1. Simulation Curriculum Development with a Scholarly Lens
Yue Ming Huang, EdD, MHS
Assistant Adjunct Professor
Department of Anesthesiology
David Geffen School of Medicine at UCLA
Director of Operations, UCLA Simulation Center
Mini Simulation User Network Conference
West Coast University, North Hollywood, CA
August 20, 2012

2. Disclosures
I have no conflict of interest to disclose.

3. Agenda/Objectives Review educational principles for adult learners
Review steps for curriculum development
Describe considerations for scholarly dissemination
Provide examples of published curricula and other resources

4. Getting to Know You
Who is new to simulation (0-2 years), has 3-5 years, 6-10 years, >10 years of experience?
Who is at a community college, nursing school, medical school, hospital-based simulation center, others?
Who has had formal postgraduate training in education, e.g. Master/Doctorate in Education, Medical Education Fellowship, etc.?
Who has experience publishing curriculum, educational tools, or simulation-based research?

5. Simulation as an Experience
How many have been in the “hot seat” as a simulation participant/learner?
If you have not, please do so

6. History of Experiential Learning
“Experience is, for me, the highest authority. The touchstone of validity is my own experience. No other person's ideas, and none of my own ideas, are as authoritative as my experience... Neither the Bible nor the prophets -- neither Freud nor research --neither the revelations of God nor man -- can take precedence over my own direct experience.”
from On Becoming a Person Carl Rogers, 1969

7. Educational Principles
“We cannot teach another person directly; we can only facilitate his learning.” (Carl Rogers, 1969)
An effective educational environment promotes significant learning if:
1) it is non-threatening or low-risk
2) facilitator can help learner differentiate his own perceptions through experiences

8. Adult Learning Theory (Malcolm Knowles 1978)
Student centered and self-directed: Adult learners expect to have a say on what is taught, how they are taught, and how they are evaluated; Their feedback needs to be incorporated into program
Experiential: Adults come with prior knowledge and learn best experientially
Relevant: Adults need to know why they need to learn something and how they can apply new knowledge to their job/life.
Problem-solving approach to learning
Malcolm Knowles, , theory of andragogy (art/techniques of teaching adults) vs. pedagogy (teaching children), Harvard-Univ Chicago (MA, PhD)

9. Kolb’s Experiential Learning Cycle
David Kolb, Professor of Organizational Behavior at Case Western Reserve University, is credited with launching the learning styles movement in the early seventies. According to Kolb (1984, 41), experiential learning has six main characteristics:
* Learning is a continuous process grounded in experience.
* Learning is best conceived as a process, not in terms of outcomes.
* Learning involves transactions between the person and the environment.
* Learning is a holistic process of adaptation to the world.
* Learning requires the resolution of conflicts between dialectically opposed modes of adaptation to the world (learning is by its very nature full of tension).
* Learning is the process of creating knowledge that is the result of the transaction between social knowledge and personal knowledge.
Kolb D. (1984). Experiential learning: experience as the source of learning and development. Englewood Cliffs, New Jersey: Prentice Hall.
Kolb D. (1999). The Kolb Learning Style Inventory, Version 3. Boston: Hay Group.

10. Discussions & Further Study
Simulation Scenario
Concrete Experience (Doing, feeling, experiencing)
Deliberate Practice
Active Experimentation
(Applying, trying out what you learned)
Guided Debriefing
Reflective Observation
(Reviewing, watching, reflecting)
Simulation as part of
the Experiential
Learning Cycle
Discussions & Further Study
Abstract Conceptualization
(Thinking, processing, learning)

11. Neuroscience Research Says…
Learning engages the entire physiology
The search for meaning occurs through “patterning”
Emotions are critical to patterning
Learning always involves conscious and unconscious processes
Learning is enhanced by challenge and inhibited by threat

12. Circumplex of Emotions
Optimal
Activated
State =
Relaxed Alertness
(low threat,
high challenge)
James Russell, prof of psychology at Boston College
-under stress the indexing capacities of the brain are reduced and the brain’s short-term memory and
ability to form permanent new memories are inhibited (cortisol vs. adrenaline/noradrenaline)
-two types of stress “ one accompanied by a sense of pervasive threat related to a sense of helplessness and one accompanied by a sense of resolution or challenge “

13. 6 Steps of Curriculum Design (Kern, 1998)
Problem Identification and General Needs Assessment
Needs Analysis of Targeted Learners
Goals and Specific Measurable Objectives
Educational Strategies
Implementation
Evaluation and Feedback
Plan ahead with publication/dissemination in mind!

