Dr. Gale Parchoma Associate Professor Educational Studies in the Learning Sciences

1. Is there anything educators across disciplines can learn from simulation-based medical education practices? Dr. Gale Parchoma Associate Professor Educational Studies in the Learning Sciences Faculty of Education University of Calgary OCULL - 2013 Parchoma, G., Shahoumian, A., Hanson, J., Dickinson, M., and Pimblett, M. (2013).

2. Overview • Interdisciplinary research & development • Collaborative experiential learning • Simulation-based medical education (SBME) • A study of fidelity in simulation-based learning • Potential broader disciplinary applications

3. Educational Estuaries When educators (designers, instructors, researchers) work in inter- or trans-disciplinary teams, there is often a perception that educational expertise lies with the educator(s).

4. Defining collaborative experiential learning (CEL) “The construction of shared meanings for conversations, concepts, and experiences.” (Roschelle, 1992) Dimensions Group members are working on a shared problem. Thinking is distributed among group members. Group members work on the same part of the problem, sharing responsibility for the task. Group members are encouraged to share thinking as they work on the problem. (Palincsar & Herrenkhol, 2002)

5. Blended SBME - 1 Pre-briefing

6. Blended SBME – 2 • Student participation in & facilitator assessment of simulated cases

7. Blended SBME - 3 MMS supported debriefing

8. An Emergency Medicine Scenario

9. Conditions for CEL & Modes of Thinking Conditions for CEL Modes of Thinking Physical: Thinking about the physical context, including its artifacts and devices. Semantical: Thinking about concepts and their inter-relationships. Phenomenal: Thinking about emotions, beliefs, values, and the situation in which we are involved. (Lauken, 2003) • “Learning across individuals and information artifacts through and with which they interact” • Shared meaning arises from “participation, knowledge sharing, critique, and debate.” • Learning occurs within these interactions. (Suthers, 2006)

10. Defining Fidelity in Simulation Based Education Fidelity: How closely a simulated educational experience mimics, replicates, or represents ‘reality’ (Diekmann, Gaba, & Rall, 2007; Lapkin & Levett-Jones, 2011; Rudolph, Simon, & Raemer, 2007)

11. Defining Fidelity in Simulation Based Education An early (1995) theoretical framework from simulation in aviation training (Rehmann, Mittman, & Reynolds, 1995)

12. Diekmann, Gaba, & Rall’s (2007) Theoretical Framework for Examining Fidelity in SBME

13. Rudolph, Simon and Raemer’s (2007) Adapted Theoretical Framework for Examining Fidelity in SBME

14. Our study While there is a body of literature on fidelity in SBME, much of it is theoretical or reflective. There is not a lot of evidence about how learners actually perceive fidelity.

15. Preliminary Findings from a UK Case Study of 3rd Year Medical Students’ Perceptions of Fidelity in Simulation Sessions The Case • 1 cohort (74) 3rd year medical students’ experiences with SBME in one simulation center over one year Data • Direct observation of students’ experiences with SBME • Field notes • Memos • Images • Video • Interview data (3 x 13 transcripts of 20-minute interviews) • Post 1st, 2nd, & 3rd simulation sessions

16. Aims & Objectives of our Study • Critically examine existing theoretical frameworks for studying fidelity in SBME • Develop a synthesized theoretical framework for studying student perceptions of fidelity in SBME • Examine our data set for evidence student perceptions of fidelity in SBME

17. Our initial theoretical framework - 1 • Students’ perceptions of physical fidelity • Entities that can be measured (including physiological data from manikins) • Equipment (including manikins), supplies and their organization within the environment (Diekmann, Gaba, & Rall; Rudolph, Simon and Raemer)

18. Our initial theoretical framework - 2 • Students’ perceptions of semantical fidelity • Key concepts and their inter-relationships as they are presented “via text, pictures, sounds, or events” (Diekmann, Gaba, & Rall) • Engagement in “problem solving, decision-making and prediction”(Rudolph, Simon and Raemer)

19. Our theoretical framework - 3 • Students’ perceptions of phenomenal fidelity • Emotions, beliefs, and states of self- and situational awareness (Diekmann, Gaba, & Rall) • “Acting and feeling ‘as if’“the simulation has real stakes and consequences” (Rudolph, Simon and Raemer)

20. Data Analysis • Interview transcripts and field notes are being analyzed with Atlas.ti software for instances of student perceptions of physical, semantical, & phenomenal fidelity • Memos are being created during the analysis and used for critique and corroboration of early findings • Videos and images will be examined corroborating data.

