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