14. Step 1. Problem Identification and General Needs Assessment
Identify the problem or educational gap
What is the current approach (who is doing what, when, how, resource limitations)
What is the ideal approach
Ideal – current approach = general assessment

15. Step 2. Needs Analysis of Targeted Learners
Who are the learners, level of training, previous experience, current performance, learning styles/preferences
What are barriers or enabling/reinforcing factors
What are the available resources to this group (simulation, faculty, clinical experiences)
Use multiple ways to obtain info/needs assessment

16. Needs Assessment Methods
Informal discussions
Questionnaires/Surveys
Interviews
Focus groups
Observations
Tests
Literature review
Available documents – ACGME, Joint Commission, national board research
Include different sites
Other ideas?

17. Scholarly Work for Steps 1 & 2
Systematic review of literature
Needs assessment report
Assessment tool
Keep in mind:
Is there a need? A gap in the literature? Clinical significance?
Has it been done before? Am I contributing something new? Is it generalizable?
Is it innovative and compelling?

18. Step 3. Goals and Objectives
Review types (learner, process, outcome) and levels of objectives
Learning domains: cognitive, psychomotor, affective
Review Bloom’s Taxonomy of educational objectives
Write SMART (specific, measurable, achievable, relevant, timely) objectives
Ask this question: Who will do what and how much/how well by what time (when)?

19. Bloom’s Taxonomy of Educational Objectives

20. Learning, Mastery & Expertise
Proficient
Competent
Advanced Beginner
Novice
George Miller
Miller’s Model of Assessment
1990
Dreyfus & Dreyfus Model of Skills Acquisition
1988

21. Essential Components of a Learning Objective
Behavior/Skill: need to be specific and observable
Condition: under what circumstances is this behavior achieved; are tools/assistance allowed?
Standard: what is an acceptable level of performance; by what criteria is the behavior measured against?

22. Step 4. Educational Strategies
Use multiple educational methods and match methods to objectives
Review/discuss pros/cons of different methods
Choose methods that are feasible in terms of resources
Consider different simulation options
Other interactive methodologies (games, ARS, engaging exercises etc.)

23. Simulation Methods Screen-based virtual patients Role plays
Standardized patients
Artificial models, procedural task trainers
Virtual reality simulators
Full body computerized simulators
Hybrid simulation
Group learning projects
Games and other engaging activities

24. Scholarly Work for Steps 3 & 4
Creation/description of a new educational tool or method
Simulation scenarios
Theoretical/comparative paper on the merits of educational processes or tools

25. Step 5. Implementation
Consider resources: personnel, time, facilities, funding/costs
Administration and operations
Piloting, phasing-in, full implementatoin

26. Step 6. Evaluation and Feedback
Identify users and use (formative, summative), resources for evaluation, questions to ask, evaluation design
Choose/construct measurement method – address reliability, validity, bias
Ethical concerns
Data collection and analysis
Result reporting

27. Kirkpatrick’s Levels of Evaluation
Level 1: Reaction – How did learners perceive the course, the process? Satisfaction surveys
Level 2: Learning – What knowledge and skills were gained? Written tests, demonstrations, checklists
Level 3: Behavior - What are the observable practice changes, transfer of learning from lab to job? Field evaluations, observations
Level 4: Results - What are the tangible outcomes (return in investment, cost reduction, improved quality, increased production/efficiency,decreased complications, etc.)

28. Indicators of Deep Understanding
Performance in Multiple Contexts
Ability to Question
Able to ask the right questions
Know how to find the answers
Know what to do with the answers
Appropriate Performance in Unexpected Situations

29. Scholarly Work for Steps 5 & 6
Research study
Descriptive study of curriculum implementation
Cost effective analysis report
Assessment tool
Keep in mind:
Get IRB and funding early
Document each step in detail, keep notes
Consult with education and research experts
Collaborate

30. Curriculum Maintenance and Enhancement
Continuous quality assurance methods for improvement
Faculty development
Resource allocation
Management of change
Scholarly activity by learner and faculty

31. 12 Tips for Effective Short Course Design
Assess the clinical problem.
Determine learning outcomes.
Use evidence-based medicine to develop content.
Identify resources.
Select teaching strategies for active learning.
Select teaching strategies that foster reflection.
Use passive strategies sparingly to ensure a common knowledge base.
Create an individualized needs or pre-course assessment.
Prepare teachers.
Commitment to change and evaluation.
Provide a 2–3 month post-course reflective exercise.
Use data in an iterative way.
Lockyer et al, Medical Teacher 2005

