building competency with blended learning: integrating simulation into continuing education julianne...
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Building Competency with Blended Learning:
Integrating Simulation into Continuing Education
Building Competency with Blended Learning:
Integrating Simulation into Continuing Education
Julianne Perretta MSEd, RRT-NPSThe Johns Hopkins Medicine Simulation Center
Baltimore, MD
Julianne Perretta MSEd, RRT-NPSThe Johns Hopkins Medicine Simulation Center
Baltimore, MD
Define Continuing Education Motivations for Learning Competency Assessment vs. Education Learning Styles (VARK) Questionnaire Adult Learner Characteristics (Knowles) Best Practices in Simulation Education
Define Continuing Education Motivations for Learning Competency Assessment vs. Education Learning Styles (VARK) Questionnaire Adult Learner Characteristics (Knowles) Best Practices in Simulation Education
ObjectivesObjectives
At the end of this session learners will be able to: Determine the goals of continuing education in
health care Differentiate between competency assessment and
education and how that affects simulation design Review key elements of adult learners Identify different learning styles and how different
forms of simulation can address each Initiate simulation design based on some best
practices in Simulation Education
At the end of this session learners will be able to: Determine the goals of continuing education in
health care Differentiate between competency assessment and
education and how that affects simulation design Review key elements of adult learners Identify different learning styles and how different
forms of simulation can address each Initiate simulation design based on some best
practices in Simulation Education
Continuing EducationContinuing Education
Health Professions Education: A Bridge to Quality (Institute of Medicine, 2003)1. Provide patient centered care
2. Work in interdisciplinary teams
3. Employ evidence-based practice
4. Apply quality improvement
5. Utilize informatics
Health Professions Education: A Bridge to Quality (Institute of Medicine, 2003)1. Provide patient centered care
2. Work in interdisciplinary teams
3. Employ evidence-based practice
4. Apply quality improvement
5. Utilize informatics
Continuing EducationContinuing Education
“Features, such as opportunities to reflect on learning and apply it to practice, and interpersonal interaction, have been identified as characteristics of CME that are most likely to result in practice enhancement”
-Allen, p. 234
“Features, such as opportunities to reflect on learning and apply it to practice, and interpersonal interaction, have been identified as characteristics of CME that are most likely to result in practice enhancement”
-Allen, p. 234
Motivations for LearningMotivations for Learning
Why are you here today?Why are you here today?
Motivations for LearningMotivations for Learning
1. Social Relationships
2. External Expectations
3. Social Welfare
4. Professional Advancement
5. Escape/Stimulation
6. Cognitive Interest
1. Social Relationships
2. External Expectations
3. Social Welfare
4. Professional Advancement
5. Escape/Stimulation
6. Cognitive Interest
Morstain and Smart (1974), noted in Learning in adulthood.
Competency Assessment vs. Education
Competency Assessment vs. Education
Sometimes what we call “education” is really assessment, and what we call assessment is not that, either.
What happens when we assess the quality of someone’s work, and they don’t pass?????
Sometimes what we call “education” is really assessment, and what we call assessment is not that, either.
What happens when we assess the quality of someone’s work, and they don’t pass?????
Competency Assessment vs. Education
Competency Assessment vs. Education “Fail”
What do you do when you find a knowledge deficit? A skills deficit? How do you remediate?
Reteach Reassess Performance Plan
What do you do with them in the meantime?
“Fail” What do you do when
you find a knowledge deficit? A skills deficit? How do you remediate?
Reteach Reassess Performance Plan
What do you do with them in the meantime?
Competency Assessment vs. Education
Competency Assessment vs. Education
eLearning Pre Assessment (study/practice)
New to simulation Nervous performers
Post Assessment (remediation) Specific goals based on performance Score-based Knowledge deficit Decision-making deficit
Unlimited time access
eLearning Pre Assessment (study/practice)
New to simulation Nervous performers
Post Assessment (remediation) Specific goals based on performance Score-based Knowledge deficit Decision-making deficit
Unlimited time access
Competency Assessment vs. Education
Competency Assessment vs. Education
Skills deficit Partial Task Trainers
I.O. Leg IV arm Central Line Trainer Intubation head
Virtual Reality
Skills deficit Partial Task Trainers
I.O. Leg IV arm Central Line Trainer Intubation head
Virtual Reality
Adult Learners:Adult Learners:
Are more independent and self-directed Want to feel accepted, respected and supported
when learning Want to feel a partnership with their instructor Have a wealth of experience they draw from
when learning Want to feel they can immediately use what
they are learning (problem-centered) Have many different motivations for learning
Are more independent and self-directed Want to feel accepted, respected and supported
when learning Want to feel a partnership with their instructor Have a wealth of experience they draw from
when learning Want to feel they can immediately use what
they are learning (problem-centered) Have many different motivations for learning
Malcolm Knowles, Andragogy, 1968, 1980.
