1. Retooling Health Assessment: It Takes More Than a Hammer Cheryl Wilson MSN, ARNP, ANP-BC

2. Objectives  Understand the gap between knowledge and skill  Identify strategies to bridge knowledge and skill from Advance Health Assessment across to clinical courses  Understand the continuum of simulated learning and how to apply in blended courses

3. Who Am I?  Advanced Registered Nurse Practitioner- Adult Health Board Certified  Instructor Graduate and Undergraduate programs  Disclosure-provide non- compensated consultation as a SME to Shadow Health

5. What were the challenges?  Hybrid course only met 3 times a semester  No simulation integrated into Health Assessment course  Identified a gap between knowledge and skills  Application of skills in the clinical setting

6. Faculty challenges  Use of simulation  Faculty background and training  Preparation for lab  Ratio of faculty to students  Consistency of lab experiences

7. Modalities of Learning  Task Trainers  Digital Clinical Experience (DCE)  Problem Based Learning (PBL)  Clinical Reasoning exercises  Case Studies  Electronic Health Records (EHR)  Observed Structured Clinical Exam (OSCE)  Standardized Patients (SP’s)

8. Digital Clinical Experiences  Students interview the patient for a full health history  Go through full physical exam of each system  Documentation of findings

9. Digital Clinical Experience  Standardized experience  Communication skills  Physical exam skills  Clinical judgment

10. Problem Based Learning  Case presentation in small groups  Provide partial information in history –Students ask additional History questions –Discuss physical exam they would perform –4-5 differential diagnosis –Match up signs and symptoms from case

11. Observed Structured Clinical Exam  Utilization of standardized patients  Full health history  Focused physical exam  Differential diagnosis  Final course competency-putting all the pieces together

12. Continuum of Simulated Learning  Why Simulation? –Provide opportunities to enhance critical thinking and clinical judgment –Ability to evaluate students effectively –Provide scenarios to enhance learning Clinical situations possibly encountered in practice and how to work through clinical problems.

13. Continuum Task Trainers Low Fidelity High Fidelity DCE Standardized Patients OSCE

14. Faculty involvement  Role of course coordinator  Integration of simulation  Digital clinical examination  Facilitation of clinical reasoning  Consistency of skills taught across all sections

15. Pedagogical Background  Development of expertise  Clinical competence  Benner (1984) From Novice to Expert

16. Benner, P. (1984) Expert Proficient Competent Advanced Beginner Novice

17. Training  Provide faculty training in integration of the digital clinical experience –How to review results –Synthesize results –Troubleshoot student problems with software application  Weekly schedule of all lab activities –Assigned to each faculty –Resource to prepare for upcoming lab sessions

18. Documentation  Integrated documentation of patient findings within the DCE –Model notes provided in grading rubric  Documentation in EHR of Problem Based Learning group work

19. Strategies  Provide consistent training of all faculty in lab  Integration of simulation throughout the course  Inter-rater reliability of grading and evaluation

20. Conclusion  Re-tooling of the course to integrate simulation and strengthen diagnostic reasoning/clinical judgment skills.  Utilization of multiple modalities of learning  Training of faculty for reliability in evaluation and consistency of delivery  Continuous evaluation of course to improve student learning outcomes

21. References