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@southlondonsim http://southlondonsim.com/ SLSN Intro to Sim2017 Introduction to Simulation Level 1 Course South London Simulation Network Faculty Development Framework Welcome Please help yourself to Tea and Coffee

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Page 1: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Introduction to SimulationLevel 1 Course

South London Simulation Network Faculty Development Framework

WelcomePlease help yourself to Tea and Coffee

Page 2: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Faculty

Colette Laws-Chapman, Deputy Director, SaIL Centre

Seema Nathoo, Simulation Fellow

Nik Karydis, Consultant

Page 3: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Acknowledgements

• South London Simulation Network• Health Education England• International Nursing Association for Clinical Simulation and

Learning (INACSL)• Association for Simulated Practice in Healthcare (ASPiH)• Society for Simulation in Healthcare (SSH)• Society in Europe for Simulation as Applied to Medicine

(SESAM)• Centre for Medical Simulation (CMS) and Harvard Business

School, Boston

Page 4: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Experience Survey #1Your experience teaching clinical skills

Expert +5 years teach, design, curriculum planning, published

Proficient2-5 years teach, design and contribute to sessions or course development

Competent 1-2 years skills-based teaching

Novice 0-1 years bedside teaching

Page 5: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Experience Survey #2Your experience in simulation

Expert +5 years debrief, design, support faculty (debrief the debrief), curriculum planning,

published in the field

Proficient2-5 years debrief, design and contribute to sessions or course development

Competent 1-2 years intermittent debrief practice, some experience in other areas of sim

Novice 0-1 years experience as a participant

Page 6: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Participant Introductions

• Your name

• Your professional background & clinical expertise

• Your favourite pastime

Page 7: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Social Media Guidelines

• tweeters - use the hashtag

#SaILintro2sim

• tweet about your experiences - our twitter handle

@huMANikin

Page 8: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Faculty Development Framework SLSN 2017

Level 1 -Novice

Preparatory learning (readings, observation,

experience)

Introduction to Simulation

(Two days, including basic debriefing skills)

Essential Debriefing (Debriefing with

Diamond or other model)

Introduction to Human Factors in Healthcare

Level 2 -Advanced

Advancing your Debriefing

Teaching the skills of Human Factors

Debriefing in in situ environments

Human Factors 2.0: Understanding Patient

Safety

Level 3 -Expert

Advanced reflective practice and debriefing

the debrief

Simulation as a Teaching Tool (Harvard CMS Instructor Course)

CPD or training in further models of

debriefing

Page 9: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Faculty Development Programme

Day one•Identifying & Writing Learning Objectives

•Designing Simulation-based Training

•Delivering Simulation-based Training

Day two•Practice: Deliver & debrief your own scenario

•Evaluate Your Simulation Practice

Page 10: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Research & the Informed Consent Process

• Simulation is an emerging field of scholarship & research

• Colleagues around South London are exploring various aspects of simulation, including links between simulation training, your learning outcomes and patient safety

Page 11: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Research & the Informed Consent Process

• Through examination of video data, questionnaires, interviews, & focus groups, we hope to demonstrate the value of simulation in the training of healthcare professionals

• We seek your consent for all aspects of this research

• Please read the information sheet & complete the consent form

• If you do not wish to consent for any aspect of this research your training will not be affected

Page 12: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Learning Objectives

By the end of the course, you will be able to:

• Identify & write learning objectives for clinical skills or scenario-

based simulation training appropriate to your clinical setting

• Design a clinical scenario aligned with learning objectives

• Create an effective learning environment in the workplace

• Use low technology simulators, part-task trainers or manikins to

create realistic learning opportunities

• Use basic debriefing skills to contribute to simulation learning

Page 13: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Hopes and Concerns

Page 14: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Course Director’s Role

• Manage schedule (stick to time)

• Manage people (the go-to person)

• Responsible for the learning environment

• Facilitator

Page 15: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Organisation

• Venue – rooms / environment / fire exits

• Refreshments

• Bio breaks & rest breaks

• Copyright

• Cameras – live feed / accessible by centre staff only

Page 16: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

SaIL Centre- STH

Page 17: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Course Principles

• Your previous experience is an important asset – & the starting point for our work

• To that we add some new knowledge & practice over the course

• We are all learners, working together • We strive to create a learning environment

where it’s safe to take risks & to try new things

• Basic assumption:– Our colleagues are capable, want to do their best,

& want to improve

Page 18: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Course Principles (continued)

• Experiential learning • Sharing our learning together

– Mistakes are ok– Curious stance

• Embedded participant• Safety • Code Phrase ‘this is not a

simulation’• Evaluation

Page 19: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Rapid Learning Needs Assessment

In pairs:

• What topic do you hope to develop?