Simulation & the Adult LearnerSimulation & the Adult Learner
Work independently or with a group; use debrief to direct learning
Create a environment of respect, support, and safety during simulations
Dialogue between trainer and learner Build on previous experience and create new
experiences Scenarios that are directly applicable to job Goal oriented learning
Work independently or with a group; use debrief to direct learning
Create a environment of respect, support, and safety during simulations
Dialogue between trainer and learner Build on previous experience and create new
experiences Scenarios that are directly applicable to job Goal oriented learning
Learning StylesLearning Styles
How a person approaches learning tasks “Manner in which…learners most
efficiently and effectively perceive, process, store and recall what they are attempting to learn” (James and Blank, 1993, pp. 47-48).
Helps you identify your strengths and weaknesses as learners
How a person approaches learning tasks “Manner in which…learners most
efficiently and effectively perceive, process, store and recall what they are attempting to learn” (James and Blank, 1993, pp. 47-48).
Helps you identify your strengths and weaknesses as learners
Learning Styles How do you learn best?
Learning Styles How do you learn best?
VARK Multiple Intelligences(Multiple Intelligences
Questionnaire: http://www.thirteen.org/edonline/concept2class/mi/index.html)
Learning Styles Inventory (Learning Styles Inventory Questionnaire: http://www.rrcc-online.com/%7Epsych/LSInventory.html)
VARK Multiple Intelligences(Multiple Intelligences
Questionnaire: http://www.thirteen.org/edonline/concept2class/mi/index.html)
Learning Styles Inventory (Learning Styles Inventory Questionnaire: http://www.rrcc-online.com/%7Epsych/LSInventory.html)
Learning StylesLearning Styles
How do you learn best? Visual Aural Read/write Kinesthetic
How do you learn best? Visual Aural Read/write Kinesthetic
http://www.vark-learn.com/english/page.asp?p=questionnaire
Learning StylesLearning Styles
How do you learn best? Visual
Charts graphs flow charts (arrows, circles, hierarchies) algorithms
How do you learn best? Visual
Charts graphs flow charts (arrows, circles, hierarchies) algorithms
Learning StylesLearning Styles
How do you learn best? Aural
Lectures Tutorials Tapes Group discussion Email Speaking Webchat “Talking Things Through”
How do you learn best? Aural
Lectures Tutorials Tapes Group discussion Email Speaking Webchat “Talking Things Through”
Learning StylesLearning Styles
How do you learn best? Read/write
Text-based input and output List-makers
How do you learn best? Read/write
Text-based input and output List-makers
Learning StylesLearning Styles
How do you learn best? Kinesthetic
Practice Hands-on Examples Simulations
How do you learn best? Kinesthetic
Practice Hands-on Examples Simulations
Learning StylesLearning Styles
V- schematics, algorithms in debriefs
A- Debrief discussions Interactive online (with feedback) May be better at telling you the answers than doing them
R- handout and ppt debriefings Readings on evidence-based new info.
K- Simulation, hands-on debriefing Can include eSimulation as well
V- schematics, algorithms in debriefs
A- Debrief discussions Interactive online (with feedback) May be better at telling you the answers than doing them
R- handout and ppt debriefings Readings on evidence-based new info.