21. Overview of Preliminary Findings

22. Preliminary Findings (1) Student perceptions of phenomenal fidelity Representative quotations: • “I didn’t get nervous or feel any pressure, you know the way you would in a real situation.” • “We started to talk and we said, ‘Okay if the patient has those symptoms, what would you do?’ So we discussed it as a group and we were able to learn from each other.” • In the debriefing session “you were able to reflect on what you had done, why you had done it, and what you should be doing instead.” • “So anything you’ve gotten wrong here that you might come across in a clinical setting will get applied and hopefully avoided.”

23. Student perceptions of phenomenal fidelity • Expressions of emotions, beliefs, and states of self- and situational awareness (Diekmann, Gaba, & Rall, 2007) • Accounts of “Acting and feeling ‘as if’“the simulation has real stakes and consequences” (Rudolph, Simon and Raemer, 2007)

24. Preliminary Findings (2) Student perceptions of semantical fidelity Representative quotations: “The ABCDE thing. I won’t really forget it. And simple things like obstructions…. Not assuming that just because the patient is breathing that there isn’t an obstruction.” “You have to think from the physiological point of view what the consequences are, what’s the consequence of this and what is the consequence of that.” “We were trying to balance up the blood pressure and heart rate and respiration rate. We said, ‘Okay at what point the respiration rate needed to increase and at what point decrease, so we were talking about the physiological side of everything.’ ”

25. Students’ perceptions of semantical fidelity • Negotiating and/or understanding of key concepts and their inter-relationships as they are presented “via text, pictures, sounds, or events” (Diekmann, Gaba, & Rall, 2007) • Engagement in “problem solving, decision-making and prediction”(Rudolph, Simon and Raemer, 2007)

26. Preliminary Findings (3) Student perceptions of physical fidelity Representative quotations: “I felt a lot of the time we were running around looking for [things]. So it would be good to have a chance to look around the lab and familiarize ourselves with where everything is before the session because I feel it’s a waste of time when you could have been doing other things to help the patient.” “ I didn’t know how to use the oxygen mask…. I think it is… important to know how to deal with a new environment… Somehow I wish we’d got teaching on how to use the equipment in the room.”

27. Student perceptions of physical fidelity • Awareness of entities that can be measured (including physiological data from manikins) • Degree of familiarity with equipment (including manikins), supplies and their organization within the environment Adapted from Diekmann, Gaba, & Rall (2007) and Rudolph, Simon and Raemer (2007)

28. Potential Implications In designing simulations for learners’ first experiences of SBME: • Include an orientation to the physical environment & its relative devices • Expect initial lack of ‘buy in’ • Consider and plan for peer influences on learning and performance • Plan a second, time-delayed, debriefing session for reflection on initial perceptions of phenomenal and sematical fidelity

29. My question to you… Do you see anything in this example of simulation-based medical education practice that could be adopted more broadly across disciplinary teaching practices?

30. References Carson, J.R. (2012). Human simulation for physician assistants. In L. Wilson and L. Rockstaw (Eds.) Human simulation for nursing and health professions, (pp. 293-316). New York: Springer. Diekmann, P., Gaba, D., & Rall, M. (2007). Deepening theoretical foundations of patient simulation as social practice. Simulation in Healthcare, 2(3), 183-193. Lapkin, S., & Levett-Jones, T. (2011). A cost-utility analysis of medium vs. high-fidelity human patient manikins in nursing education. Journal of Clinical Nursing, 20, 3543-3552. Palinscar, A.S., & Herrenkohl, L.R. (2002). Designing collaborative learning contexts. Theory into Practice, 41(1), 26-32. Rehmann, A., Mitman, R., & Reynolds, M. (1995). A handbook of flight simulation fidelity requirements for human factors research. Technical report no. DOT/FAA/CT-TN96/46. Wright-Patterson Air Force Base, OH: Crew Systems Ergonomics Information Analysis Center.

31. References Roschelle, J. (1992). Learning by collaborating: Converging conceptual change. Journal of the Learning Sciences, 2, 235-276. Rudolph, J.W., Simon, R., & Raemer, D.B. (2007). Which reality matters? Questions on the path to high engagement in healthcare simulation. Simulation in Healthcare, 2(3), 161-163. gale.parchoma@ucalgary.ca