Simulation-Based Education: Developing Scenarios and the Importance of Debriefing


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Presented at the 2008 Midwest Human Patient Simulation Network - Chicago, IL

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Simulation-Based Education: Developing Scenarios and the Importance of Debriefing

  1. 1. Simulation-Based Education: Developing Scenarios and the Importance of Debriefing Eric Bauman, PhD, RN, Paramedic Faculty Associate Department of Anesthesiology The University of Wisconsin School of Medicine and Public Health  Bauman 2008 – No duplication or use of this presentation is allowed without proper citation and/or permission of the author
  2. 2. Disclosures <ul><li>Health Sciences Educational Consultant </li></ul><ul><ul><li>Vernon Memorial Healthcare </li></ul></ul><ul><ul><li>Town of Madison Fire Department </li></ul></ul>
  3. 3. Objectives <ul><li>Learn the importance of objective driven scenario development </li></ul><ul><li>Identify variables that influence situated learning environments </li></ul><ul><li>Explore the importance of debriefing as it relates to simulation-based education </li></ul>
  4. 4. Objective Driven Scenario Development <ul><li>Poorly written or executed scenarios are confusing and frustrating at best </li></ul><ul><li>Worse - they may instill poor practice habits and allow learners to misinterpret important cues relevant to future practice </li></ul>
  5. 5. Picking your objectives <ul><li>What is it you want your students to learn? </li></ul><ul><li>Who is your audience? </li></ul><ul><li>Can or should a scenario have different objectives or more than one objective </li></ul>
  6. 6. Tease out the objective <ul><li>The high-fidelity learning environment is best suited facilitating behavioral change </li></ul><ul><ul><li>Do not try to make the scenario excessively hard or tricky </li></ul></ul><ul><ul><li>Scenarios should be realistic </li></ul></ul><ul><ul><li>Scenarios should be engaging - promoting interaction </li></ul></ul>
  7. 7. The Novice Learner <ul><li>Consider scenarios that focus on just ONE objective </li></ul><ul><ul><li>Calling for Help </li></ul></ul><ul><ul><li>Administering a medication </li></ul></ul><ul><ul><li>Maintaining the airway </li></ul></ul><ul><ul><li>Assessing the patient </li></ul></ul>
  8. 8. Intermediate & Advanced Learner <ul><li>Consider the introduction of events that focus on serial objectives rather than multiple “All-At-Once” events </li></ul><ul><ul><li>Overly complicated scenarios are difficult to evaluate </li></ul></ul><ul><ul><ul><li>Unpredictable </li></ul></ul></ul><ul><ul><ul><li>Often lack fidelity </li></ul></ul></ul><ul><ul><ul><li>Can be very confusing for learners - and are often not believable </li></ul></ul></ul>
  9. 9. Who is your Audience <ul><li>Your scenario and the objectives you hope to introduce must be appropriately situated for your audience </li></ul><ul><li>Know your audience and situate the clinical back fill and created environment to their world </li></ul>
  10. 10. One Scenario - Various Objectives <ul><li>Good Scenarios take time to develop </li></ul><ul><li>Good scenarios often evolve over time </li></ul><ul><li>Your Objectives can be audience dependent </li></ul><ul><ul><li>Same Scenario - different objectives for different audiences </li></ul></ul>
  11. 11. Traditional Pedagogy <ul><li>Experiential Learning </li></ul><ul><ul><li>Kolb’s Learning Cycle </li></ul></ul><ul><ul><li>Benner: Thinking-in-action </li></ul></ul><ul><ul><li>Schon: thinking-on-action </li></ul></ul><ul><ul><li>While these theories predate modern </li></ul></ul><ul><ul><li>simulation,they do share the common and </li></ul></ul><ul><ul><li>useful theme of experiential learning </li></ul></ul>Kolb’s Learning Cycle
  12. 12. Situated Learning Environments Contemporary Theories for Simulation-Based Education <ul><li>Created or Designed Environments </li></ul><ul><ul><li>Environmental Fidelity Drives Psychological Fidelity </li></ul></ul><ul><li>Situated Learning Spaces </li></ul><ul><ul><li>Embodied Experience </li></ul></ul><ul><li>Created and Situated Spaces are </li></ul><ul><li>Dynamic & Interactive </li></ul>Bauman, 2007; Gee, 2003; Squire, 2006
  13. 13. Fidelity <ul><li>Theatrical or contextualized fidelity increases psychological fidelity </li></ul>Environmental Fidelity Psychological Fidelity Engagement Meaning
  14. 14. Prime your students for success! Simulation to Practice Pathway Bauman, 2007
  15. 15. The Power of Simulation <ul><li>Poorly designed and executed simulation may be worse than no simulation at all </li></ul><ul><li>Good simulation provides a powerful platform experiential learning </li></ul><ul><li>Simulation-based learning scenarios may rival actual experience </li></ul>
  16. 16. Higher Order Simulation <ul><li>Moves Beyond Task Training </li></ul><ul><li>Engages Behavioral aspects of learning </li></ul>Critical Thinking Team Dynamics Leadership Distributed Knowledge
  17. 17. Why is the Behavioral gain or change so important when it comes to clinical education?
  18. 18. <ul><li>Cognitive knowledge without the ability to apply it in an actual environment is not clinically useful - Simulation allows us to test the waters </li></ul><ul><li>Even when cognitive knowledge is deficient, it may be possible for students or clinicians to provide safe and effective care if they have the behavioral ability to succeed </li></ul>
  19. 19. Debriefing: Learning <ul><li>Debriefing is the reflective part of the learning experience </li></ul><ul><li>Debriefing facilitates peer-to-peer evaluation </li></ul><ul><li>The teacher acts as a guide to facilitate learning through reflection </li></ul>
  20. 20. Debriefing: Emotional Safety <ul><li>Debriefing allows the facilitator to check in with the participants </li></ul><ul><li>The debriefing allows the facilitator to set the record straight </li></ul><ul><ul><li>This is an important wtih simulations that involve High-Risk, Low-Incidence Scenarios that may involve deception or become emotionally charged </li></ul></ul>
  21. 21. After Implementation <ul><li>ALL SIMULATION SCENARIOS MUST BE DEBRIEFED </li></ul>Opportunities for change Things that went well +
  22. 22. References <ul><li>Bauman, E. (2007). High fidelity simulation in healthcare. Ph.D. dissertation, The University of Wisconsin – Madison, United States. Dissertations & Thesis @ CIC Institutions database. (Publication no. AAT 3294196) </li></ul><ul><li>Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice . Menlo Park, CA: Addison-Wesley. </li></ul><ul><li>Gee JP: What video games have to teach us about learning literacy. New York, Palgrave MacMillan, 2003 </li></ul><ul><li>Glavin, R. J., & Maran, N. J. (2003). Integrating human factors into the medical curriculum. Medical Education, 37 (Suppl. 1), 59-64. </li></ul><ul><li>Merriam, S. B., & Caffarella, R. S. (1999). Learning in adulthood: A compressive guide (2 nd ed.) . San Francisco: Jossey-Bass. </li></ul><ul><li>Squire, K. (2006). From content to context: Videogames as designed experience. Educational Researcher. 35(8), 19-29. </li></ul><ul><li>Stewart, L. (1992). Ethical issues in postexperimental and postexperiential debriefing. Simulation and Gaming, 23 (2), 196-211. </li></ul><ul><li>Thiagarajan, S. (1992). Using games for debriefing. Simulation and Gaming, 23 (2), 161-173. </li></ul>