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Developing a Successful Simulation-Based Curriculum
Leigha Jansen, EdD and Clint Johnson, MA
Disclosures
• Leigha Jansen and Clint Johnson are employees of SpeechPathology.com, the license holder of SimuCaseTM
• Neither presenter has any relevant nonfinancial relationships to disclose
Agenda
The benefits of simulation-based education (SBE)
The critical instructional elements of simulation-based education (SBE)
Guided versus unstructured instruction with SBE
Practical tips and activities for integration of SBE
Evaluation of SBE in SLP and AuD training programs
Learning Objectives
• List and define define the benefits of SBE
• Define the critical instructional elements of SBE and apply each element to CSD undergraduate and graduate level courses
• Formulate effective learning activities that support SBE in the CSD classroom.
Who remembers?
“Annie, Annie, are you okay?”
Simulations in Allied Health
“A simulation is a generic term that refers to the artificial representation of a real world
process to achieve education goals via experiential learning.”
(Flanagan, Nestel, & Joseph, 2004, p.57)
Simulations in Allied Health
“Simulation technology is now a central thread in the fabric of
medical education”
(McGaghie, Issenberg, Petrusa, & Scalese, 2009)
(Jansen, 2014)
Core Instructional Components of SBE
• Guided Instruction
• Integration of Evidence-Based Practice
• Instructional Alignment
• Effective Facilitation
• Feedback
(INACSL, 2013)
Guided, Student Centered Instruction
Scaffolding
Problem-Based Learning
Traditional Learning
Problem-Based Learning
Experiential Learning
(Kolb, 1984)
• Doing it
• Thinking about it
• Making sense of it
• Apply it to new situations
Guided Instruction
• Educational approaches that provide extensive guidance to students are more effective and efficient than approaches that are minimally guided.
(Clark, Yates, Early, & Moulton, 2010; Kirschner, Sweller, & Clark, 2006)
Integration of Evidence-Based Practice
(ASHA, 2004)
Instructional Alignment
Effective Facilitation
Feedback
• Summative
• Formative
Feedback
Faculty feedback (debriefing) is the most important and frequently cited variable when using SBE to promote effective
learning
(Issenberg, McGaghie, Petrusa, Gordon, & Scalese, 2005)
The Role of Guided Instruction inSimulated-Based Education
Compared two SLP graduate level courses at two universities targeting child language disorders using a computer-based simulation experience (SimuCase) within their curriculum.
Graduate level course A (n=10) had limited faculty support during simulation experiences – encouraging students to work independently
Graduate level course B (n=10) had strong faculty support duringsimulation experiences – using guided instruction
Both SLP graduate level courses consisted of first year students with similar educational backgrounds and experiences
Results
First year graduate students performed significantly higher on a virtual human simulation experience when provided guided instruction compared to their counterparts.
Program A (M=72.98, SD=5.88) and program B (M=82.49, SD=6.38) for virtual human simulation performance scores [t (18)=2.878, p<.01]
Research-based SBE model: NCSBN Study
• Randomized, controlled, longitudinal study of 650+ nursing students across 10 programs
• No significant difference in clinical competency comparing traditional clinical education to 25% and 50% clinical simulation hours• Across two time periods (education and employment)• Two types of evaluators (educators and managers)
(Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014 )
Practical Tips for Integration of SBE
The Prebrief and the Debrief
• Planned activity prior to the simulation experience
• Designed to provide instructions and set learner expectations.
• Sets the stage for the scenario
• Assists learners in achieving defined learning objectives.
The Prebrief and the Debrief
• Learner-centered reflective discussion
• Requires planned facilitation.
• Safe, open environment
• Promotes self-reflection and critique
• Aligned with learning objectives
First Session
• Discuss learning format and explain the software interface
• Review critical components of the simulation
• Ensure relevancy to clinical experiences
• Prepare for frustration-resolution moments (highly emotional, immersive technology)
The Prebrief and the Debrief
Research provides evidence that the debrief is the most important component of the simulation-based
learning experience.”
(Decker, et al., 2013, p. S27)
The Debrief SessionAfter each simulation always have an after-action review
Skilled debriefers or “facilitators tend to position themselves not as authorities or experts, but rather as co-learners”(Fanning & Gaba, 2007, p.118).
Provide formal thought time for students to recollects, reflect and report• How did it go?• What did you do well?• What could you do better?• What will you do differently next time?• How does this apply to what you have already experienced or will
experience?
Collaborative Learning
“Collaborative learning occurs when students and faculty work together to create knowledge … It is a pedagogy that has at its center the assumption that
people make meaning together and that process enriches and enlarges them.”
(Matthews, 1996, p. 101)
Collaborative learning occurs when students and faculty work together to create knowledge … It is a pedagogy that has at its center the assumption that
people make meaning together and that process enriches and enlarges them.”
Collaborative Learning
• Collaborative activities are defined by four characteristics:• Learner centered
• Experiential
• Social learning
• Realistic scenarios
Collaborative Learning and SBE
1. Work the case in small groups (2-3) and present the evidence-based rationale for clinical decisions.
2. Work the case in small groups (2-3) and debrief with the full class.
3. Compete!
4. Work the case as a class. Write – Pair – Share
(Cornell University, 2014)
Interprofessional Education (IPE)
When students from two or more professions learn about, from and with each other to enable effective
collaboration and improve health outcomes”
(WHO, 2010)
Interprofessional Education (IPE)
• IP Collaborative Practice Competency Domains• Values/Ethics for Interprofessional Practice
• Roles/Responsibilities
• Interprofessional Communication
• Teams and Teamwork
(IPE Collaborative Expert Panel, 2011)
IPE Activities
Roles and responsibilities• Define
• Compare and contrast
Report writing• Audience
• “The 3 C’s”
Case coordination• Future care and IP collaboration
Everybody Wins
Potter & Allen (2013) conducted a simulation of a bedside swallow exam on a manikin with a tracheostomy experiencing respiratory distress following aspiration.
Six groups of students (10 students in speech-language-pathology and 1 undergraduate nursing student)
All students received the same training prior to the exam.
SLP students performed the swallowing exam and the nurses performed deep-suctioning.
Instructors provided guidance only when necessary to complete the exam.
Results
All students indicated that they understood the importance of collaboration and communication with other professionals.
Students were able to perform the procedure in a safe environmenwith minimal involvement from their instructors.
Instructors realized that although they considered the students to be trained (textbook, lecture, practice in class), there were gaps in their knowledge base and consequently were able to provide remediation.
(Potter & Allen, 2013)
Interproffesional Education
• Communicating roles and responsibilities clearly to other professions
• Recognizing your limitations
• Engaging a professional who complements your expertise
• Working as a team to optimize patient care
(Interprofessional Education Collaborative, 2014)
Feedback
Summative vs.
Formative Feedback
Curriculum Integration
1. Review course goals and objectives
2. Review SBE options
3. Choose instructional methods
4. Plan for feedback
5. Evaluate outcomes
Evaluation of SBE in CSD Training
• SBE is an opportunity for an innovative teaching methodology to bridge the gap between the didactic and practical education
• The simulation in and of itself does not represent sound instructional design
• A comprehensive, evidence-based model of SBE must be implemented to maximize student learning (i.e. INACSL model)
Future Research
James Madison UniversitySimulation needs assessment surveyLongitudinal competency study replacing clinical hours
St. Xavier’s UniversityPraxis performance comparison study
Valdosta State UniversityEstablishing baseline data for simulations (SimuCase)
California University of PAStudent performance and supervision benchmarks
Questions?
you!
