From Learning Objectives to Outcomes Assessment During Simulation

1. From Learning Objectives to OutcomesAssessment During Simulation Paul E. Phrampus Director Winter Institute for Simulation, Education and Research (WISER) University of Pittsburgh

2. Assessment • Why • What • When • Where • How

3. The Future of Simulation………

4. What is a simulation for? • Education • Assessment • Fun • 1 and 2

5. TESTING TEACHING Individuals  Teams The Simulation Advantage Psychomotor Skills • Decision Making Skills and Decisions

6. What is “Simulation”….. Really…..

7. Psychomotor Skills Decision Making Base Knowledge Communications Skills Teamwork Skills Professionalism Skills The Job of Healthcare Educators

8. Why is this so hard?

9. Learning Objective • You have to have a clear reason of why you are running any simulation.

10. Lets Watch

11. What is most important aspect to debrief?

12. Where does a simulation fit? • It depends on what your doing!

13. EACH Sim is part of a bigger plan!

14. What is this?

15. Does it belong here?

16. Course (Global) objectives v sim objectives

17. Global Objectives • Course Objectives • 1. Demonstrate a proper patient assessment • 2. Demonstrate following the emergency protocol • 3. Demonstrate Airway Management Skills

18. Course Schedule / Flow • Sim 1 • Sim 2 • Lecture • Skills Lab • Sim 3 • Sim 4 Course Objectives • Session Objective • Ventilate w BVM • Recognize Narcotic Overdose • Activate Protocol

19. How do you determine “success” of a simulation? • Students liked it • Learning objectives achieved • Students passed the scenario • Not Sure

20. How do you determine “success” of a simulation? Instructor Number 1 Instructor Number 2 Instructor Number 3

21. How do you determine “success” of a simulation? Instructor Number 1 Instructor Number 2 Instructor Number 3 Measure Here

22. You can only keep track of so many things at one time

23. How many of you feel like this ?

24. Tools for Success • Make it easy for your faculty to stay on track • “In my opinion…..”

25. Assessment Methodology • Identify methods for measuring core aspects in simulation education / assessment • Discuss development and deployment of measurement tools

26. Student Learning Outcomes Teaching & Learning Assessment Evaluation Curriculum

27. Assessment and Evaluation • Assessment and Evaluation often used interchangeably • Assessment – learner outcomes • Evaluation – course or program outcomes

28. Performance Assessment

29. Rate the Performance • Pass or Fail • Score Performance • Procedural Check

30. Assessment • Why • What • When • Where • How Rosen, MA et al. Measuring Team Performance in Simulation-Based Training: Adopting Best Practices for Healthcare. Sim Healthcare 3:2008;33–41.

31. Assessment of clinical skills/competence/performance ACTION PERFORMANCE COMPETENCE KNOWLEDGE Miller GE, The assessment of clinical skills/competence/performance. Academic Med. 1990 Sep;65(9):S63-7.

32. Performance Assessment • Basic to performance – Do they know it and know how? • Competence – Can they do it? • Performance – Do they do it?

33. DOES SHOWS HOW KNOWS HOW Knows When KNOWS Assessment of clinical skills/competence/performance Miller GE, The assessment of clinical skills/competence/performance. Academic Med. 1990 Sep;65(9):S63-7.

34. DOES Practice Review Audits, Video, UC-SP, 360O SHOWS HOW Performance Tests OSCE, TaskDemo, SIM/SP KNOWS HOW Clinical Based Tests Pt Mgt Qs, Essay, Oral Knows When KNOWS Knowledge Tests MCQs, Essay, Oral exam Assessment of clinical skills/competence/performance Miller GE, The assessment of clinical skills/competence/performance. Academic Med. 1990 Sep;65(9):S63-7.

35. Assessment • Formative Assessment • Lower stakes assessment • One of several assessments over time of course or program • May be evaluative, diagnostic, or prescriptive • Often results in remediation or progression to next level • Summative Assessment • Higher stakes assessment • Generally final course or program assessment • Primary purpose is performance evaluation • Often results in a Go-No Go outcome

36. Assessment • Assessment data sources • Live observation • Video recording • SIM device logs • Assessors • Instructors • Observers • SIM/Patients • Peers • Participants • Instruments • AV annotation • Pencil/Paper • Scantron form • TabletPC or PDA

37. Variables in Assessment STUDENT PATIENT ASSESSMENT EVALUATOR

38. Assessment Validity • Validity – • Degree to which an assessment tool measures what it is intended to measure • Construct validity • Accuracy of tool to measure intended construct • Concurrent validity • Content validity • Predicative validity

39. Assessment Reliability • Test Reliability – • consistency of a test to yield the same measure over time (does not assure validity) • Test-Retest Reliabilityconsistency among different administrations • Parallel Forms Reliabilityto assure that memory effects do not occur use a different pre- and posttest • Inter-Rater Reliabilitytwo or more observers rate the same subjects with strong positive correlation of their ratings

40. Variables in Assessment STUDENT PATIENT ASSESSMENT EVALUATOR

41. Assessment Improvement • Improving Reliability and Validity • Base assessment on outcome/objectives > event triggers > observable behavior > behavioral rating > assess against competencies • Define <low – medium – high> performance • Use of Rubric or rating metric • Use (video) training examples of performance • Employ a quality assurance/improvement system

42. Assessment Based on Objectives and Events Rosen, MA, et al A measurement Tool for Simulation –Based Training in Emergency Medicine: The Simulation Module for Assessment of Resident Targeted Event Responses (SMARTER) Approach. Sim Healthcare 3:2008;170-179.

43. Event – Behavior – Scale - Report Rosen, MA, et al. Measuring Team Performance in Simulation –Based Training: Adapting Best Practices for Healthcare. Sim Healthcare 3:2008;33-41.

44. Assessment Metrics • Procedural or Check List assessment • Global Rating assessment

45. Assessment Metrics • Procedural or Check List assessment *Assist

46. Assessment Metrics • Global Rating assessment Pts.

47. Assessment Metrics • Procedural or Check List assessment • Global Rating assessment < EXAMPLES> • Pros and Cons to each • Multiple modes & points vs. Single assessment • QA/QI Metric – collective vs single assessment

48. Brett-Fleegler, MB et al. A simulator-based tool that assesses pediatric resident resuscitation competency. Pediatrics 121(3):2008;597-603.

49. Gaba, DM et al. Assessment of Clinical Performance during Simulated Crises Using Both Technical and Behavioral Ratings. Anesthesiology, 89(1)July 1998:8-18.

50. Guise, JM et al. Validation of a Tool to Measure and Promote Clinical Teamwork. Sim Healthcare 3:2008;217–223.