Presentation on theme: "Improving Efficiencies in Simulation Education, Blended Learning in Basic and Advanced Cardiac Life Support Training Geoffrey T. Miller Associate Director,"— Presentation transcript:
1 Improving Efficiencies in Simulation Education, Blended Learning in Basic and Advanced Cardiac Life Support TrainingGeoffrey T. Miller Associate Director, Research and Curriculum Development Division of Prehospital and Emergency Healthcare Gordon Center for Research in Medical Education University of Miami Miller School of Medicine
2 Session aims In the context of BLS and ACLS training: Review the fundamental benefits of simulationDiscuss various examples of simulationDiscuss key questions surrounding blended learningExplore practical applications of simulationParticipate in simulation activities for BLS and ACLS training (Part 2)
4 What is medical simulation? “In general, medical simulations aim to imitate real patients, anatomic regions, or clinical tasks, or to mirror real-life situations in which medical services are rendered.”“simulation refers broadly to any device or set of conditions… that attempts to present patient problems authentically, whereas a simulator, more narrowly defined, is a simulation device.”Issenberg, SB, Scalese, RJ. Simulation in Healthcare Education.Perspectives in Biology and Medicine. Vol. 51, No. 1:
5 Why use simulation? Benefits of medical simulation Safe environment, mistake forgivingTrainee focused vs. patient focusedControlled, structured, proactive clinical exposureReproducible, standardized, objectiveDebriefing as a norm in everyday practice public trust in professionDeliberate and repetitive practice
6 Why use simulation? Assessment of professional competence Patient care Medical knowledgePractice-based learning & improvementCommunication skillsProfessionalismSystems-based practice
7 Why use simulation? What does the science say… Examples: Overwhelmingly positive and favors use of simulationExamples:Written evaluation is not a predictor for skills performance in Advanced Cardiovascular Life Support course – Rodgers DL, et. al. Resuscitation 2010“The ACLS written evaluation was not a predictor of participant skills in managing a simulated cardiac arrest event”2. A longitudinal study of internal medicine residents’ retention of advanced cardiac life support skills – Wayne DB, et. al. Academic Medicine, 2006.“ACLS skill improved significantly… cohort followed for 14 months and the skills did not decay”3. Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case-control study – Wayne DB, et. al. Chest, 2008.“Simulation-based educational program significantly improved the quality of care during actual events”
8 Food for thought… and discussion "Excellence is an art won by training and habituation. We are what we repeatedly do. Excellence, then, is not an act but a habit."Aristotle
9 Another interesting thought… How could learning style affect awareness, pattern recognition and “habits”?
11 Inattentional blindness Inattentional blindness is the phenomenon of not being able to perceive things that are in plain sightCan result from:no internal frame of reference, ormental focus or attention which cause mental distractions
12 ‘Right conditions’ for learning in simulation Feedback should be provided during the learning experienceLearners should engage in repetitive practiceSimulation should be integrated into the overall curriculumLearners should practice with increasing levels of difficultyMultiple learning strategies should be employedSimulations should represent clinical variationThe simulation environment should be controlledSimulations should foster individualized learningOutcomes must be clearly defined and measuredThe simulator should be valid as a representation of a human or situationMetaanalysis not possible due to lack of homogeneity in the literature. Thematic review of 109 articlesIssenberg SB,McGaghie WC, Petrusa ER, Gordon D, Scalese RJ (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Medical Teacher 27(1): 10–28.
13 Fidelity The degree of realism Types: Environmental Physical Technical PsychologicalKey Question: Is the simulation activity “realistic” enough to accomplish the desired outcomes.
15 “Realism versus relevance” Key Question:Which concept is more important in choosing and developing the learning activity?RealismRelevance
16 Realism and relevance Most cost-effective Best learning High Expert Prior LearningExperiencedNoneNoviceLowHighFidelity (realism)RelevanceAdapted from: Alessi S. Design of Instructional Simulations. J Computer-based Instruction
17 BEME: multiple learning strategies and clinical variation Learning ladderBEME: multiple learning strategies andclinical variationEmphasis on multiple learning strategies. From bottom to up. People work with objects, and models like a heart or cutaway model of the airway.High-fidelity will have thorough scenario. Wouldn’t start student here.
