
Clinics of North America. 55: 1035-1050.
Institute of Medicine. 2003. Health professions education: A bridge to
quality. Washington, DC: The National Academy Press.
Merriam, S.B., Caffarella, R.S. (1999). Learning in Adulthood. San
Fransisco: Jossey Bass.
Notes from a Benjamin Bloom Lecture. (1987, April). Retrieved May 15,
2009, from http://www.humboldt.edu/~tha1/mastery.html
Smith, M.K. David A. Kolb on experiential learning. Retrieved May 1,
2009 from http://www.infed.org/biblio/b-explrn.htm
VARK Categories. (2001-2009). Retrieved August 10, 2007, from VARKA Guide to Learning Styles: http://www.varklearn.com/english/page.asp?p=categories
Questions? Please contact me:
Julianne S. Perretta MSEd, RRT-NPS
jstickl1@jhmi.edu
Simulation Educator
The Johns Hopkins Medicine Simulation Center
Baltimore, MD