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Demian Szyld, MD, EdMMedical Director and Fellowship Director
New York Simulation Center for the Health Science (NYSIM)
Education Theory in Healthcare Simulation;
Implications for Simulation Faculty Development
South London Simulation Network Conference
February 26th, 2016
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Disclosures
•NYU School of Medicine•NYSIM•Center for Medical Simulation Boston•Society for Simulation in Healthcare
•Board of Directors, External and Strategic Relations•Formal Training Affinity Group•Accreditation Committee
•Simulación de Sur a Norte Podcast (www.MundodeSimulacioN.com)
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NYSIM: NYU y CUNY Collaboration
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NYU Langone Medical Center3 Hospitals, 30,000 employees
Undergraduate Med Ed (600 students)Graduate Med Ed (1200 residents and fellows)
The City University of New York170,000 students
Undergraduate Med Ed (160 students)>15 Nursing, EMS, Respiratory programs
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ED,Trauma, ICU y
Operating Rooms
Labor and Delivery
Pediatrics
5 Flexible Bays
OSCE Wing(14 Rooms)
Mu
ltip
urp
ose
4 Classrooms
5 Debriefing Rooms
Administrative
Offices
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NYSIM: Flexibility and Creativity
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Debriefing©
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Objectives
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1. Describe useful educations theories for educators and instructors
2. Differentiate theories from frameworks from evidence
3. Implement relevant theories for faculty development programs
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Agenda
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1. Make theory practical and relevant
2. Definitions
3. Theories, Frameworks, and Evidence
4. Faculty Development
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Definitions
Theory: an idea or set of ideas intended to explain
facts or events; idea that is suggested or presented
as a possibly true but that is not known or proven to
be true
Framework: a conceptual structure that serves as
support
Evidence: visible signs that something exists
Merriam-Webster Diccionary
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Relationship
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Growth in Evidence for Sim
Bradley. The history of simulation in medical education and possible future directions. Med Educ (2006) vol. 40 (3) pp. 254-62
Growth in Evidence for Sim
Bradley. The history of simulation in medical education and possible future directions. Med Educ (2006) vol. 40 (3) pp. 254-62
What theories do you rely on?
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Base Theory: Theories of Action
Argyris & Schon 1974
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Base Theory: Theories of Action
Argyris & Schon 1974
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Base Theory: Theory of Action
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Base Theory: Theory of Action
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What are the implications
of this this theory?
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Theories of Action, Implications for
Learning
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Educational Frameworks:The role of theory in faculty development
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Examples:
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Resuscitation Room
Central Venous Catheter
Lumbar Puncture
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Educational Frameworks:The role of theory in faculty development
Value of Theory-based SBME
Potentiates Learning
Common Language
Shared perspective and design guide
Invites and structures research
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Education Theory for SBME
Education
Business and Management
Psychology
Health Professions Education
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Theories and Frameworks… and some evidence
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1) Kolb Experiential Learning:
Learning and experience
Kolb, D. A. 1984. Experiential learning: Experience as the source of learning and development. Englewood Cliffs, JNJ: Prentice-Hall.
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1) Kolb Experiential Learning:
Learning and experience
Kolb, D. A. 1984. Experiential learning: Experience as the source of learning and development. Englewood Cliffs, JNJ: Prentice-Hall.
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What are the implications
of this this theory?
1)Design for experience and reflection
2)Understand that one can enter from all 4 sides
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2)Bloom’s Taxonomy
Anderson, L. W., & Krathwohl, D. R. (Eds.). (2001). A taxonomy for learning, teaching and assessing: A revision of Bloom's Taxonomy of educational objectives: Complete edition, New York : Longman. Original: Bloom (1955)
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2)Bloom’s Taxonomy
Anderson, L. W., & Krathwohl, D. R. (Eds.). (2001). A taxonomy for learning, teaching and assessing: A revision of Bloom's Taxonomy of educational objectives: Complete edition, New York : Longman. Original: Bloom (1955)
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What are the implications
of this this theory?
1)Aim objectives to Apply/Analize level
2)Avoid evaluating ability to memorize facts
3)Dreyfus model of skill acquisition
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3)Dreyfus model of skill acquisition
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What are the implications
of this this theory?
1)Think of where learner is developmentally and of their needs
2)Avoid using age or hair color/amount as guide
4)Deliberate PracticeK. Anders Ericsson
To reach expert level:
MotivationDefined objective
Effective FeedbackRepeated practice
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Ericsson, K. A., & Charness, N. (1994). Expert performance: Its structure and acquisition. American
Psychologist, 49(8), 725–747. doi:10.1037/ 0003-066X.49.8.725
4)Deliberate PracticeK. Anders Ericsson
To reach expert level:
MotivationDefined objective
Effective FeedbackRepeated practice
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Ericsson, K. A., & Charness, N. (1994). Expert performance: Its structure and acquisition. American
Psychologist, 49(8), 725–747. doi:10.1037/ 0003-066X.49.8.725
What are the implications
of this this theory?
1)Decide what are the desired objectives
2)Instructors, assistants, or near peers can give feedback
3)Propose longitudinal programs >> ½ day workshops
5)Mastery Learning
7 Key Criteria (McGaghie)1. Diagnostic Evaluation2. Clear and sequential learning objectives3. Motivation or interest in achieving objectives4. Minimum passing standard for each unit5. Formative evaluation6. Advance to the next unit7. Practice or study each unit until mastery
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5)Mastery Learning
7 Key Criteria (McGaghie)1. Diagnostic Evaluation2. Clear and sequential learning objectives3. Motivation or interest in achieving objectives4. Minimum passing standard for each unit5. Formative evaluation6. Advance to the next unit7. Practice or study each unit until mastery
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What are the implications
of this this theory?