• What information do you need to facilitate an interactive learning session in your dept?

• Who can help you?

• What resources do you need / have?

Page 20: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

A Few Important Reminders

• Registration & data management

• Questionnaires

• Belongings

• Phones / computers

• Check / clean equipment

• Tidy up

Page 21: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Break

Page 22: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Circle of Learning Modules

Evaluation and

ReviewIdentifying and

writing learning

objectives

Designing

simulation

training

Simulation

training

delivery

Stage

1

Stage

2

Stage

3

Stage

4

Page 23: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

•Identifying and Writing Learning Objectives

Module 1

Page 24: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Module 1:Identifying & Writing Learning Objectives

Module Objectives

Upon completion of this module, you should be able to:

• Describe learning needs assessment in the process of educational planning.

• Use different methods of learning needs assessment.

• Write simple, practical and specific learning objectives.

Page 25: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

‘Learning is more likely to lead to change when a

needs assessment has been conducted’

Definition:

A Learning Needs Assessment (LNA) is a review of

learning and development requirements designed to

support individual, team and organisational

development. Grant, J (2001) BMJ

Where do we start? What do our learners need?

Page 26: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Why?

• Starting point for all training design• Identify training needs• For effective learner-centred training• To determine the gap between existing & desired skills,

knowledge, abilities• Enables focussed educational interventions• Engagement of stakeholders• Funding• Evaluation

Page 27: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

But how?

Individual / Team:

• Interviews / focus groups

• Questionnaires / Surveys

• Observation

• Self / peer assessment

• Reflection

• Formal assessment

Organisational / clinical governance:

• Critical incident analysis

• Patient / staff surveys

• Risk assessment

• Morbidity patterns

• Trust priorities

• Audit/ research data

Page 28: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Small Group Activity

Planning your learning needs assessment• The medical director has announced a trust-wide push to

educate & inform everyone about the Sepsis Six, with a large communications campaign across the site. She also has a small budget for some training, & has asked you to help.

In pairs, consider: • What information do you need to collect?• Who from?• How do you get that information?

Page 29: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Small Group Activity

Planning your learning needs assessment

• You have returned from a meeting with the Chief Nurse. She would like all the nursing assistants to have extended roles in venepuncture & cannulation.

In pairs, consider:

• What information do you need to collect?

• Who from?

• How do you get that information?

Page 30: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Small Group Activity

Planning your learning needs assessment

• A consultant in obstetrics has approached you for help thinking about a training programme that she has received funding for that is intended to improve handoffs between midwives & obstetricians.

In pairs, consider:

• What information do you need to collect?

• Who from?

• How do you get that information?

Page 31: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Great… now what?

Page 32: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Writing Learning Objectives

• Writing clearly defined learning objectives is crucial to the design, delivery & evaluation of training

• Focus on learning (what will students learn today?)rather than teaching (What will I teach today?)

• Essential to plan, carry out, & eventually (if appropriate) assess learning

Page 33: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Bloom’s Taxonomy, 1956The Cognitive Domain

Page 34: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

A learning objective consists of…

Action Verb What Insert a central line

Condition How Guided by ultrasound

Criteria How Well Successfully / Safely

‘At the end of this module, participants will be able to

successfully insert a central line guided by ultrasound.’

