Preconference Course PC 2.M Simulation-Enhanced

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Yue Ming Huang, EdD, MHS
Assistant Adjunct Professor
Department of Anesthesiology
David Geffen School of Medicine at UCLA
Director of Operations, UCLA Simulation Center
Mini Simulation User Network Conference
West Coast University, North Hollywood, CA
August 20, 2012
1
Disclosures
 I have no conflict of interest to disclose.
2
Agenda/Objectives
 Review educational principles for adult learners
 Review steps for curriculum development
 Describe considerations for scholarly
dissemination
 Provide examples of published curricula and other
resources
3
Getting to Know You
 Who is new to simulation (0-2 years), has 3-5
years, 6-10 years, >10 years of experience?
 Who is at a community college, nursing school,
medical school, hospital-based simulation center,
others?
 Who has had formal postgraduate training in
education, e.g. Master/Doctorate in Education,
Medical Education Fellowship, etc.?
 Who has experience publishing curriculum,
educational tools, or simulation-based research?
4
Simulation as an Experience
 How many have been in the “hot seat” as a simulation
participant/learner?
 If you have not, please do so
5
History of Experiential Learning
 “Experience is, for me, the highest authority. The
touchstone of validity is my own experience. No
other person's ideas, and none of my own ideas, are
as authoritative as my experience... Neither the
Bible nor the prophets -- neither Freud nor research
--neither the revelations of God nor man -- can take
precedence over my own direct experience.”
from On Becoming a Person
Carl Rogers, 1969
6
Educational Principles
 “We cannot teach another person directly; we can
only facilitate his learning.” (Carl Rogers, 1969)
 An effective educational environment promotes
significant learning if:
1) it is non-threatening or low-risk
2) facilitator can help learner differentiate his own
perceptions through experiences
7
Adult Learning Theory (Malcolm Knowles 1978)
 Student centered and self-directed: Adult learners
expect to have a say on what is taught, how they
are taught, and how they are evaluated; Their
feedback needs to be incorporated into program
 Experiential: Adults come with prior knowledge
and learn best experientially
 Relevant: Adults need to know why they need to
learn something and how they can apply new
knowledge to their job/life.
 Problem-solving approach to learning
8
Kolb’s Experiential Learning Cycle
9
Simulation
Scenario
Concrete
Experience
(Doing, feeling,
experiencing)
Deliberate
Practice
Active
Experimentation
(Applying, trying
out what you
learned)
Simulation as part of
the Experiential
Learning Cycle
Discussions &
Further Study
Abstract
Conceptualization
(Thinking,
processing,
learning)
Guided
Debriefing
Reflective
Observation
(Reviewing,
watching,
reflecting)
Circumplex of Emotions
Optimal
Activated
State =
Relaxed Alertness
(low threat,
high challenge)
6 Steps of Curriculum Design (Kern,
1998)
1.
2.
3.
4.
5.
6.
Problem Identification and General Needs
Assessment
Needs Analysis of Targeted Learners
Goals and Specific Measurable Objectives
Educational Strategies
Implementation
Evaluation and Feedback
Plan ahead with publication/dissemination in mind!
13
Step 1. Problem Identification and General
Needs Assessment
 Identify the problem or educational gap
 What is the current approach (who is doing what,
when, how, resource limitations)
 What is the ideal approach
 Ideal – current approach = general assessment
14
Step 2. Needs Analysis of Targeted Learners
 Who are the learners, level of training, previous
experience, current performance, learning
styles/preferences
 What are barriers or enabling/reinforcing factors
 What are the available resources to this group
(simulation, faculty, clinical experiences)
 Use multiple ways to obtain info/needs assessment
15
Needs Assessment Methods
Informal discussions
2. Questionnaires/Surveys
3. Interviews
4. Focus groups
5. Observations
6. Tests
7. Literature review
8. Available documents – ACGME, Joint Commission,
national board research
9. Include different sites
10. Other ideas?
1.
16
Scholarly Work for Steps 1 & 2
 Systematic review of literature
 Needs assessment report
 Assessment tool
 Keep in mind:
 Is there a need? A gap in the literature? Clinical
significance?
 Has it been done before? Am I contributing something
new? Is it generalizable?
 Is it innovative and compelling?
17
Step 3. Goals and Objectives
 Review types (learner, process, outcome) and levels of
objectives
 Learning domains: cognitive, psychomotor, affective
 Review Bloom’s Taxonomy of educational objectives
 Write SMART (specific, measurable, achievable,
relevant, timely) objectives
 Ask this question: Who will do what and how
much/how well by what time (when)?
