Intergrating simulation into education

1. Building Competency with
Blended Learning:
Integrating Simulation into
Education
Charles M. Ware, D.H.Ed., CHES

2. What we are covering?
• Define Continuing Education
• Motivations for Learning
• Competency Assessment vs. Education
• Learning Styles (VARK) Questionnaire
• Adult Learner Characteristics (Knowles)
• Best Practices in Simulation Education

3. Objectives
At the end of this session learners will be able to:
• 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

4. Motivations for Learning

5. Motivations for Learning
1. Social Relationships
2. External Expectations
3. Social Welfare
4. Professional Advancement
5. Escape/Stimulation
6. Cognitive Interest
Morstain and Smart (1974), noted in Learning in adulthood.

6. 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?????

7. 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?

8. 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

9. Competency Assessment vs. Education
• Skills deficit
• Partial Task Trainers (hands on training tools)
• I.O. Leg
• IV arm
• Central Line Trainer
• Intubation head
• Virtual Reality

10. 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.

11. 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

12. 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

13. Learning Styles-How do you learn best?
• VARK- Link to VARK Questionnaire
• Multiple Intelligences-Link to Multiple
Intelligences Questionnaire
• Learning Styles Inventory-Link to Learning Styles
Inventory Questionnaire

14. Learning Styles
How do you learn best?
• Visual
• Aural
• Read/write
• Kinesthetic

16. Learning Styles
How do you learn best?
• Visual
• Charts
• graphs
• flow charts (arrows, circles, hierarchies)
• algorithms

17. Learning Styles
How do you learn best?
• Aural
• Lectures
• Tutorials
• Tapes
• Group discussion
• Email
• Speaking
• Webchat
• “Talking Things Through”

18. Learning Styles
How do you learn best?
• Read/write
• Text-based input and output
• List-makers

19. Learning Styles
How do you learn best?
• Kinesthetic
• Practice
• Hands-on
• Examples
• Simulations

20. 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

21. 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

22. 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

23. 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

24. Best Practices in Simulation Education
• Same equipment as in unit
• Groups bring specific equipment
• Basic Life Support (BLS) training for med students
includes how to function with new BLS skills in hospital
setting

25. Best Practices in Simulation Education
Situated Learning/Peripheral Participation (Lave & Wenger)
• Learning through real-life participation
• Learners observe actions while working side-by-
side with a skilled person (content expert)
• Begin participating in observed tasks, bringing
them from periphery to participation

26. 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

27. 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)

28. Best Practices in Simulation Education
• Hybrid simulations to practice very specific skills
• Tension Pneumothorax
• Patient death
• Intubation
• Aspiration

29. 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

30. 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)

31. Best Practices in Simulation Education
• Build debrief tools based on agreed upon standards
• Debrief should be based on simulation objectives

32. 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

33. Best Practices in Simulation Education
• eLearning
• Practice makes Perfect PERMANENT
• Automotive Service Excellent (ACE)
• National Automotive Technicians Education Foundation
(NATEF) practical simulation course
• Journeyman Electrician License

34. Putting it all Together
• Continuing education in healthcare should include:
• Opportunities to reflect on learning
• Opportunities to apply learning to practice
• Interpersonal interaction

35. 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

36. Putting it all Together
• Adult learners:
• Are problem-centered
• Have a wealth of experience to draw from
• Have many different motivations for learning

37. Putting it all Together
• Different learning styles mean people are most comfortable
in a particular way.
• Build simulations and debriefings to meet these styles

38. Putting it all Together
• Key learning theories to consider when building a
simulation are:
• Experiential Learning
• Contextual Learning
• Situated Learning/ Peripheral Participation
• Deliberate Practice
• Feedback
• Mastery Learning

39. 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 VARK-A
Guide to Learning Styles: http://www.vark-
learn.com/english/page.asp?p=categories

40. Questions?