Page 35: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Use Bloom's taxonomy to identify verbs

• Knowledge/Remembering: define, list, recognise

• Comprehension/Understanding: characterise, describe, explain, identify, locate, recognise, sort

• Application/Applying: choose, demonstrate, implement, perform

• Analysis/Analysing: analyse, categorise, compare, differentiate

• Evaluation/Evaluating: assess, critique, evaluate, rank, rate

• Synthesis/Creating: construct, design, formulate, organise, synthesise

Page 36: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Revisit – Our Objectives

By the end of the course, you will be able to:

• Identify & write learning objectives for clinical skills or scenario-

based simulation training appropriate to your clinical setting

• Design a clinical scenario aligned with learning objectives

• Create an effective learning environment in the workplace

• Use low technology simulators, part-task trainers or manikins to

create realistic learning opportunities

• Use basic debriefing skills to contribute to simulation learning

Page 37: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Verbs to avoid

• Understand

• Appreciate

• Know about

• Become familiar with

• Learn about

• Become aware of

Page 38: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Small group activityIn pairs,

• Watch the Videohttps://www.youtube.com/watch?v=IJNR2EpS0jw

• Write three learning objectives that you think might have been intended from this video. Include one for:

1. Knowledge recall

2. Skill comprehension

3. Application (this could be a utilisation of 1 & 2)

Page 39: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

•Designing Simulation Training

Module 2

Page 40: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Module 2: Designing simulation training

Module Objectives

Brief overview of theory & key principles

• Define the experiential learning cycle

• Consider how learning using simulation methods can be enhanced

• Describe what is required to develop clear, engaging & clinically accurate scenarios

• Design a clinical scenario aligned with learning objectives

Page 41: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Why simulation-based education (SBE)?

• Naturalistic learning

• Simulation

• Skill acquisition

Page 42: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Experiential Learning Cycle (Kolb, 1984)

Page 43: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Gibbs’ Reflective Cycle, 1988

Page 44: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Novice to Expert

Dreyfus Model of Skill

Acquisition, 1980

Page 45: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Deliberate PracticeEricsson, 1993

• What’s important is the amount of deliberate practice as compared to the amount of sheer practice

• Four components to achieve expert level:

Page 46: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Activity: Experiential Learning

In pairs

– 1 x physical limitation suit

– 1 x caring role (be yourself)

• Tasks

– Feed yourself

– Assisted feeding by partner in caring role

– Give your partner feedback

– Assisted feeding again applying feedback received

• Reflect on your feelings & share on flipchart

Page 47: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Lunch

Page 48: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Designing Simulation Scenarios

Driven by - LNA & objectives

• Review your commission remit / the brief- what have you been asked to do?

• Generate ideas / options – involve your technical team

• Work out ‘best’ plan to trial (run through)

• Consider fidelity, mode of delivery, who will be faculty

– Develop a draft plan and share with stakeholders

• Plan a run-through date

Page 49: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Scenario Design

Run through

• Create a draft timetable

• Develop your scenarios / teaching sessions

• Determine faculty support - inc. a technician

• Create a props/ equipment list

• Share with your faculty

• Test your scenarios with kit/ people/ timings

• Adjust and prepare to run your pilot

Page 50: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Top tips

• Have a session/ course director

• Keep scenarios simple

• Develop a maximum amount of learning objectives– Remember that learners may have their own objectives too!

• Use the best simulator suited to your needs

• Consider timing for the session/ scenario/ debrief

• Brief your faculty & actors– All ‘roles’ should have a story

– If role playing – be subtle

– Stay in role

Page 51: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Scenario Design Template

• Patients name / age / DOB / hospital number

• Main medical problem

• Learning goals

– Clinical

– Human Factor skills

• Narrative description/ Case overview

• Staffing / faculty

– Embedded participants/ standardized patient/ actor

– Director/ technician/ role player(s)

Page 52: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Scenario Design Template 2

Participant outline

– Intended participants for scenario/ session

Case briefing

– To participants

Room set-up & skills station/ manikin preparation

– Position & dressing of patient (manikin) inc. cannula, catheter etc.

