Practical Updates in Anesthesiology Dr. Mark Wigginton MB,BS FRCA

How to Teach A Brainiac: Educational theories in medical simulation

Content 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 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 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:

Integration of learning theory

Kolb’s learning cycle related to a simulation scenario CONCRETE EXPERIENCE: Once the simulation has run the decisions made and the effects they had can be viewed in entirety. They become concrete experience. 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. 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. 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.

Suspension of disbelief

Techniques for improving fidelity 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

Kolb’s learning cycle related to a simulation scenario CONCRETE EXPERIENCE: Once the simulation has run the decisions made and the effects they had can be viewed in entirety. They become concrete experience. 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. 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. 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.

Debrief 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 Why is simulation not straight forward Theories of learning Types of simulation How educational theory is relevant to medical simulation Fidelity Effective debrief

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