Download to read offline
More Related Content
Similar to nursing education- Simulation Learning 2.pptx
nursing education- Simulation Learning 2.pptx
- 1. Simulation Based Learning Ms.Saraswathy Asst.Professor ApolloCollege of Nursing
- 2. See One, DoOne, Teach One See One, Practice Many, Do One Teaching methodologies
- 3. What is simulation? Simulation is defined as a: “real world event that that represents a referent which then draws its essential meaning from that referent” Unlike a simulator: “a simulator is comparable to a genetic code, and a simulation to the realization of that code into the living organism” Crookhall, Oxford and Saunders (1987)
- 5. Values Psychological safety Controlled environment Repetitivepractice, proficiency Enhanced teamwork and collaboration Cognitive, practical understanding
- 6. Values - * Communication* Improve Critical Thinking Judgment Organizational culture Prioritization
- 7. . Simulation is astep in the circle of learning that follows knowledge acquisition, skills proficiency and decision making learning It is a technique, rather than just a technology that promotes experiential and reflective learning.
- 8. History of simulation Jousting, chess, war-gaming, military exercise, Aviation 1832 – Anatomy Act 1960’s – SimONE 1980’s –GAS 1990’s – Surgical haptic simulators 2000’s – HPS/ECS 2010 – 3G/iStan
- 9. Defining simulation types Wargaming Aviation Nuclear industry Space programme Tribal dancing Military training Jousting Chess Emergency services Forensics
- 10. Theory – practicedichotomy If used correctly simulation will facilitate classical conditioning (2nd nature) Objective outcome measurement (Anne vs iStan) Development of communication and psychomotor domains
- 11. Formula for theeffective use of simulation Training Resources Trained Educators Curricular Institutionalization X X = Effective Simulation- based Healthcare Education Issenberg, SB. The Scope of Simulation-based Healthcare Education. Simulation in Healthcare. 2006.
- 12. Options for runningsimulations Free-form Easy but poor learning ‘On the fly’ Scripted but intensive for the ‘controller’ and some variables may appear discontinuous Programmed trends More sophisticated simulations possible Trends and event handlers Facilitates high-fidelity simulation with most realistic response to interventions
- 13. Resources needed Equipment: Simulators, monitors, defibrillator, trolleys, etc Disposables: Appropriate for scenario, setting and participants, re-use w/o compromising fidelity Faculty: Trained, available, practised Support staff: Technician/bio-medical engineer essential!
- 14. Before and aftersimulations... Set-up scenario eg. make blood, set up area, X-rays, notes, etc Load simulation program Check everything works Cameras, VCR, communicators Afterwards... Check simulator (replace or repair parts) Clean everything used and put away Replace/reorder all used items
- 15. Benefits of simulation Patients are not exposed to complete novices Safe environment where mistakes become learning opportunities Complexity can be altered according to the needs of the student Self efficacy can be built before contact with real patients
- 16. Benefits of simulation Studentscan: repeat the skill as often as necessary to develop confidence learn at their own pace experience being ‘on the receiving end’ express their fears and ask ‘difficult’ questions make mistakes and appreciate the consequences without harm to the patient
- 18. Hi fidelity simulation disadvantages Adrenaline gap Uncanny valley Fear / upset Manpower hours
- 20. Simulation as aconcept Low fidelity manikin Hi Fidelity manikin Part task trainers Games (driving rehearsal) Haptic systems VR Simulated patients Multimedia There are many terms that are afforded the term simulation, including:
- 21. Human patient simulatorStandardized patients
- 22.
- 24.
- 26. Trainees learning cricothyrotomy on apart-task trainer (Note educational aids in background) Trainee performing an emergency cricothyrotomy in a full-mission simulation. (Note more realistic setting)
- 27.
- 28. Hi fidelity simulationadvantages Draws referent from clinical practice (context) Aims to facilitate suspension of disbelief Allows for 4D teaching (time) Allows for repetition and rehearsal Stress innoculation (covert sensitisation)
- 29. Briefin g- why and how Simulatio n- the real situation Debrief,reflection with highest potential for learning Structure of a Simulation Scenario Reacti ons Analys is Sum mary
- 31. Successful strategies forcrisis management: Use of written checklists to help prevent crises Use of established procedures in responding to crises Training in decision making and resource co- ordination Systematic practise in handling crises including part-task trainers and full-mission realistic simulation
- 32.