– Dressing the scene / specialist equipment / Special effects

Simulator operation

– Starting observations

– Observations as scenario progresses & post-interventions

• Props / consumables needed to run the scenario

Page 53: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Scenario Design Template 3

Ensure:

• Consistency of information

• Abbreviations explained

• No jargon

• Lots of social history & background

• Explanation of medical condition where necessary

• Expected behaviours during scenario

• Keep scenarios simple

• Ensure it can be run by anyone

• Be flexible

• Be prepared for anything

Page 54: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Activity: Scenario Design

In small groups or pairs, using template provided, write and plan for the following scenario.

Vignette:

35-year-old female admitted to the ward with pyelonephritis, prescribed co-amoxiclav and gentamicin. No previous history. Patient develops anaphylaxis on the ward.

Her partner is present as it is visiting time.

Page 55: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

•Simulation Training Delivery

Module 3

Page 56: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Module Three: Simulation Training Delivery

Module Objectives

At the end of this module, you will be able to:

• Create an effective learning environment in the workplace

• Use low technology simulators, part-task trainers or manikins to create realistic learning opportunities in the workplace

• Use basic debriefing skills to contribute to simulation learning

Page 57: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Adult Learning Principles (Knowles, 1984)

http://elearninginfographics.com/adult-learning-theory-andragogy-infographic

Page 58: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Creating the Environment for Change & Learning (Safety)

http://www.foamem.com/2014/07/13/7-simulation-pearls/

Page 59: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

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Ways to Create Trust & Enhance Engagement

• Confidentiality contract- not an assessment– Free to share learning principles – but keep confidentiality personal issues shared

• Basic assumption – everyone is capable, wants to do their best & are looking to improve

• Fidelity & Realism• Mistakes are ok• Maintain a curious stance• Give people time to think & reflect• A good introduction• Orientate to the environment / equipment• Explain the learning objectives• Set ground rules • Be respectful, courteous & curious

– To each other– To self

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Engaging in Simulation: Realism

• Immersion / Reality

• Initial thoughts on realism?

• The Fiction Contract - Suspension of Disbelief

• Acknowledge limitations

– Simulation isn’t perfect

– Ask for buy-in

– Act as if it is – AND be yourself

– Work to resolve the problem / case presentation

– You may act differently - but it’s ok

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Teaching Skills: Peyton’s Four Stage Approach, 1998

• Demonstration: show skill at normal speed (no explanation)

• Deconstruction: repeat demonstration with full explanation. Encourage questions

• Comprehension: repeat demonstration with the learner providing explanation of each step & being questioned on key issues

• Performance: learner demonstrates while describing steps

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Exercise

• 4 Stage technique

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Break

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Debriefing for Learning

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What is Debriefing?

A conversation between two or more people to review an event, real or simulated, in which participants

analyse 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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Feedback vs. Debriefing

•Feedback: provision of information

•Debriefing: facilitated discussion of a prior event

Feedback definition

Specific information about the comparison between a trainee’s observed performance & an expected

standard, given with the intent to improve the trainee’s performance.

adapted from Van der Ridder et al (2008)

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Basic Debriefing Objectives

• Review simulation events

• Sort out and clarify thinking

• Release emotional tension

• Reinforce specific teaching points

• Alter thought patterns

• Correct misconceptions

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Tone of Debriefing

Ideal debriefs have:

• Structure

• Deliberate positive tone

• Room for all to have a voice

• Inclusive language

• Open questions

• Skillful and sensitive facilitation

• Engaged and interested facilitator

Potential Pitfalls:

• Disorganised

• Judgmental

• Facilitator dominated

• Language that excludes

• Closed questions

• Controlled by facilitator

• Facilitator appears tired or disinterested

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Theory-based Models

• DAA

• Diamond

• Debriefing with Good Judgment

• 3D

• 4E’s

• TeamGains (hybrid)

• PEARLS (hybrid)

• Plus Delta (+/Δ)

• GAS

• SHARP

• DEBRIEF / AAR

• GREAT

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Diamond debrief model

• Sophisticated model & skill

• Includes scripted questions & prompts to use while learning the model

• Re-framing ways we think & learn – applying human factors

• Requires practice & further reading to develop the knowledge & skill

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Plus / Delta (+/∆) (Decker 2009, Jeffries 2010)

+: What went well? And why?

∆: What would you change? And how?