18
Bloom’s Taxonomy of Educational
Objectives
19
Learning, Mastery & Expertise
Expert
Proficient
Competent
Advanced Beginner
Novice
Miller’s Model of Assessment
1990
Dreyfus & Dreyfus Model of Skills Acquisition
1988
20
Essential Components of a
Learning Objective
 Behavior/Skill: need to be specific and observable
 Condition: under what circumstances is this behavior
achieved; are tools/assistance allowed?
 Standard: what is an acceptable level of performance;
by what criteria is the behavior measured against?
21
Step 4. Educational Strategies
 Use multiple educational methods and match
methods to objectives
 Review/discuss pros/cons of different methods
 Choose methods that are feasible in terms of resources
 Consider different simulation options
 Other interactive methodologies (games, ARS,
engaging exercises etc.)
22
Simulation Methods
 Screen-based virtual patients
 Role plays
 Standardized patients
 Artificial models, procedural task trainers
 Virtual reality simulators
 Full body computerized simulators
 Hybrid simulation
 Group learning projects
 Games and other engaging activities
23
Scholarly Work for Steps 3 & 4
 Creation/description of a new educational tool or
method
 Simulation scenarios
 Theoretical/comparative paper on the merits of
educational processes or tools
24
Step 5. Implementation
 Consider resources: personnel, time, facilities,
funding/costs
 Administration and operations
 Piloting, phasing-in, full implementatoin
25
Step 6. Evaluation and Feedback
 Identify users and use (formative, summative),
resources for evaluation, questions to ask, evaluation
design
 Choose/construct measurement method – address
reliability, validity, bias
 Ethical concerns
 Data collection and analysis
 Result reporting
26
Kirkpatrick’s Levels of Evaluation
 Level 1: Reaction – How did learners perceive the
course, the process? Satisfaction surveys
 Level 2: Learning – What knowledge and skills were
gained? Written tests, demonstrations, checklists
 Level 3: Behavior - What are the observable practice
changes, transfer of learning from lab to job? Field
evaluations, observations
 Level 4: Results - What are the tangible outcomes
(return in investment, cost reduction, improved
quality, increased production/efficiency,decreased
complications, etc.)
27
Indicators of Deep Understanding
 Performance in Multiple Contexts
 Ability to Question
 Able to ask the right questions
 Know how to find the answers
 Know what to do with the answers
 Appropriate Performance in Unexpected
Situations
28
Scholarly Work for Steps 5 & 6
 Research study
 Descriptive study of curriculum implementation
 Cost effective analysis report
 Assessment tool
 Keep in mind:
 Get IRB and funding early
 Document each step in detail, keep notes
 Consult with education and research experts
 Collaborate
29
Curriculum Maintenance and Enhancement
 Continuous quality assurance methods for
improvement
 Faculty development
 Resource allocation
 Management of change
 Scholarly activity by learner and faculty
30
12 Tips for Effective Short Course Design
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Assess the clinical problem.
Determine learning outcomes.
Use evidence-based medicine to develop content.
Identify resources.
Select teaching strategies for active learning.
Select teaching strategies that foster reflection.
Use passive strategies sparingly to ensure a common knowledge base.
Create an individualized needs or pre-course assessment.
Prepare teachers.
Commitment to change and evaluation.
Provide a 2–3 month post-course reflective exercise.
Use data in an iterative way.
Lockyer et al, Medical Teacher 2005
31
6 Steps of Curriculum Design
1.
2.
3.
4.
5.
6.
Problem Identification and General Needs
Assessment
Needs Analysis of Targeted Learners
Goals and Specific Measurable Objectives
Educational Strategies
Implementation
Evaluation and Feedback
32
Where to Publish?
 Simulation in Healthcare journal
 Medical education journals (see list at
http://www.med.uottawa.ca/aime/eng/journals.html):
Academic Medicine, Medical Education, Medical Teacher,
Teaching and Learning, Advances in Health Sciences,
Journal of Nursing Education, Nurse Education Today,
Nurse Educator, etc.
 Clinical specialty journals: watch for calls for Education
issues
 MedEdPortal – curriculum, case scenarios, tutorials,
facilitator guides
33
MedEdPortal Examples
 Ragsdale L, Gutman D, Kobayashi L. Geriatric Emergency Medicine Curriculum Using
High Fidelity Medical Simulation. MedEdPORTAL; 2010. Available from:
www.mededportal.org/publication/3168
 Acton R, Schmitz C, Chipman J, Reihsen T, Gilkeson J, Groth S, et al. University of
Minnesota Surgical Clerkship Simulation Skills Curriculum and Instructor Guide.
