Post on 22-May-2015
transcript
Progressive simulation for pediatric skills training
Adam Dubrowski, PhD
Progressive simulation for pediatric skills training
Adam Dubrowski, PhD
Progressive simulation for pediatric skills training
Adam Dubrowski, PhD
const ruct iv i sm
Explains how knowledge is constructed when information comes into contact with existing knowledge that has been developed by experiences.
A number of studies suggest skills learned in simulation
improve
McGaghie 2011, Gurusamy 2008, Nestle 2011
A number of studies suggest skills learned in simulation
can transfer to the clinical
setting
Sturm 2008, Grancharov 2009, Seymour 2002, Barusk 2009a, Park 2007, Wahidi
2010
simulation works
simulation worksHow and why
simulatorsrange of
clinical settings
range of
optimize
learning outcomes
structures
Description & Justification
Theoretical & ConceptualFrameworks
Cook, 2008; Cook 2010; Diekmann 2011; Cook, 2012
MRC 2000, 2008; McGaghie 2011
A complex intervention
“[Move] away from research that is intended to prove the effectiveness of … educational endeavours and towards research that aims to understand the complexity inherent in those activities”
Eva, 2010
Need research focuses on instructional design.
[…] is the practice of creating "instructional experiences which make the acquisition of knowledge and skill more efficient, effective, and appealing."
Merrill et al., 1996
I n s t ruc t i ona l Des ign
Scerbo, 2007; Dieckmann 2007
Norman, 2012
Authenticity of the simulated environment is of paramount importance
Authenticity LearningTransferM
ore
Kneebone, 2005
EssentialContextual Realities
• Learning specificity (Schmidt and Lee, 2011)
• Situated learning (Brown 1989; Nestle 2009)
• Context and encoding specificity (Godden and Badley 1975; Wright 1996)
• Identical elements theory (Thorndike, 1903)
Motor Learning and Cognitive Theories
Evidence
Dieckmann 2007
conflicting results
Kassab 2011
Novices laparoscopic cholecystectomy
contextualized
Vs
decontextualized
Anastakis et. al., Matsumoto et. al. and Grober et. al.
Novices anastomosis
High realismVs
Low realism
Scerbo et al 2004, 2006
Novices intravenous cannulation and phlebotomy
High realismVs
Low realism
Sidhu et. al. 2007
Experienced Anastomosis
High realismVs
Low realism
Sidhu et. al. 2007
Novice Anastomosis
High realism
Vs
Low realism
Task ComplexityLearner
Expertise
• Cognitive Load Theory (Sweller, 1988; van Merrienboer and Sweller, 2010)
• Elaboration Theory(Reigeluth, 2007)
Competing Theories
Cognitive Load
Theory (CLT)
Sweller, 1988; van Merrienboer and Sweller, 2010
Infinite Long-Term
Memory
weller, van Merrienboer, Paas 1998
Severely Limited
Working Memory
Multitasking
weller, van Merrienboer, Paas 1998
Technical skill training improves the ability to learn
Kurahashi et. al. 2011
Practice: Trained SkillsTest
WrittenTest
1 week rest
No practice: Novice
Kurahashi et. al. 2011
Skills Test: Expert Opinion
05
10152025
Written Test: Score
05
1015
2025
TrainedNovice Novice
TrainedNovice Novice
Kurahashi et. al. 2011
Significant load is placed on novices
when there is a high degree of
interactivity between elements
of information presented.
Sweller, van Merrienboer and Paas, 1998
Brunken 2002 in Brunken 2003
Cognitive Load Theory does not provide direct guidance for how to moderate load to optimize learning
Reigeluth, 2007
ElaborationTheory
recommends the use of a simple-to-complex instructional sequences
Progress i ve Sequenc ing
Deconstruct the procedure into smaller sub-tasks
Gallagher, 2005; Cristancho, Moussa, Dubrowski, 2012
Take on the procedure in its entirety
Brydges 2007
Serial Multisegment
ed Tasks
Brydges 2007; Park 2004
Dubrowski et. al. 2005 , Brydges et. al. 2007
Practicing the procedure
as a Whole
Naylor and Briggs, 1963
ChoicesInteractivity and coordination between constituent motor and cognitive skills
Coordinating progressive levels of simulation fidelity to maximize educational benefit.
Brydges et al., 2010
Guadagnoli & Lee [2004]
Progressive Learning
Low complexity
VR Simulator
Brydges et al., 2010
Sim-Man
High complexity
Brydges et al., 2010
Progressive
VR Simulator
Brydges et al., 2010
Progressive
VR Simulator
Arm Simulator
Brydges et al., 2010
Progressive
VR Simulator
Arm Simulator
Sim-Man
Brydges et al., 2010
Transfer Test
Integrated Procedural Performance Instrument (IPPI) scenario.
Brydges et al., 2010
*
IPPI ra
ting
0
10
20
30
40
50*
* P < .05
Delayed Transfer-test
Progressive High LowBrydges et al., 2010
Progressive learning provides a match between student experience and simulator fidelity.
Brydges et al., 2010
A Bad Place
To learn how to tie a knot
S imu la t i on
simulation works
simulation worksHow and why
T h e S t a t e o f
A d a m D u b r o w s k i P h D a d a m . d u b r o w s k i @ g m a i l . c o m
t h e S c i e n c e