• Simple method developed for military use,

• Adopted for civilian use after notable accidents in 1970s

• + Plus: positive, desirable aspects of performance or behaviour

• ∆ : Greek letter Delta used to denote change or uncertainty

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How to use +/∆ for debriefing

• Consider level of facilitation – aim for a learner-led process

• Open, leading & exploring questions

• Record insights on a flipchart (+ / ∆)

• Strategies to maintain psychological safety

• Avoid PLUS=POSITIVE and DELTA=NEGATIVE

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Advantages Disadvantages

Easy and quick to learn and use Can be superficial – may not promote

deeper reflective learning

Non-threatening No opportunity for venting of strong

emotional responses

Useful for focusing on specific behaviours May neglect non-technical aspects of

performance which can be explored by

addressing feelings and thinking

Useful for testing systems, processes,

protocols

Can generate meaningful, practical action

plans

Advantages and Disadvantages

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Your Homework for our Next Session

• Design a 10 minute scenario (or skills session)

• Use the template provided

• Work together in small groups of 3 (4 x groups)

• Make sure you have each others’ contact information

• Think about all the aspects of learning that we’ve gone through today

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Whip around and +/∆

• Whip around: share one significant moment / learning from today

• Take a few minutes and create at least two post-it notes for +/∆ chart on your way out:

– +: What was a real ‘plus’ of today (what went well & should be repeated)?

– ∆: What could we change to improve the course?

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Further learning opportunities

To develop your simulation experience it is worth attending as a participant: whole range of courses:

• Taking Care Safer Tracheostomy management• Skilful Response End-of Life Care• Hospital @ Home Delirium and Dementia• Building Resilience for change Safer Sepsis six

Join us as volunteers on Hands up For Health, working with local schoolchildren

• Come and learn to be a faculty member, leading debriefs..• Introduction to In situ Simulation Based-Education & Essential Debriefing

Email: [email protected]

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• Kolb, D. A. 1984. Experiential learning: Experience as the source of learning and development. Englewood Cliffs, JNJ: Prentice-Hall.

• Bloom, B.S. (Ed.). Engelhart, M.D., Furst, E.J., Hill, W.H., Krathwohl, D.R. (1956). Taxonomy of Educational Objectives, Handbook I: The Cognitive Domain. New York: David McKay Co Inc.

• Dreyfus, Stuart E.; Dreyfus, Hubert L. (February 1980). "A Five-Stage Model of the Mental Activities Involved in Directed Skill Acquisition"

• Ericsson, K. A., Krampe, R. Th., & Tesch-Römer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100, 363–406.

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Introduction to Simulation

Day 2

WelcomePlease help yourself to Tea and Coffee

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Faculty

Colette Laws-Chapman, Deputy Director, SaIL

Centre

Seema Nathoo, Simulation Fellow

Nik Karydis, Consultant

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Icebreaker and Introduction

• Choose an adjective that describes yourself & starts with the same first letter as your name. Add it to the front of your name.

• Introduce yourself:

“Hi my name is Bubbly Beth.”

• The person next to you will introduce you

and then himself/herself: “You are ‘Bubbly Beth’ and I am ____.”

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Learning Objectives

By the end of the course, you will be able to:

• Identify and write learning objectives for clinical skills or scenario-based

simulation training appropriate to your clinical setting

• Design a clinical scenario aligned with learning objectives

• Create an effective learning environment in the workplace

• Use low technology simulators, part-task trainers or manikins to create realistic

learning opportunities

• Use basic debriefing skills to contribute to simulation learning

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Course Principles

• Your previous experience is an important asset – & the starting point for our work

• To that we add some new knowledge and practice over the course

• We are all learners, working together

• We strive to create a learning environment where it’s safe to take risks and to try new things

• Basic assumption:– Our colleagues are capable, want to do their

best, and want to improve

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Course Principles (continued)

• Experiential learning

• Sharing our learning together– Mistakes are ok

– Curious stance

• Embedded participant

• Safety

• Code phrase ‘this is not a simulation’

• Evaluation

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Review your scenarios

In your small groups with a facilitator

• Review scenarios/ provide a list of equipment

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Exercise

• Simulated group exercise and model debrief with Plus/ Delta

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Exercise

• All participate in abstract exercise & facilitated debrief

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•Simulation Training Delivery

