Building Competency with Blended Learning: Integrating Simulation into Continuing Education

1. Building Competency with Blended Learning:Integrating Simulation into Continuing Education Julianne Perretta MSEd, RRT-NPS The Johns Hopkins Medicine Simulation Center Baltimore, MD

2. Define Continuing Education Motivations for Learning Competency Assessment vs. Education Learning Styles (VARK) Questionnaire Adult Learner Characteristics (Knowles) Best Practices in Simulation Education

3. Objectives 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

4. Continuing Education • Health Professions Education: A Bridge to Quality (Institute of Medicine, 2003) • Provide patient centered care • Work in interdisciplinary teams • Employ evidence-based practice • Apply quality improvement • Utilize informatics

5. Continuing 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

6. Motivations for Learning Why are you here today?

7. Motivations for Learning • Social Relationships • External Expectations • Social Welfare • Professional Advancement • Escape/Stimulation • Cognitive Interest Morstain and Smart (1974), noted in Learning in adulthood.

8. 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?????

9. 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?

10. Competency Assessment vs. Education • 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

11. Competency Assessment vs. Education • Skills deficit • Partial Task Trainers • I.O. Leg • IV arm • Central Line Trainer • Intubation head • Virtual Reality

12. 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 Malcolm Knowles, Andragogy, 1968, 1980.

13. Simulation & 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

14. Learning 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

15. 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)

16. Learning Styles How do you learn best? Visual Aural Read/write Kinesthetic http://www.vark-learn.com/english/page.asp?p=questionnaire

18. Learning Styles How do you learn best? • Visual • Charts • graphs • flow charts (arrows, circles, hierarchies) • algorithms

19. Learning Styles How do you learn best? • Aural • Lectures • Tutorials • Tapes • Group discussion • Email • Speaking • Webchat • “Talking Things Through”

20. Learning Styles How do you learn best? • Read/write • Text-based input and output • List-makers

21. Learning Styles How do you learn best? • Kinesthetic • Practice • Hands-on • Examples • Simulations

22. Learning Styles • 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

23. Best Practices in Simulation Education Hunt et al, 2008 • 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)

24. Best Practices in Simulation Education Experiential Learning (Kolb) • Direct encounter with the phenomenon being studied rather than merely thinking about the encounter, or only considering the possibility of doing something about it • Education that occurs as a direct participation in the events of life

25. Best Practices in Simulation Education 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

26. Best Practices in Simulation Education 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

27. Best Practices in Simulation Education 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

28. Best Practices in Simulation Education 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: • Unconsciously incompetent • Consciously incompetent • Consciously competent • Unconsciously competent

29. Best Practices in Simulation Education Self-Efficacy and Competency (Maibach et al) • Framework for assessing clinical competency (Miller) • Knowledge (knows) • Competence (knows how) • Performance (shows how) • Action (does)

30. Best Practices in Simulation Education • Hybrid simulations to practice very specific skills • Neonatal Chest Tube Management • Patient death • ECMO • NP Aspirate

31. Best Practices in Simulation Education 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

32. Best Practices in Simulation Education 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)

33. Best Practices in Simulation Education Build debrief tools based on agreed upon standards Debrief should be based on simulation objectives

34. Best Practices in Simulation Education 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

35. Best Practices in Simulation Education • eLearning • Practice makes Perfect PERMANENT • AHA BLS course

36. Putting it all Together • Continuing education in healthcare should include: • Opportunities to reflect on learning • Opportunities to apply learning to practice • Interpersonal interaction

37. Putting it all Together 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

38. Putting it all Together • Adult learners: • Are problem-centered • Have a wealth of experience to draw from • Have many different motivations for learning

39. Putting it all Together Different learning styles mean people are most comfortable in a particular way. Build simulations and debriefings to meet these styles

40. Putting it all Together • Key learning theories to consider when building a simulation are: • Experiential Learning • Contextual Learning • Situated Learning/ Peripheral Participation • Deliberate Practice • Feedback • Mastery Learning

41. Resources 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

42. Questions? Please contact me:Julianne S. Perretta MSEd, RRT-NPS jstickl1@jhmi.edu Simulation Educator The Johns Hopkins Medicine Simulation Center Baltimore, MD