- 33. 1 - Analysis What and why should this be undertaken? Determine through: Needs assessments Quality assurance/quality management data Curricular requirements Focus groups, evaluations
- 34. Defining outcomes Learnersare more likely to achieve competency and mastery of skills if the outcomes are well defined and appropriate for the level of skill training Define clear benchmarks for learners to achieve Plain goals with tangible, measurable objectives Start with the end-goal in mind and the assessment metrics, then the content will begin to develop itself
- 35. High fidelity simulation(1) Determine educational needs and choose most efficient and effective Need to balance resource availability and student demand May need to ‘promote’ low-tech solutions
- 36. Possible outcome competencies Patient care Medical knowledge Practice-based learning and improvement Interpersonal and communication skills Professionalism Systems-Based Practice Knowledge Skills Attitudes
- 37. Miller’s Pyramid ofCompetence Learner: “Knows” – learns information “Knows How” - to use learned information “Shows” - how to use the information “Does” – performs in practice Instructor: “Knows” – content to be taught “Knows how” – to teach “Shows” – teaching is delivered “Does” – teaches effectively Does Shows Knows How Knows George E. Miller MD. The Assessment of Clinical Skills/Competence/Performance. Academic Medicine. 1990. Vol. 65 No. 9: S63-67.
- 38. 2 – Design:“agree on content” Choose curriculum content to ensure it address the learning outcomes. This will enable one to describe which core learning outcomes are addressed by specific content. Redundancies and omissions of content that address core competencies should be noted and modified.
- 39. 2 – Design:“organize the content” Develop the curriculum design to ensure a vertically integrated curriculum. There should be: a repetition of core topics, topics should be revisited at numerous levels of difficulty, new learning should be related to previous learning, and the competence of learners should increase with each exposure to a topic. When developing assessment it is important to ensure that learners are assessed based on the same schema or organization that is presented during their learning opportunities.
- 40. 2 – Design:“decide on the educational strategy” These include: student-centered vs. teacher-centered learning; problem-based / task-based learning vs. information oriented learning; integrated/interprofessional vs. subject / discipline-based; community-based vs. hospital-based learning; systematic vs. opportunistic
- 41. High fidelity simulation(2) Confirm teaching goals can be achieved using simulation Develop scenario, acquire equipment needed and prepare associated materials Test and validate the simulation
- 42.
- 43.
- 44. 2 – Design:“decide the appropriate teaching methods” An effective curriculum makes effective use of a range of teaching methods applying each method for the use to which it is most appropriate. These include: lectures; small-group sessions; independent study; clinical skills exercises. NOTE: simulations can be integrated into each of these areas.
- 45. Ranges of difficulty Learning is enhanced when a wide range of difficulty levels is employed Learners will have different “learning curves” Begin at the basic level, allow learner to demonstrate mastery, then proceed to progressively higher levels of difficulty
- 46. Alessi S. Designof Instructional Simulations. J Computer-based Instruction. 1988. 40-7. Effect of realism and initial learning
- 47. Tips for improvingsimulation validity Determine the appropriate level of “simulator” technology to accomplish the desired outcome Develop the appropriate levels of “simulation” fidelity around the simulator Low fidelity High technology Low fidelity Low technology High fidelity High technology High fidelity Low technology Fidelity Technology
- 48. High fidelity simulation(3) Allow time for briefing and familiarisation with the patient simulator and equipment Brief participants on: Broad objectives The scenario How to get help
- 49. 3 – Development:“prepare the assessment” What should be assessed? Every aspect of the curriculum that is considered essential and/or has had significant teaching time designated to it Should be consistent with the learning outcomes that have been established as they are the competencies students should master at the end of the course / phase of study
- 50. High fidelity simulation(4) Always follow the script but... …have alternative outcomes planned and rehearsed Simulation control room
- 51. Assessments Should includeassessment of: Knowledge – not only factual recall, but comprehension, application, analysis, synthesis and evaluation of cognitive knowledge Skills – communication, physical exam, informatics, self-learning, time management, problem-solving Attitudes – behavior, teamwork – key personal qualities thought necessary of a professional
- 52. Assessing team performance Team Structure Leadership •Assemble team • Establish leader • Identifies team goals and vision • Assigns roles and responsibilities • Hold team accountable • Actively shares information • Utilizes resources to maximize performance • Balances workload within the team • Delegates tasks or assignments, as appropriate • Conducts briefs, huddles and debriefs • Empowers team to speak freely and ask questions Situation Monitoring Mutual Support • Includes patient/family in communication • Cross monitors team members • Applies the STEP process • Fosters communication to ensure a shared mental model • Provides task- related support • Provides timely and constructive feedback • Effectively advocates for the patient • Uses the “two- challenge” rule, CUS, DESCscript to resolve conflict • Collaborates with team Communication • Coaching feedback routinely provided to team members when appropriate • Provides brief, clear, specific, and timely information • Seeks information from all available sources • Verifies information that is communicated • Uses SBAR, call- outs, check- backs, and handoff
- 53. Assessments Choose theappropriate assessment method: Formative Summative Self Peer
- 54. 4 – Implementation:“provide communication about the curriculum” Teachers have the responsibility to ensure that students have a clear understanding of: What they should be learning – the learning outcomes; The range of learning experiences and opportunities available; How and when they can access these most efficiently and effectively; How they can match the available learning experiences to their own needs; Whether they have mastered the topic or not, and if not, what further studies and experience are required.