1)Define competency and measure it
2)Not all people learn at the same rate
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Evidence for Mastery Learning
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ML & Simulation
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ML & Simulation
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What are the implications
of this this theory?
1)ML to reach competency without risk to patients
2)Seek evidence that supports our work
3)When there is evidence follow it!
Conceptual fidelity
Realism (property of
the
participant)
Engagement (property of
the educational
experience)
Fiction contract
Physical fidelity
Emotional / Experiential fidelity
Fidelity ���� Realism ���� Engagement
6)Fidelity and Realism©
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Conceptual fidelity
Realism (property of
the
participant)
Engagement (property of
the educational
experience)
Fiction contract
Physical fidelity
Emotional / Experiential fidelity
Fidelity ���� Realism ���� Engagement
6)Fidelity and Realism©
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What are the implications
of this this theory?
1)Fidelity for what purpose?
2)Fiction contract!
1. Emotional state during the experience influences retention and activation
2. Learning is indelible3. Performance improves when the emotional
state of learning is similar to the emotional state of the performance
7)Emotional Learning
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1. Emotional state during the experience influences retention and activation
2. Learning is indelible3. Performance improves when the emotional
state of learning is similar to the emotional state of the performance
7)Emotional Learning
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What are the implications
of this this theory?
1)Work hard to create interesting scenarios
2)Prepare myself to have challenging debriefings
Faculty Development Programs
1)Content
2)Design
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Debriefing
A conversation between two or more people to review an event, real or
simulated, in which participants analize their actions and reflect on the role of their thought processes, psychomotor skills and emotions to improve or
sustain their performance in the future.(Center for Medical Simulation, Boston)
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8)Models of Debriefing
GAS/Structured and Supported Debriefing
PEARLS
Diamond Debrief
Debriefing with Good Judgment
SHARP
Debriefing for Meaningful Learning
Team Gains
TALK Debrief
3D model of debriefing
Rapid cycle deliberate practice
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8)Models of Debriefing
GAS/Structured and Supported Debriefing
PEARLS
Diamond Debrief
Debriefing with Good Judgment
SHARP
Debriefing for Meaningful Learning
Team Gains
TALK Debrief
3D model of debriefing
Rapid cycle deliberate practice
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What are the implications
of this this theory?
1)Pick on method and perfect it!
2)Study other debriefing methods and practitioners
9)Learner Centered Debriefing for
Healthcare Simulation Education
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9)Learner Centered Debriefing for
Healthcare Simulation Education
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What are the implications
of this this theory?
1)Learner-teacher centeredness is a spectrum
2)Simulation is not just for practice, we are all learning
to learn and reflect too
10)Massed VS. Spaced Practice
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10)Massed VS. Spaced Practice
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What are the implications
of this this theory?
1)An instructor course has limmited utility… think of other models
2)Invest in instructors who teach often enough
11)Community of Practice
A group of people who share a common interest,
problem or pasion for a topic and who want to
enrich their knoledge and improve constantly
Requirements:Domain of knowledge
Community
Shared discipline
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1. Wenger E. Communities of Practice: Learning, Meaning, and Identity. Cambridge: Cambridge University; 1998.
2. Wenger E, McDermott R, Snyder WM. Cultivating Communities of Practice. Harvard Business School Press; 2002.
11)Community of Practice
A group of people who share a common interest,
problem or pasion for a topic and who want to
enrich their knoledge and improve constantly
Requirements:Domain of knowledge
Community
Shared discipline
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1. Wenger E. Communities of Practice: Learning, Meaning, and Identity. Cambridge: Cambridge University; 1998.
2. Wenger E, McDermott R, Snyder WM. Cultivating Communities of Practice. Harvard Business School Press; 2002.
What are the implications
of this this theory?
1)We are a community and need to be connected
2)We need time to reflect together within CoP
12)Types of Curricula
Formal
Informal
Hidden
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Instructor CoursesCertificatesFellowshipMasters Doctorate
Networks and workgroupsConferencesVisiting colleaguesPodcast
Pre-requisites for teachingProfessional background of instructorWhat we do and how we teach in coursesHow faculty behave and interact with learners and with each other
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12)Types of Curricula
Formal
Informal
Hidden
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Instructor CoursesCertificatesFellowshipMasters Doctorate
Networks and workgroupsConferencesVisiting colleaguesPodcast
Pre-requisites for teachingProfessional background of instructorWhat we do and how we teach in coursesHow faculty behave and interact with learners and with each other
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What are the implications
of this this theory?
1)Offer formal and informal opportunities for development
2)Reflect to surface the hidden curriculum align it
My intent today…
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Teoría (Modelo Mental)
Teoría (Modelo Mental)
Teoría (Modelo Mental)
Teoría (Modelo Mental)
Teoría (Modelo Mental)
Teoría (Modelo Mental)
Teoría (Modelo Mental)
Teoría (Modelo Mental)
Teoría (Modelo Mental)
Teoría (Modelo Mental)
Teoría (Modelo Mental)
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Thank you!
•Health Education South London (HESL)
•SLSN and organizing committee
•NYSIM y NYU Team
•Center for Medical Simulation in Boston
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Thanks for your attention!©
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@demianszyld@NYSIMCenter@Simdesuranorte