Module 3

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Module Three: Simulation Training Delivery

Module Objectives

At the end of this module, you will be able to:

• Create an effective learning environment in the workplace

• Use low technology simulators, part-task trainers or manikins to create realistic learning opportunities in the workplace

• Use basic debriefing skills to contribute to simulation learning

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Circle of Learning Modules

Evaluation and

ReviewIdentifying and

writing learning

objectives

Designing

simulation

training

Simulation

training

delivery

Stage

1

Stage

2

Stage

3

Stage

4

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Group planner

Running Concurrently – 30 minutes Simulation Debriefing – 30

minutes Practice Debriefs Scenario Set-Up

Group A (debriefers)

Groups B & C (participants)

Group D Group D – delivering, facilitating &

debriefing A, B, C

Group B (debriefers)

Groups A & D (participants)

Group C Group C – delivering, facilitating &

debriefing A, B, D

Group D (debriefers)

Groups A & C (participants)

Group B Group B – delivering, facilitating &

debriefing A, C, D

Group C (debriefers)

Groups B & D (participants)

Group A Group A – delivering facilitating &

debriefing B, C, D

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Practice debrief exercise

This exercise is designed to help facilitators ask +/∆debriefing questions. The aim is to share stories and to:

– Acknowledge successes and challenges

– Help your group learn from their experiences

In your groups, think of a time (to share) when you:

A. hosted a party

B. attended a job interview

C. planned a holiday

D. delivered a training session

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Lunch

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Group planner

Running Concurrently – 30 minutes Simulation Debriefing – 30

minutes Practice Debriefs Scenario Set-Up

Group A (debriefers)

Groups B & C (participants)

Group D Group D – delivering, facilitating &

debriefing A, B, C

Group B (debriefers)

Groups A & D (participants)

Group C Group C – delivering, facilitating &

debriefing A, B, D

Group D (debriefers)

Groups A & C (participants)

Group B Group B – delivering, facilitating &

debriefing A, C, D

Group C (debriefers)

Groups B & D (participants)

Group A Group A – delivering facilitating &

debriefing B, C, D

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•Evaluation and Review

Module 4

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Evaluation and Review

Module Objectives

At the end of this module, you will be able to:

• Describe why evaluating educational interventions is critical to maintaining and enhancing educational quality

• Apply Kirkpatrick’s four-level model of evaluation to simulation training

• Develop an evaluation strategy for your training intervention that measures Kirkpatrick levels 1 and 2 outcomes

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What is evaluation?

• Evaluation is defined as a systematic process by which the worth or value of something is judged.

• In education it is concerned with the measurement of:– The performance of learners

– The effectiveness of teachers

– The quality of the programme

• In relation to educational objectives

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Why do we evaluate?

Good practice to determine:

• the effectiveness of the educational intervention to meet its outcomes– what worked well and what could be improved

• the experience of the learners (drivers for motivation)

• the impact and value of what you are doing (ROI)

• teaching effectiveness (feedback and reflective practice)

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What do we consider when evaluating?

• Who is the evaluation for?

• What do you need / want to know?

• Why do you need / want to know it?

• Will the evaluation make a difference?

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Three Boxes of Evaluation

Evaluation of effects,

without

addressing the

components that make

up the programmes

Components

of a

programme

are discerned

but inner

workings not

fully revealed

Addresses effects but

also the inner workings

and operations of the

components of a

programme and how

they are connected, as

well as their connections

to other systems

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Or Evaluation can be about...

Process:

• Strengthen or improve the learning process / training intervention while it’s happening

Outcome:

• Examine the effects or outcomes of the learning process / training intervention

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Activity: Thinking about Evaluation

Group 1:

• What methods / tools / instruments might be used to evaluate the LEARNING that has occured?

• Differentiate between those that might be process and those that might be output.

Group 2:

• What methods / tools / instruments can be used to evaluate your TEACHING effectiveness?

• Differentiate between those that might be process and those that might be output.