- 55. 4 – Implementation:“define the teaching team” Learning activity Technicians Confederates Instructors Assessors Actors/SPs Facilitators Course Directors, SMEs, Authors NOTE: Multidisciplinary learner groups = multidisciplinary instructor groups
- 56. 4 – Implementation:“promote appropriate educational environment” The educational environment or ‘climate’ is a key aspect of the curriculum Although it is less tangible than the content studied, or the teaching methods used or the examinations, it is just as important For example: there is little point in developing a curriculum whose aim is to orient a student to prehospital disaster preparedness, if the students perceive that what is valued by the faculty is routine prehospital healthcare rather than disaster preparedness.
- 57. 4 – Implementation:“provide effective curriculum management” This will ensure proper communication at multiple levels regarding different aspects of the curriculum Communication should occur between: faculty and the learners, so they are apprised of their performance in the course or assessment, between faculty members to evaluate the effectiveness of the learning opportunities or assessments
- 58. High fidelity simulation(5) Using simulation situations can be re-run to explore outcome with different treatments Mission critical tasks can be performed by learners without putting patients at risk
- 59. 5. Evaluation: “measure effectiveness” Evaluate Course Learners Instructors Effect on practice
- 60. High fidelity simulation(6) Facilitated debriefing with an expert practitioner. Participants reflect on their own performance and discuss this with the group
- 61. Three Phases ofDebriefing Reactions - Clear the air and set the stage for discussion - Feelings - Facts Understanding - Exploring - explore participant perspectives on scenario events - Discussion and teaching Summary - distill lessons learned for future use - What worked well - What should be changed next time - Major take always
- 62.
- 63.
- 69.
- 71. Few Procedures inOBG Amniocentesis Vaginal breech delivery Cesarean section Cordocentesis Eclampsia Maternal cardiac arrest Episiotomy repair
- 72. The future ofsimulation... Skills training tool for all disciplines Acute care Try new techniques and/or equipment Patient safety initiatives Retraining Multi-disciplinary training inter-professional communication team performance Training in decision-making/resource co- ordination
- 73. Simulation technologies usedin medical education Computer-based simulations (micro- worlds, micro-simulation) Virtual environments +/- haptics Part-task trainers Low-fidelity simulators/manikins Simulated or standardised patients Hybrid simulations High-fidelity (full mission) simulation
- 74. Simulation research mustaddress healthcare training needs Improved outcomes Fewer adverse events, fewer preventable incidents, fewer ‘near miss’ events Increased efficiency of training Improved outcomes in same or (preferably) less training time Improved use of resources Fewer failures, more efficient training, quicker performance
- 75. High Quality Simulation-can substitute upto 50% clinical hours High quality simulation experiences could be substituted for up to 50% of traditional clinical hours across the pre-licensure nursing curriculum
- 76. Best practice is characterizedby Evidence supports best practices for simulation based education 1. Feedback 2. Repetitive Practice (LDHF) 3. Distributed Practice 4. Curriculum Integration 5. Clinical variation 6. Range of difficulty 7. Individualized learning 8. Multiple learning strategies 9. Defined Outcomes 10. Valid simulator 1. Facilitated Reflective Debriefing Debriefing = reflective discussion Feedback = provision of information
- 77. Cognitive improvement 0 1020 30 40 50 60 70 80 90 Posttest Pretest 54.5% 84.2% n= 264, p= < 0.0005
- 78.
- 79. Individual and teamskills
- 80.
- 81.
- 82. Practise makes perfect Practisemakes permanent! Only well supervised practise with constructive feedback makes perfect
- 83.