Integrating Instructional Strategies with Thick Narrative Branching Simulations

1. Integrating Instructional Strategies with Thick Narrative Branching Simulations Kira King, PhD Decision Simulation Rosalyn P. Scott, MD, MSHA Dayton Veterans Affairs Medical Center Wright State University Mary Davidson, MSN APRN CHPN Veterans Affairs Healthcare System of Ohio Edward Bope, MD Chief of Primary Care/Palliative Care Physician Columbus Veterans Affairs Ambulatory Care Center

2. Palliative Care VP Simulations • Type: thick narrative situational VP • Learners: primary care providers • Content: communication strategies • Access: scheduled as a patient • Strategy: video-based choose your own adventure format • Reflection: mentor simulates apprenticeship (Baile et al., 2001; Bizzocchi & Schell, 2009) 2

3. Creating Effective On-Line Learning U.S. Department of Education reviewed 176 experimental research studies between 1996 – 2008. Learners: • Most common learner: undergraduate and graduate (90%+) • Most common content: healthcare or medical education (20 – 30%) “Real change happens when people see things they have not seen before.” (David Rock, 2009, p. 218) http://www2.ed.gov/rschstat/eval/tech/evidence-based-practices/finalreport.pdf

4. Facilitating Insight Context Decisions Consequences Insights Engagement Reflection (Allen & Sites, 2012; Means,Toyama, Murphy, Badia & Jones, 2010; Rock, 2009)

5. Matched Examples and Non-Examples Description:Best used to teach a concept or “kinds of” • Define concept and show example • Highlight the discriminating properties of the concept • Provide a pair of similar examples • Provide a pair with an example and a non-example • Begin with easy to identify contrasts • Progress to more similar pairs Matched Pairs for the Concept: Triangle Example Similar Example Example Non-Example (David Merrill, 2009)

6. Matched Example and Non-Example What will you say next? Dr. Parker: During our last conversation, we went over your test results and how more chemotherapy or radiation would not help…Given these circumstances, I want to focus on what’s most important for you as we move forward. Reflection Reflection Open-Ended Closed-Ended What challenges Are you able to take are you facing? care of yourself?

7. Matched Example and Non-Example

8. Discussing Goals of Care Goals of Care Discussion Nursing Home No Goals of Care Cardiac Arrest Reflection Reflection Reflection Non-Example Patient Centered Non-Example

9. How will you Discuss Goals of Care?

10. Branching: Delayed Consequences I wanted to give you an update on Marcus. Hospice is helping him live as comfortably at home. He’s asked us to help with an Advance Directive. Marcus is in the hospital with all of these tubes. This sure isn’t what he wanted. I was hoping he could have stayed at home, but it was tough without help. Resources New Goals Intubation HomeResources HospiceNot Utilized

11. Branching Techniques Examples & Non-Examples Delayed Consequences Decision Promotes insightful learning by demonstrating consequences of decisions as the simulation progresses. Decision Reflection Reflection Consequences Consequences Learners explore examples of what is and what is not the concept. Reflection Reflection

12. Questions?