32. 6 Steps of Curriculum Design
Problem Identification and General Needs Assessment
Needs Analysis of Targeted Learners
Goals and Specific Measurable Objectives
Educational Strategies
Implementation
Evaluation and Feedback

33. Where to Publish? Simulation in Healthcare journal
Medical education journals (see list at Academic Medicine, Medical Education, Medical Teacher, Teaching and Learning, Advances in Health Sciences, Journal of Nursing Education, Nurse Education Today, Nurse Educator, etc.
Clinical specialty journals: watch for calls for Education issues
MedEdPortal – curriculum, case scenarios, tutorials, facilitator guides

34. MedEdPortal Examples
Ragsdale L, Gutman D, Kobayashi L. Geriatric Emergency Medicine Curriculum Using High Fidelity Medical Simulation. MedEdPORTAL; Available from:
Acton R, Schmitz C, Chipman J, Reihsen T, Gilkeson J, Groth S, et al. University of Minnesota Surgical Clerkship Simulation Skills Curriculum and Instructor Guide. MedEdPORTAL; Available from:
Chakraborti C. A Simulation-Based Curriculum For 4th Year Medical Students During An Internal Medicine Acting Internship. MedEdPORTAL; Available from:
Motz L, Lloyd B, Donato A, Chaudhary A, Kaliyadan A, Stavarski D, et al. Interdisciplinary Curriculum and Simulation Cases for Teaching Leadership and Communication to Medical Rapid Response Teams. MedEdPORTAL; Available from:
Brown C, Gephardt G, Lloyd C, Swearingen C, Boateng B. Teaching Palliative Care Skills Using Simulated Family Encounters. MedEdPORTAL; Available from:

35. Example Curricular Papers
Fernandez GL et al. Boot Camp: Educational Outcomes After 4 Successive Years of Preparatory Simulation-Based Training at Onset of Internship. J Surg Educ 2012 Mar-Apr;69(2):242-8.
Binstadt ES et al. A comprehensive medical simulation education curriculum for emergency medicine residents. Ann Emerg Med Apr;49(4): , 504.e1-11.
Norman J. Systematic review of the literature on simulation in nursing education. ABNF J Spring;23(2):24-8.
Hudson D, Dunbar-Reid K, Sinclair PM. The incorporation of high fidelity simulation training into hemodialysis nursing education: part 2--a pictorial guide to modifying a high fidelity simulator for use in simulating hemodialysis. Nephrol Nurs J Mar-Apr;39(2):
Rhodes HA. Simulation in Kansas practical nursing programs. J Pract Nurs Fall;61(3):10-3.

36. References
Kern DE et al. Curriculum Development for Medical Education: A Six-Step Approach. Johns Hopkins University Press, 1998.
Lockyer J, Ward R, Toews J. Twelve tips for effective short course design. Med Teach Aug;27(5):392-5.
Seropian MA et al. An Approach to Simulation Program Development. Journal of Nursing Education Apr;43(4):170-4.
Jeffries PR. A framework for designing, implementing, and evaluating simulations used as teaching strategies in nursing. Nurs Educ Perspect Mar-Apr;26(2):

37. Web Resources
UW collaborative website:
Society for Academic Emergency Medicine scenario library:

38. Nursing Simulation Resources
Simulation Innovation Research Center (NLN):
California Institute for Nursing and Healthcare (CINH) Simulation Alliance:
Scenario Libraries:
Kansas State Board of Nursing:
Montgomery College:
Massachusetts Dept of Higher Ed:

39. Hot Topics Interprofessional team training simulation curriculum
Train-the-trainer (faculty/instructor development)
Assessment with simulation

40. More to Consider How do I get buy-in for simulation training?
What are my available resources/funding opportunities?
What is already in the literature and available online?
How do I incorporate technical and non-technical behavioral skills (e.g. leadership and communication skills training)?
How many simulation sessions/scenarios do I need to achieve objectives?
Realistically/logistically, how often/how many can learners come to the simulation center?

41. More to Consider
How can I incorporate more independent simulations since I do not have enough faculty to teach?
What do I need to consider for limited space and scheduling?
How do I get all my faculty trained to teach in this curriculum?
How do I add a competency/evaluation component to a course that has been primarily instructional?
What approach should I take when I have to follow a national standardized curriculum?

42. Questions? Yue Ming Huang, EdD, MHS