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Teaching First or Teaching Last

Teaching First or Teaching Last. Benjamin Zendejas Mummert, MD David A. Cook MD, MHPE David R. Farley, MD Mayo Clinic, Rochester, MN. Does it matter in simulation based surgical scenarios?. Simulated Scenario. Briefing. Debriefing. Simulation-Based Scenarios.

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Teaching First or Teaching Last

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  1. Teaching First or Teaching Last Benjamin Zendejas Mummert, MD David A. Cook MD, MHPE David R. Farley, MD Mayo Clinic, Rochester, MN Does it matter in simulation based surgical scenarios?

  2. Simulated Scenario Briefing Debriefing Simulation-Based Scenarios • Military, Aviation, Healthcare • “Safe” Rehearsal

  3. Simulated Scenario Briefing Debriefing

  4. Simulated Scenario Briefing Debriefing

  5. Simulated Scenario Briefing Debriefing

  6. Simulated Scenario Briefing Debriefing Simulation-Based Scenarios • When to teach?

  7. Teaching First • Knowledge upfront • Scenario stress • Demand attention • Information overload

  8. Teaching Last • Scenario activates prior knowledge • Knowledge gap • More receptive • Scenario stress

  9. Study Design Pre-Post Test Crossover Design Knowledge and Attitudes Instructional Modules 3 x 2 • 6 Sessions • 3 Scenarios / Session

  10. Sessions 1, 4 & 6 Teaching-First Scenario 1 Scenario 2 & 3 Brief Scenario Debrief Post-Test Sessions 2, 3 & 5 Teaching-Last Simulated Sessions (3 hours) Pre-Test

  11. 38 Surgical Residents N = 49 11 Med Students 14 Concordant 9 Alternate Teaching-First 42 Teaching-Last 34 Study Participation

  12. 10 8 6 ∆ 1.56 4 P= NS 2 0 Pre-Test Post-Test Teaching First Teaching Last Knowledge Test Scores 10 MCQ Test 95%CI 0.79, 2.33 Large ES 0.8

  13. P=0.01 Figure 3: Attitude Survey Results Where were you the most nervous? Where were you the most nervous? Choose the Better Learning Experience Choose the Better Learning Experience P=0.01 P=0.01 P=0.004 P=0.03 Proportion of participants responding to each survey question and only statistically significant comparisons are shown. Attitudes

  14. P=0.004 Figure 3: Attitude Survey Results Where were you the most nervous? Where were you the most nervous? Choose the Better Learning Experience Choose the Better Learning Experience P=0.01 P=0.01 P=0.004 P=0.03 Proportion of participants responding to each survey question and only statistically significant comparisons are shown. Attitudes

  15. Teaching-First Reactions

  16. Teaching-Last Reactions

  17. Summary Teaching-Last • Stress during scenarios • 10-20% Knowledge improvement • “Eu-Stress”? Conceptual Frameworks • Stress • Activation of Prior Knowledge • Cognitive Load Theory

  18. Scenario Debrief Stress Attentional Resources Teaching-First Brief + Lecture Cognitive Overload

  19. Debrief + Lecture Scenario Knowledge Gain Activation Prior Knowledge Stress Teaching-Last Brief

  20. Implications • Use of Instructional Design Theory • Activate Prior Knowledge • Minimize Cognitive Overload

  21. Future Directions How our results apply to: • Other competencies - skills? • Other settings – WBL? • Different levels of expertise? Long-term retention?

  22. Questions?mummertben@mayo.edu Thank You

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