Building Competency with Blended Learning: Integrating Simulation into Continuing Education Julianne...

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


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 “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?



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



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)

http://www.thirteen.org/edonline/concept2class/mi/index.html


http://www.rrcc-online.com/~psych/LSInventory.html









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








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


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”


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


How do you learn best? Kinesthetic

Practice Hands-on Examples Simulations

How do you learn best? Kinesthetic

Practice Hands-on Examples Simulations


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


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



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



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



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



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



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



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)



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



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



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)



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



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



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


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


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


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


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

http://www.humboldt.edu/~tha1/mastery.html



http://www.infed.org/biblio/b-explrn.htm






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

mailto:[email protected]

mailto:[email protected]

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