27 Who are our Learners? Key Questions: Who are our learners? Why do they Learn?What are their Motivations?Social relationships: to make new friends, to meet a need for associations and friendships.External expectations: to comply with instructions from someone else; to fulfill the expectations or recommendations of someone with formal authority.Social welfare: to improve ability to serve mankind, prepare for service to the community, and improve ability to participate in community work.Personal advancement: to achieve higher status in a job, secure professional advancement, and stay abreast of competitors.Escape/Stimulation: to relieve boredom, provide a break in the routine of home or work, and provide a contrast to other exacting details of life.Cognitive interest: to learn for the sake of learning, seek knowledge for its own sake, and to satisfy an inquiring mind.
28 Blended learning Key Questions: What is “blended learning? Where does it happen?What does this mean to me as a healthcare educator?
33 Standardized Patients Represent ultimate alternative to live patientsStandardized role play of psychological and physiological aspects of patientsFacilitator & peers evaluate student performanceFacilitator & SP provide feedback & trainingStudent examines patient
34 Screen-based simulations Software driven systems that include multimedia and VR components.Ranges from simple non- interactive to fully interactive teaching programs.Enhance cognitive knowledge, clinical reasoning and decision making.
36 Realistic high-tech interactive patient simulators Realistic full-sized manikin, computer, and interface devices that operate manikin physiology and drive monitorsCan be used in a variety of settings (low to high fidelity)
37 “Testing force feedback virtual reality products for dogs”
39 Large group instructor led Reach many learners at onceAdditional equipment: cameras/projectors/AVInstructor needs practiceAudience response system
40 Small group instructor led Focused teachingAbility to assess individuals’ skillsHands-on, interactiveInterest up to 2 hrs
41 Individual self-directed learning Important for skills acquisition (deliberate practice)Ability to work at own paceResponsible for own learning
42 Independent small group learning Less “hands-on” timeOpportunity to exchange ideas & problem solvePractice team workPeer to peer
43 Assessments Should include assessment of: Knowledge – not only factual recall, but comprehension, application, analysis, synthesis and evaluation of cognitive knowledgeSkills – communication, physical exam, basic life support skills, airway management, IV therapy, defibrillation, time management, problem-solvingAttitudes – behavior, teamwork, delivering “bad news”
44 “Assessment drives learning” Assessment should be educational and formativeLearning through testingFeedback to build knowledge and skillReflection - error correction – refinement“Assessment drives learning”
45 A case study in developing a blended learning curriculum
46 Blended learning – model program Emergency Response to Terrorism TrainingMultiple healthcare professionalsMany learner levelsMethods of deliveryLecture – case basedPsychomotor skill exercisesSmall groupIndividual / independent learnerLarge group exercisesIntegration exercises – SPE-OSCEs
47 Templates and blueprints Key features:Maps out:session/course objectiveslearning opportunities and objectsassessment opportunities and objectsProvides instructor support materials and objectsAllows assessment of omissions & redundanciesProvides a common understanding
48 UM Course Design Day 1 Didactic Psychomotor Day 2 Didactic Response ConceptsOperationsPPEDecontaminationICS / IMSPsychomotorMedical ManagementAmbulatory DECONIncapacitated DECONDay 2DidacticChemical AgentsBiological AgentsRadiological and Explosive AgentsLarge Group ExercisesTriage – computer-basedTabletopIntegration ExercisesOSCEs
49 Case –Based Lecture concert 18,000 people Wind: ENE 12 knots Open-airconcert18,000 peopleTemp: 84° FWind: ENE 12 knotsChemical weapon from aboat on shoreline
50 Case –Based Lecture Plume throughout concert area Initially mistaken as smoke machine (part of show)Hundreds with symptoms within minutesConcertAreaWindPlume
57 The final resultCourse reduced to 8 hours, focused on hands on simulation based activitiesEnduring materials allow for on-time, on-demand access by learners for maintenance of knowledge and skill (to a lesser degree)Faculty time reduced and opportunity for training increasedStudent assessment scores increased
58 SummarySimulation offers a wide array of learning and assessment opportunities for BLS and ACLS trainingVariation of learning methods and clinical difficulty is key to a successful learning ladderThe greatest effect on sustained learning is developed through the application of a blended learning environment