K- Simulation, hands-on debriefing Can include eSimulation as well
Best Practices in Simulation Education
Best Practices in Simulation Education
Experiential Learning (Kolb) Contextual Learning (Kneebone) Situated Learning/Peripheral Participation (Lave &
Wenger) Self-Efficacy and Competency (Maibach et al,
Miller) Deliberate Practice (Ericcson) Feedback (Van de Ridder) Mastery Learning (Bloom)
Experiential Learning (Kolb) Contextual Learning (Kneebone) Situated Learning/Peripheral Participation (Lave &
Wenger) Self-Efficacy and Competency (Maibach et al,
Miller) Deliberate Practice (Ericcson) Feedback (Van de Ridder) Mastery Learning (Bloom)
Hunt et al, 2008
Best Practices in Simulation Education
Best Practices in Simulation Education
Experiential Learning (Kolb)1. Direct encounter with
the phenomenon being studied rather than merely thinking about the encounter, or only considering the possibility of doing something about it
2. Education that occurs as a direct participation in the events of life
Experiential Learning (Kolb)1. Direct encounter with
the phenomenon being studied rather than merely thinking about the encounter, or only considering the possibility of doing something about it
2. Education that occurs as a direct participation in the events of life
Best Practices in Simulation Education
Best Practices in Simulation Education
Contextual Learning (Kneebone)
For learning to be most effective, it must occur within a context parallel to how individuals will apply the knowledge in their own professional practice
Contextual Learning (Kneebone)
For learning to be most effective, it must occur within a context parallel to how individuals will apply the knowledge in their own professional practice
Best Practices in Simulation Education
Best Practices in Simulation Education
Same equipment as in unit Groups bring specific equipment BLS training for med students includes how
to function with new BLS skills in hospital setting
Same equipment as in unit Groups bring specific equipment BLS training for med students includes how
to function with new BLS skills in hospital setting
Best Practices in Simulation Education
Best Practices in Simulation Education
Situated Learning/Peripheral Participation (Lave & Wenger)
Learning through real-life participation Learners observe actions while working side-by-
side with a skilled person (content expert) Begin participating in observed tasks, bringing
them from periphery to participation
Situated Learning/Peripheral Participation (Lave & Wenger)
Learning through real-life participation Learners observe actions while working side-by-
side with a skilled person (content expert) Begin participating in observed tasks, bringing
them from periphery to participation
Best Practices in Simulation Education
Best Practices in Simulation Education
Self-Efficacy and Competency (Maibach et al) A person’s belief in their capability to organize
and execute a course of action to produce given attainments
4 levels of Competence:1.Unconsciously incompetent
2.Consciously incompetent
3.Consciously competent
4.Unconsciously competent
Self-Efficacy and Competency (Maibach et al) A person’s belief in their capability to organize
and execute a course of action to produce given attainments
4 levels of Competence:1.Unconsciously incompetent
2.Consciously incompetent
3.Consciously competent
4.Unconsciously competent
Best Practices in Simulation Education
Best Practices in Simulation Education
Self-Efficacy and Competency (Maibach et al) Framework for assessing clinical competency
(Miller)1.Knowledge (knows)
2.Competence (knows how)
3.Performance (shows how)
4.Action (does)
Self-Efficacy and Competency (Maibach et al) Framework for assessing clinical competency
(Miller)1.Knowledge (knows)
2.Competence (knows how)
3.Performance (shows how)
4.Action (does)
Best Practices in Simulation Education
Best Practices in Simulation Education
Hybrid simulations to practice very specific skills Neonatal Chest Tube Management Patient death ECMO NP
Aspirate
Hybrid simulations to practice very specific skills Neonatal Chest Tube Management Patient death ECMO NP
Aspirate
Best Practices in Simulation Education
Best Practices in Simulation Education
Deliberate Practice (Ericcson) Training activities that promote consistent
improvements in expert performance domains Repetitive performance in a focused domain Rigorous skills assessment (specific formative
feedback) Progressively improved performance in a
controlled setting
Deliberate Practice (Ericcson) Training activities that promote consistent
improvements in expert performance domains Repetitive performance in a focused domain Rigorous skills assessment (specific formative
feedback) Progressively improved performance in a
controlled setting
Best Practices in Simulation Education
Best Practices in Simulation Education
Feedback
• “Specific information about the comparison between a trainee’s observed performance and a standard, given with an intent to improve the trainee’s performance” (Van de Ridder)
Feedback
• “Specific information about the comparison between a trainee’s observed performance and a standard, given with an intent to improve the trainee’s performance” (Van de Ridder)
Best Practices in Simulation Education
Best Practices in Simulation Education
Build debrief tools based on agreed upon standards
Debrief should be based on simulation objectives
Build debrief tools based on agreed upon standards
Debrief should be based on simulation objectives
Best Practices in Simulation Education
Best Practices in Simulation Education
Mastery Learning (Bloom) Aptitude is the length of time it takes a person to
learn not how "bright" a person is, i.e., everyone can learn given the right circumstances
Goal: all learners to achieve the target outcome with little/no variability; amount of time to achieve will vary based on the learners
Mastery Learning (Bloom) Aptitude is the length of time it takes a person to
learn not how "bright" a person is, i.e., everyone can learn given the right circumstances
Goal: all learners to achieve the target outcome with little/no variability; amount of time to achieve will vary based on the learners
Best Practices in Simulation Education
Best Practices in Simulation Education
Putting it all TogetherPutting it all Together
Continuing education in healthcare should include: Opportunities to reflect on learning Opportunities to apply learning to practice Interpersonal interaction
Continuing education in healthcare should include: Opportunities to reflect on learning Opportunities to apply learning to practice Interpersonal interaction
Putting it all TogetherPutting it all Together
Competency assessment looks for level of knowledge/skills and identifies deficits. Focus is not on new learning.
