Presentation on theme: "Simulation Curriculum Development with a Scholarly Lens"— Presentation transcript:
1 Simulation Curriculum Development with a Scholarly Lens Yue Ming Huang, EdD, MHSAssistant Adjunct ProfessorDepartment of AnesthesiologyDavid Geffen School of Medicine at UCLADirector of Operations, UCLA Simulation CenterMini Simulation User Network ConferenceWest Coast University, North Hollywood, CAAugust 20, 2012
2 DisclosuresI have no conflict of interest to disclose.
3 Agenda/Objectives Review educational principles for adult learners Review steps for curriculum developmentDescribe considerations for scholarly disseminationProvide examples of published curricula and other resources
4 Getting to Know YouWho 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-risk2) 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 programExperiential: Adults come with prior knowledge and learn best experientiallyRelevant: 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 learningMalcolm 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 ScenarioConcrete Experience (Doing, feeling, experiencing)Deliberate PracticeActive Experimentation(Applying, trying out what you learned)Guided DebriefingReflective Observation(Reviewing, watching, reflecting)Simulation as part ofthe ExperientialLearning CycleDiscussions & Further StudyAbstract Conceptualization(Thinking, processing, learning)
11 Neuroscience Research Says… Learning engages the entire physiologyThe search for meaning occurs through “patterning”Emotions are critical to patterningLearning always involves conscious and unconscious processesLearning is enhanced by challenge and inhibited by threat
12 Circumplex of Emotions OptimalActivatedState =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 andability 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 AssessmentNeeds Analysis of Targeted LearnersGoals and Specific Measurable ObjectivesEducational StrategiesImplementationEvaluation and FeedbackPlan ahead with publication/dissemination in mind!
14 Step 1. Problem Identification and General Needs Assessment Identify the problem or educational gapWhat is the current approach (who is doing what, when, how, resource limitations)What is the ideal approachIdeal – 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/preferencesWhat are barriers or enabling/reinforcing factorsWhat are the available resources to this group (simulation, faculty, clinical experiences)Use multiple ways to obtain info/needs assessment
16 Needs Assessment Methods Informal discussionsQuestionnaires/SurveysInterviewsFocus groupsObservationsTestsLiterature reviewAvailable documents – ACGME, Joint Commission, national board researchInclude different sitesOther ideas?
17 Scholarly Work for Steps 1 & 2 Systematic review of literatureNeeds assessment reportAssessment toolKeep 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 objectivesLearning domains: cognitive, psychomotor, affectiveReview Bloom’s Taxonomy of educational objectivesWrite SMART (specific, measurable, achievable, relevant, timely) objectivesAsk this question: Who will do what and how much/how well by what time (when)?
20 Learning, Mastery & Expertise ProficientCompetentAdvanced BeginnerNoviceGeorge MillerMiller’s Model of Assessment1990Dreyfus & Dreyfus Model of Skills Acquisition1988
21 Essential Components of a Learning Objective Behavior/Skill: need to be specific and observableCondition: 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 objectivesReview/discuss pros/cons of different methodsChoose methods that are feasible in terms of resourcesConsider different simulation optionsOther interactive methodologies (games, ARS, engaging exercises etc.)
23 Simulation Methods Screen-based virtual patients Role plays Standardized patientsArtificial models, procedural task trainersVirtual reality simulatorsFull body computerized simulatorsHybrid simulationGroup learning projectsGames and other engaging activities
24 Scholarly Work for Steps 3 & 4 Creation/description of a new educational tool or methodSimulation scenariosTheoretical/comparative paper on the merits of educational processes or tools
25 Step 5. ImplementationConsider resources: personnel, time, facilities, funding/costsAdministration and operationsPiloting, phasing-in, full implementatoin
26 Step 6. Evaluation and Feedback Identify users and use (formative, summative), resources for evaluation, questions to ask, evaluation designChoose/construct measurement method – address reliability, validity, biasEthical concernsData collection and analysisResult reporting
27 Kirkpatrick’s Levels of Evaluation Level 1: Reaction – How did learners perceive the course, the process? Satisfaction surveysLevel 2: Learning – What knowledge and skills were gained? Written tests, demonstrations, checklistsLevel 3: Behavior - What are the observable practice changes, transfer of learning from lab to job? Field evaluations, observationsLevel 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 ContextsAbility to QuestionAble to ask the right questionsKnow how to find the answersKnow what to do with the answersAppropriate Performance in Unexpected Situations
29 Scholarly Work for Steps 5 & 6 Research studyDescriptive study of curriculum implementationCost effective analysis reportAssessment toolKeep in mind:Get IRB and funding earlyDocument each step in detail, keep notesConsult with education and research expertsCollaborate
30 Curriculum Maintenance and Enhancement Continuous quality assurance methods for improvementFaculty developmentResource allocationManagement of changeScholarly 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 AssessmentNeeds Analysis of Targeted LearnersGoals and Specific Measurable ObjectivesEducational StrategiesImplementationEvaluation 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 issuesMedEdPortal – curriculum, case scenarios, tutorials, facilitator guides
34 MedEdPortal ExamplesRagsdale 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 ReferencesKern 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 ResourcesUW 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:http://www.ksbn.org/cne/SimulationScenarioLibrary.htmMontgomery College:Massachusetts Dept of Higher Ed:http://www.mass.edu/currentinit/Nursing/Sim/Scenarios.asp
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 ConsiderHow 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?