1. Mr Gary Strong & Dr Rebecca Vickerstaff
Using simulation to teach decision making in Paramedic Practice: learning for the few or for the many?
Mr Gary Strong & Dr Rebecca Vickerstaff

2. Ethical Decision Making The biggest ethical challenge in paramedic practice?vs
Going to talk about death and sudden cardiac arrest – hope you are ok with that
Advance decisions, Treatment escalation plans, DNARs will help with legal aspects…..but what about the ethics of resuscitation when these documents are absent, hard to find or unclear?

3. ‘The challenge for ambulance clinicians is to differentiate those patients for whom cardiac arrest is their natural end of life event, from those where there is a chance to restore life with a quality acceptable to the patient and in accordance with their wishes’.
SWASfT (2014), Cardiac Arrest CG07. Exeter: SWASfT

4. When Paramedics met Learning Technology
Briefly discuss how it came about and how we came to get best filming set up and demonstration of the technology to allow future sustainability and best practice of appropriate technology
Becki Notes 2nd Nov PM
Explain how you and Kirstie came on our ‘Using video in teaching’ workshop and then asked us to go and run a session at PAHC which lead to discussions on simulation and clinical skills video tests. As Learning Technologists our role is to facilitate and empower academics to use the appropriate technology and show academics how technology can enhance teaching practice but only when used appropriately …que next slide

5. Technology and Appropriate Pedagogy Implementation
“Educational Technology (Edtech) in Higher Education (HE) has been promoted as having the potential to transform teaching and learning” (Laurillard, 2008)
“A critical factor in the successful implementation of Edtech in HE has been identified as the competence of teachers to know why, when and how best to implement educational technologies”. (Krumsvik, 2014).
Becki Notes 2nd Nov PM
Explain that I love these two quotes and the image!, as a Learning Technologist we recognise how technology can transform education but we are also aware how people can be distracted by the attractiveness of gadget and tech for the sake of it. We look to research and embed the appropriate technology and transfer that skillset to the academic giving them the tools to continue the practice as we cant support everything 1:1 due to resources. This in turn improves digital literacy. Our role here was to help advise you guys on the right technology, right angles, how to embed the technology and scale it up etc
Reference:
Laurillard, D. (2008). Technology enhanced learning as a tool for pedagogical innovation. Journal of Philosophy of Education, 42(3–4), 521–533. doi:  /j x
Krumsvik, R.J. (2014). Teacher educators’ digital competence. Scandinavian Journal of Educational Research, 58(3), 269–280. doi:  /

6. The Scenario:
Rodney Jones : 46 year old male with cardiovascular risk factors
Visited GP after weight loss and a change in bowel habits.
Diagnosed with colon cancer, now spreading to abdominal wall and liver
Thinks that if admitted to hospital, he would not want resuscitation
Wife Helen knows this, son David does not

7. The Scenario:
0850 am Rodney has collapsed complaining of a dull ache in his chest and shortness of breath
Wife Helen has called the community palliative care nursing team
Then called son David who called 999
Several minutes after the arrival of paramedics Rodney suffers a sudden cardiac arrest
Next few slides are just to give a flavour of how this played out and the learning situation our students found themselves in

8. Setting the scene https://youtu.be/HJuK8X6fe84

9. A critical event https://youtu.be/WWX9eqAvxV4

10. Consultation

11. Decision time https://youtu.be/ULh-yZ4383g

12. Student Feedback Great experience Importance of delegation of roles
Benefit of watching and taking part
This method of learning is really beneficial
Decision making is better as a team
Letting everyone give their opinion in real time
Keep doing this it was brilliant
Gives confidence in difficult scenarios
Been able to apply knowledge in real life scenario on work based learning
Valuable to listen to other teams decisions

13. Scalability and sustainability
Planning time: several hours, two meetings, two sites
Preparation on the day: one hour
Running time: one hour
Debrief: one hour
Participation: 6 students
Staffing: two academics, two learning technologists
Cohort of 50 students
Sharing the experience: 3 days?
NB this is a conservative estimate
Becki Notes 2nd Nov PM
From an LT perspective time was spent going up and doing a reccy on the venue, looking at camera angles, the best way to capture footage but to then show you guys where to set up and which technology to use.

