Practical Updates in Anesthesiology
Dr. Mark Wigginton MB,BS FRCA
How to Teach A Brainiac:
Educational theories in medical simulation
Content
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Why is simulation not straight forward
Theories of learning
Types of simulation
How educational theory is relevant to
medical simulation
• Fidelity
• Effective debrief
Adult Learners
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Highly motivated
Attend courses because they want to learn
Self directed educational objectives
Teaching adult learners can be difficult
Defensive reasoning
Dangers of simulation
• Stress inducing
• Under performance in company of peers
• Long term self esteem and emotional
issues
Theories of learning
• Behaviourism
– Conditioning
• Cognitivism
• Humanism
– Transformative learning
• Constructivism
• Taxonomies of intelligence
– Howard Gardner 1983 Frames of Mind
Taxonomies of intelligence
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Linguistic intelligence
Logical-mathematical intelligence
Musical intelligence
Bodily-kinesthetic intelligence
Spatial intelligence
Interpersonal intelligence
Intrapersonal intelligence
Moral / Naturalist /Spiritual / Existential
Types of Simulation
• Simulation for assessment
• Simulation for research
• Simulation for systems appraisal
• Task training
• Application of knowledge scenarios (High signal)
• Human factors – CRM scenario (High noise)
Types of simulation vs educational
objectives
• Task training
• Application of knowledge scenarios (High signal)
• Human factors – CRM scenario (High noise)
Example
• Educational objectives:
– Increased knowledge of anaphylaxis
algorithm
– Increased awareness of how to facilitate
effective teamwork
– Increased ability to perform emergency
cricothyroidotomy
• Freidman et al. Clinical Impact of Epidural Anesthesia
Simulation on Short- and Long-term Learning Curve.
Reg Anesth Pain Med 2009;34: 229-232
Integration of learning theory
CONCRETE
EXPERIENCE:
Once the simulation has run the
decisions made and the effects
they had can be viewed in
entirety. They become concrete
experience.
ACTIVE EXPERIMENTATION:
The process of doing the
simulation during which the
candidate will make decisions and
potentially need to alter these
decisions depending on response.
Kolb’s learning
cycle related to a
simulation scenario
ABSTRACT
CONCEPTUALIZATION:
Thinking about the task and using
conceptual knowledge in planning
strategy. In simulation this may
relate to pre-course material or
pre-scenario briefing.
REFLECTIVE OBSERVATION:
This part of the learning cycle
relates to the debrief phase of
simulation. If candidates are not able
to critically evaluate the results of
their actions they will not learn from
them.
Suspension of disbelief
Techniques for improving fidelity
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High fidelity mannequin
Well programmed scenario
Experienced controller
Reduced scenario leader input
Candidates adopt their normal role
Faculty adopt their normal role
Ambient sound
Realistic setting
Point-of-care simulation
Considerations for point-of-care
simulation
• Safety
• Interruption of normal activity
• Mixing of simulation equipment with real
equipment
CONCRETE
EXPERIENCE:
Once the simulation has run the
decisions made and the effects
they had can be viewed in
entirety. They become concrete
experience.
ACTIVE EXPERIMENTATION:
The process of doing the
simulation during which the
candidate will make decisions and
potentially need to alter these
decisions depending on response.
Kolb’s learning
cycle related to a
simulation scenario
ABSTRACT
CONCEPTUALIZATION:
Thinking about the task and using
conceptual knowledge in planning
strategy. In simulation this may
relate to pre-course material or
pre-scenario briefing.
REFLECTIVE OBSERVATION:
This part of the learning cycle
relates to the debrief phase of
simulation. If candidates are not able
to critically evaluate the results of
their actions they will not learn from
them.
Debrief
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Duration at least as long as the simulation
In a different area
Video debrief
There’s no such thing as non-judgmental debrief
– Espoused theory
– Theory-in-use
Summary
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Why is simulation not straight forward
Theories of learning
Types of simulation
How educational theory is relevant to
medical simulation
• Fidelity
• Effective debrief
References
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Argyris C. Teaching Smart People How to Learn. Harvard Business Review 1991;
4(2)
Pavlov I. P., (1927). Conditioned reflexes. London: Routledge and Kegan Paul.
Kang SG, Yang KS, Ko YH, Kang SH, Park HS, Lee JG, Kim JJ, Cheon J. A study on
the learning curve of the robotic virtual reality simulator. J Laparoendosc Adv Surg
Tech A. 2012 Jun;22(5):438-42.
Friedman Z., Siddiqui N., Katznelson R., Devito I., Bould M.D., Naik V. Clinical Impact
of Epidural Anesthesia Simulation on Short- and Long-term Learning Curve HighVersus Low-fidelity Model Training. Reg Anesth Pain Med 2009; 34(3):229-232
Gaba D.M., Crisis resource management and teamwork training in anaesthesia.
British Journal of Anaesthesia 105 (1): 3–6 (2010)
Kolb D., (1984) Experiential Learning: Experience as the Source of Learning and
Development. Prentice-Hall, Inc., Englewood Cliffs, N.J.
Coffield F., Moseley D., Hall E., Ecclestone K. (2004) Learning styles and pedagogy
in post-16 learning. A systematic and critical review. London: Learning and Skills
Research Centre.
Maslow A. A theory of human motivation. Psychological Review 1943; 50(4): 370-96
Hamann S. Cognitive and neural mechanisms of emotional memory. Trends in
Cognitive Sciences 2001; 5(9): 394-400
Russell J. A Circumplex Model of Affect. Journal of Personality and Social Psychology
1980; 39(6): 1161-1178
Argyris C., Schön D. Theory in practice: increasing professional effectiveness (1974)
Jossey-Bass San Francisco
Rudolph J., Simon R., Dufresne R., Raemer D. There’s No Such Thing as
“Nonjudgmental” Debriefing: A Theory and Method for Debriefing with Good
Judgment. Simulation in Healthcare 2006; 1(1): 49-55