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Examples

Formative methods:

• Rubrics / rating scales

• Discussions

• Checklists

• Observations / Observational rating scale

• Questionnaires

• Journals / progress notes

• Self-evaluations / reflections

• Conferences / interviews

• Peer-evaluations / observations

Summative Methods

•Rubrics / rating scales•Written assessments / reports•Creative assignments•Presentations•Portfolios•Oral assessments•Practical assessments (in real situation or in simulated conditions)•Direct observation•Projects / products•Peer / self-evaluation•Individual or group interviews•Clinical / performance audits

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Kirkpatrick’s four-level evaluation model (1959)

Level 1 – REACTION: Measures learners perception (thoughts & feelings) of the learning event.

Not indicative of skills or performance.

Level 3 – BEHAVIOUR: Measures change in behaviour (performance) and transfer of

learning to the workplace. Can be measured in the workplace.

Level 2 – LEARNING: Measures the change in knowledge, skills and attitude.

Evaluated pre and post training through learner assessment.

Level 4 – RESULTS / IMPACT:Measures the impact of learning on the organisation (ROI).

Often evaluated through clinical and quality outcomes.

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Kirkpatrick’s four-level evaluation model (1959)

• Impact / Results

• Behaviour / Performance

• Learning

• Reaction

Increasing:

• complexity

• difficulty to measure

• time and cost

• expertise required to

evaluate!

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Activity: Evaluation

In your groups, based on the scenario you delivered today, list two ways you would measure each of the following:

1. Reactions

2. Learning

Be specific, getting right down to the type of data you might collect, and even right down to the level of questions you might ask!

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Evaluation is:

• an essential component of any educational development

• considered carefully before implementation of any training intervention

• directly related to educational objectives.

• realistic and practical

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Review

• Closes the loop in the curriculum development cycle

– maintaining and enhancing educational quality

• A successful training intervention must respond to:

– evaluation and feedback

– internal and external requirements

– changes in learners, resources, knowledge and competency requirements, institutional and societal needs and values etc.

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Now What?• Coaching in Practice

• Develop your scenario & add to it

• Develop evaluation tools

• Book your Kit / Date

• Run session

• Debrief your debrief

[email protected]

• Observe in centre or in situ

• Book onto the Essential Debriefing Skills course

Advancing Your Debriefing

Practice

Teaching the Circle of Care

Practice

Introduction to Human Factors

Practice

Essential Debriefing Skills

Practice

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Whip around and +/∆

• Whip around: share one significant moment / learning from today

• Take a few minutes and create at least two stick notes for +/∆ chart on your way out:

– +: What was a real ‘plus’ of today (what went well & should be repeated)?

– ∆: What could we change / improve?

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Further learning opportunities

To develop your simulation experience it is worth attending as a participant: whole range of courses:

• Taking Care Safer Tracheostomy management• Skilful Response End-of Life Care• Hospital @ Home Delirium and Dementia• Building Resilience for change Safer Sepsis six

Join us as volunteers on Hands up For Health, working with local schoolchildren

• Come and learn to be a faculty member, leading debriefs..• Introduction to In situ Simulation Based-Education & Essential Debriefing

Email: [email protected]

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@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

Further reading

Page 113: Introduction to Simulation€¦ · @southlondonsim SLSN Intro to Sim2017  Faculty Colette Laws-Chapman, Deputy Director, SaIL Centre Seema Nathoo, Simulation Fellow Nik

@southlondonsim http://southlondonsim.com/SLSN Intro to Sim2017

• Kolb, D. A. 1984. Experiential learning: Experience as the source of learning and development. Englewood Cliffs, JNJ: Prentice-Hall.

• Bloom, B.S. (Ed.). Engelhart, M.D., Furst, E.J., Hill, W.H., Krathwohl, D.R. (1956). Taxonomy of Educational Objectives, Handbook I: The Cognitive Domain. New York: David McKay Co Inc.

• Dreyfus, Stuart E.; Dreyfus, Hubert L. (February 1980). "A Five-Stage Model of the Mental Activities Involved in Directed Skill Acquisition"

• Ericsson, K. A., Krampe, R. Th., & Tesch-Römer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100, 363–406.