14. Scalability and sustainability
Simulation based learning
Labour intensive
Low participant numbers
The challenge:
Finding a format that allows all students to experience the same cognitive and affective steps in learning construction
Use of Bloom. Can leave out the psychomotor as they learn these elsewhere. But cognitive, affective….interpersonal skills?
Becki Notes 2nd Nov PM
The use of the appropriate technology proves vital here, which technology is future proof (well probably none long term as it changes so much) but we need to ensure what we do is achievable for staff and attractive and ready for students.
Disler, R.T., Rochester, S.F., Kelly, M.A., White, H. and Forber, J., Delivering a large cohort simulation-beginning nursing students’ experience: A pre-post survey. Journal of Nursing Education and Practice, 3(12), p.133.
Carson, P.P. and Harder, N., Simulation use within the classroom: recommendations from the literature. Clinical Simulation in Nursing, 12(10), pp

15. + Future Option One = “What would you do next?” Becki Notes 2nd Nov PM
This would use a combination of pre recorded scenes based on judgements and embedded into Moodle where students would watch a video then answer a question based on their judgement, this then branches off depending on decision to different videos. Needs lots of variants to ensure its not totally linear and lots of prep work but it would become a reusable object that students could practice on and the academic could track engagement via the DLE and provide feedback on collaborate forums as well.
= “What would you do next?”

16. Future Option Two Live simulation Stream to classroom
Live Moodle forum
Academic moderator(s)
Debrief with full cohort
Live simulation
Stream to classroom
Live Moodle forum
Academic moderator(s)
Debrief with full cohort
Becki Notes 2nd Nov PM
Future learning spaces are being piloted and there is potential research into using the rooms with the new surface hubs for collaborative work and streaming.

17. Research Questions
Can the use of scripted online simulation videos allow students to achieve the same learning outcomes as ‘live’ participants in simulation?
When using simulation, can non-participating students follow the same process of learning construction as the participants to achieve the same learning outcomes?
Which of the suggested learning methodologies offers students the most effective learning experience?
Funding for this project?

18. Acknowledgements Plymouth University graduates and staff:
Maisie Grainger
David Williams
Emily Haydon
James Kiss
Dean Gray
Spencer Ward
Ed Bartlett
Kirstie Brown
Adam Harvey

19. Questions?

20. Thank You

21. Selected Bibliography
Canadian Interprofessional Health Collaborative. (2010). A National Interprofessional Competency Framework. Vancouver, Canada: Canadian Interprofessional Health Collaborative.
Carson, P.P. and Harder, N., Simulation use within the classroom: recommendations from the literature. Clinical Simulation in Nursing 12(10), pp
Disler, R.T., Rochester, S.F., Kelly, M.A., White, H. and Forber, J., Delivering a large cohort simulation-beginning nursing students’ experience: A pre-post survey. Journal of Nursing Education and Practice 3(12), p.133.
Flin, R., & Maran, N. (2004). Identifying and training non-technical skills for teams in acute medicine. Quality & Safety in Health Care. 13(Supplement 1), i80-i84.
Nicol, D. J., & MacFarlane-Dick, D. (2006). Formative assessment and self regulated learning: a model and seven principles of good feedback practice. Studies in Higher Education
Reeves, S., Freeth, D., McRorie, P., & Perry, D. (2002). ‘It teaches you what to expect in future...’: interprofessional learning on a training ward for medical, nursing, occupational therapy and physiotherapy students. Medical Education. 36,

22. Selected Bibliography
Reeves, S., Freeth, D., McRorie, P., & Perry, D. (2002). ‘It teaches you what to expect in future...’: interprofessional learning on a training ward for medical, nursing, occupational therapy and physiotherapy students. Medical Education. 36,
Riesen, E., Morley, M., Clendinneng, D. et al (2012). Improving interprofessional competence in undergraduate students using a novel blended learning approach. Journal of Interprofessional Care. 26,
Solomon, P., Marshall, D., Boyle, A. et al (2011). Establishing face and content validity of the McMaster-Ottawa team observed structured clinical encounter (TOSCE). Journal of Interprofessional Care. 25(2),
Smith, K., Klaasen, J. , Zimmerman, C. & Cheng, A-L (2013). The Evolution of a High Fidelity Patient Simulation Learning Experience to Teach Legal and Ethical Issues. Journal of Professional Nursing, Vol 29, No. 3; 168–173
Williams, B., Brown, T., Scholes, R., Archer, F., & al, e. (2010). Can Interdisciplinary Clinical DVD Simulations Transform Clinical Fieldwork Education for Paramedic, Occupational Therapy, Physiotherapy and Nursing Students? Journal of Allied Health. 39(1), 3-10.