Assessing clinical decision making skills using an interactive online tool.

1. Assessing clinical decision making skills using an interactive online tool. Verina Waights & Ali Wyllie Faculty of Health and Social Care COLMSCT CETL Fellows OU Conference ‘Making Connections’ (30th April 2008) Quality eLearning strand

2. Outline • Context of Project • Overview principles of quality eLearning experience • Outline characteristics of CDM tool • Demo CDM • Findings to date • Looking to the future

3. Background • Nurses make clinical decisions in response to changes in each patient's condition, which may occur within very small time-frames • The ability to make clinical judgements depends on both a sound theoretical background and good decision-making skills • Clinical decisions are strongly influenced by the context in which they are made (Bucknall 2000) • As the complexity of decision tasks increases, so context-specific knowledge determines the effectiveness of decision-making (Botti & Reeve 2003)

4. Aims • to develop a web-based tool to provide decision-making opportunities, building on Laurillard (2002): who suggests that: • ‘Traditional modes of assessment of knowledge are seen as inadequate because they fail to assess students‘ capability in the authentic activities of their discipline’. • to assess nursing students’ decision-making skills in a context-driven virtual environment.

5. What makes quality eLearning • Boud and Prosser’s (2002) principles for designing a high quality learning environment suggests learning activities should: • support learner engagement - build on prior knowledge • acknowledge the learning context – integral with study • seek to challenge learners – active participation • provide practice – through individual and/or group activities

6. Principles of good feedback practice • Nicol and Milligan (2007:72) seven principles of good feedback practice. Principle 6: Good feedback practice ‘provides opportunities to close the gap between current and desired performance’. • Boud’s (2000:158) arguments about closing the gap can be viewed in 2 ways: • It is about supporting students in the act of production of a piece of work • It is about providing opportunities to repeat the ‘task –performance – feedback cycle’.

7. Pedagogical approach • Based on principles of case-based learning design and experiential learning (Kolb 1984). • Students’ options are scaffolded • Learning is student - led and asynchronous • Feedback is contexual, individualised to student’s learning journey and timely • Intention is to assist students to practice in risk-free environment until ready to practice in work setting.

8. Research methods • Students’ perceptions of their decision-making skills and efficacy of tool will be evaluated through: • Individual completion of an online questionnaire to enable quantitative and qualitative evaluation • Qualitative output from video observation and ‘Think aloud’ techniques with students’ interacting in the IET Userlab

9. Case study: patient with a leg ulcer • Realistic: case prepared in collaboration with a practice nurse to mimic reality • Relevant: Wound healing and clinical decision-making are integral components of Nursing Programme of study • Ethical: consent obtained from the patient and anonymity assured • Context: Miss Alice Phelps, an independent 80 year old lady with an ulcer on her left lower leg.

10. Case study – patient with leg ulcer

11. Narrative • The story evolves over a series of consultations depending on the treatment the patient receives. • At each stage students consult resources to find out about their patient’s condition then determine the best treatment from 3 available options. Their decisions result in the patient progressing through successive consultations until an end point is reached. • They are encouraged to have a second attempt at the maze if their first attempt is unsuccessful. • Images of the consultations and patient’s final outcome create a visual narrative within the maze

12. Practice Resources • The students have a range of media resources to consult: • Audios of consultations between the nurse and patient • Photos of leg ulcers • Instruction sheets on possible treatments • Patient charts and records • Patient records • Laboratory reports • Links to the BNF (British National Formulary)

13. Reflective Log • The Reflective Log captures each decision point and the student’s reasons for their choice. • At the end of each attempt the student can review their pathway and reflect on their decisions and reasoning. • The final attempt additionally provides author feedback on decision-making at each stage.

14. Example Reflective log

15. Scoring • Scoring at each decision point depends on the type of decision as outlined below and whether it is the first or second attempt: • For example: • 1st attempt: a 5 b 3 c 0 2nd attempt: a 3 b 2 c 0 • The final score is an average of the two attempts at the maze.

16. Findings to date - score • 7 students completed tool/8 students partly completed tool

17. Findings to date - questionnaire

22. Summary to date • Students felt using tool:- • Increased their confidence in decision-making and caring for leg ulcers – support learner engagement • would assist in their practice – acknowledge the learning context • Positive, motivating experience – challenge learners • Developed their knowledge and skills - provide practice

23. Looking toward the future • The approach piloted in this project can be applied in part or whole in other courses, programmes or disciplines. • The tool can be combined with other VLE tools, such as online discussion forums and voting tools, to create flexible and collaborative learning and assessment sequences. • The Reflective Log can become part of a TMA. • Our findings are being used to inform future assessment strategies within HSC. We are particularly interested in: Contextualised CMA questions; Narratives; Embedded multiple media; Case-based CMAs; Decision-Making; Confidence-indicator tool.