MedEdPORTAL; 2010. Available from: www.mededportal.org/publication/7948
 Chakraborti C. A Simulation-Based Curriculum For 4th Year Medical Students During
An Internal Medicine Acting Internship. MedEdPORTAL; 2009. Available from:
www.mededportal.org/publication/1687
 Motz L, Lloyd B, Donato A, Chaudhary A, Kaliyadan A, Stavarski D, et al.
Interdisciplinary Curriculum and Simulation Cases for Teaching Leadership and
Communication to Medical Rapid Response Teams. MedEdPORTAL; 2012. Available
from: www.mededportal.org/publication/9145
 Brown C, Gephardt G, Lloyd C, Swearingen C, Boateng B. Teaching Palliative Care Skills
Using Simulated Family Encounters. MedEdPORTAL; 2011. Available from:
www.mededportal.org/publication/8507
34
Example Curricular Papers
 Fernandez GL et al. Boot Camp: Educational Outcomes After 4




Successive Years of Preparatory Simulation-Based Training at Onset of
Internship. J Surg Educ 2012 Mar-Apr;69(2):242-8.
Binstadt ES et al. A comprehensive medical simulation education
curriculum for emergency medicine residents. Ann Emerg Med. 2007
Apr;49(4):495-504, 504.e1-11.
Norman J. Systematic review of the literature on simulation in nursing
education. ABNF J. 2012 Spring;23(2):24-8.
Hudson D, Dunbar-Reid K, Sinclair PM. The incorporation of high
fidelity simulation training into hemodialysis nursing education: part
2--a pictorial guide to modifying a high fidelity simulator for use in
simulating hemodialysis. Nephrol Nurs J. 2012 Mar-Apr;39(2):119-23.
Rhodes HA. Simulation in Kansas practical nursing programs. J Pract
Nurs. 2011 Fall;61(3):10-3.
35
References
• Kern DE et al. Curriculum Development for Medical
Education: A Six-Step Approach. Johns Hopkins University
Press, 1998.
 Lockyer J, Ward R, Toews J. Twelve tips for effective short
course design. Med Teach. 2005 Aug;27(5):392-5.
 Seropian MA et al. An Approach to Simulation Program
Development. Journal of Nursing Education. 2004
Apr;43(4):170-4.
 Jeffries PR. A framework for designing, implementing, and
evaluating simulations used as teaching strategies in
nursing. Nurs Educ Perspect. 2005 Mar-Apr;26(2):96-103.
36
Web Resources
 UW collaborative website:
http://collaborate.uw.edu/educators-toolkit/scenariobuilding-library.html-0
 Society for Academic Emergency Medicine scenario
library:
http://www.emedu.org/simlibrary/default.aspx?AspxA
utoDetectCookieSupport=1
37
Nursing Simulation Resources
 Simulation Innovation Research Center (NLN): http://sirc.nln.org/
 California Institute for Nursing and Healthcare (CINH) Simulation
Alliance: http://www.cinhc.org/programs/simulation/
 Scenario Libraries:
 Kansas State Board of
Nursing:http://www.ksbn.org/cne/SimulationScenarioLibrary.h
tm
 Montgomery College:
http://cms.montgomerycollege.edu/nursingsims/
 Massachusetts Dept of Higher
Ed:http://www.mass.edu/currentinit/Nursing/Sim/Scenarios.as
p
38
Hot Topics
 Interprofessional team training simulation curriculum
 Train-the-trainer (faculty/instructor development)
 Assessment with simulation
39
More to Consider
 How do I get buy-in for simulation training?
 What are my available resources/funding
opportunities?
 What is already in the literature and available online?
 How do I incorporate technical and non-technical
behavioral skills (e.g. leadership and communication
skills training)?
 How many simulation sessions/scenarios do I need to
achieve objectives?
 Realistically/logistically, how often/how many can
learners come to the simulation center?
40
More to Consider
 How can I incorporate more independent simulations
since I do not have enough faculty to teach?
 What do I need to consider for limited space and
scheduling?
 How do I get all my faculty trained to teach in this
curriculum?
 How do I add a competency/evaluation component to
a course that has been primarily instructional?
 What approach should I take when I have to follow a
national standardized curriculum?
41
Questions?
 Yue Ming Huang, EdD, MHS
 Email: [email protected]
42
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