Should include avenues for remediation and opportunities for student study/practice prior
Competency assessment looks for level of knowledge/skills and identifies deficits. Focus is not on new learning.
Should include avenues for remediation and opportunities for student study/practice prior
Putting it all TogetherPutting it all Together
Adult learners: Are problem-centered Have a wealth of experience to draw from Have many different motivations for learning
Adult learners: Are problem-centered Have a wealth of experience to draw from Have many different motivations for learning
Putting it all TogetherPutting it all Together
Different learning styles mean people are most comfortable in a particular way.
Build simulations and debriefings to meet these styles
Different learning styles mean people are most comfortable in a particular way.
Build simulations and debriefings to meet these styles
Putting it all TogetherPutting it all Together
Key learning theories to consider when building a simulation are: Experiential Learning Contextual Learning Situated Learning/ Peripheral Participation Deliberate Practice Feedback Mastery Learning
Key learning theories to consider when building a simulation are: Experiential Learning Contextual Learning Situated Learning/ Peripheral Participation Deliberate Practice Feedback Mastery Learning
ResourcesResourcesAllen, M., Curran, V. Ferrier, D. Ho, K., Kirby, F., Allen, J. et al (2004). Interactive
on-line continuing medical education: Physician’s perceptions and experiences. The Journal of Continuing Education in the Health Professions 24 (4): 227-236.
Hunt, E.A., Fiedor-Hamilton, M., Eppich, W. (2008). Resuscitation education: Narrowing the gap between evidence-based resuscitation guidelines and performance using best educational practices. Pediatric Clinics of North America. 55: 1035-1050.
Institute of Medicine. 2003. Health professions education: A bridge to quality. Washington, DC: The National Academy Press.
Merriam, S.B., Caffarella, R.S. (1999). Learning in Adulthood. San Fransisco: Jossey Bass.
Notes from a Benjamin Bloom Lecture. (1987, April). Retrieved May 15, 2009, from http://www.humboldt.edu/~tha1/mastery.html
Smith, M.K. David A. Kolb on experiential learning. Retrieved May 1, 2009 from http://www.infed.org/biblio/b-explrn.htm
VARK Categories. (2001-2009). Retrieved August 10, 2007, from VARK-A Guide to Learning Styles: http://www.vark-learn.com/english/page.asp?p=categories
Allen, M., Curran, V. Ferrier, D. Ho, K., Kirby, F., Allen, J. et al (2004). Interactive on-line continuing medical education: Physician’s perceptions and experiences. The Journal of Continuing Education in the Health Professions 24 (4): 227-236.
Hunt, E.A., Fiedor-Hamilton, M., Eppich, W. (2008). Resuscitation education: Narrowing the gap between evidence-based resuscitation guidelines and performance using best educational practices. Pediatric Clinics of North America. 55: 1035-1050.
Institute of Medicine. 2003. Health professions education: A bridge to quality. Washington, DC: The National Academy Press.
Merriam, S.B., Caffarella, R.S. (1999). Learning in Adulthood. San Fransisco: Jossey Bass.
Notes from a Benjamin Bloom Lecture. (1987, April). Retrieved May 15, 2009, from http://www.humboldt.edu/~tha1/mastery.html
Smith, M.K. David A. Kolb on experiential learning. Retrieved May 1, 2009 from http://www.infed.org/biblio/b-explrn.htm
VARK Categories. (2001-2009). Retrieved August 10, 2007, from VARK-A Guide to Learning Styles: http://www.vark-learn.com/english/page.asp?p=categories
Questions? Please contact me:Julianne S. Perretta MSEd, RRT-NPS
Questions? Please contact me:Julianne S. Perretta MSEd, RRT-NPS
[email protected] Simulation Educator
The Johns Hopkins Medicine Simulation Center
Baltimore, MD
[email protected] Simulation Educator
The Johns Hopkins Medicine Simulation Center
Baltimore, MD