Simulation: a teaching strategy

1. Simulation: a teaching strategy Mayumi Anthony Cheryl Muffley

2. Overview of Simulation • Definition: • A method of instruction whereby an artificial or hypothetical experience that engages the learner in an activity reflecting real-life conditions but without the risk-taking consequences of an actual situation is created (Bastable, 2008, p. 635). • Description: • Participants make decisions in a safe environment, witness the consequences, and evaluate the effectiveness of their actions.

3. Application of Educational Theories • Social Learning Theory • Self-efficacy or social change occurs through modeling and reinforcement learning. • Educator designs a simulation to teach a skill, pattern, or role play, and then designs additional simulations where the target behavior is reinforced. • Simulation provides planned stimuli organized in a way so as to give the participant opportunity to respond. • Experiential Learning Theory • Educator designs simulation to match a student’s needs and preferences for learning. • Students are assigned to participate in a simulation activity that matches their learning style.

4. Application of Simulation to teaching situations • Assessment Skills • Assessment of and early intervention for patients with acutely deteriorating conditions • Improved proficiency in advanced life support following simulation training compared to clinical experience alone (Wayne et al., 2005) • Hospital resuscitation teams trained in advanced life support using simulation can improve patient outcomes following cardiac arrest (Moretti et al., 2007) • Pharmacological concepts • Drug recognition unit allows simulator to respond physiologically (Rauen, 2004) • Ex. Simulated morphine injection causes pupil size of mannequin to change and the respiratory rate, heart rate, and blood pressure to decrease • Instructor can pause simulation to review assessments, detect problems, or discuss treatment

5. Application of Simulation to teaching situations (cont.) • Basic and Advanced Cardiac Life Support Techniques • Developing and demonstrating critical thinking skills • Scenarios require students to use classroom knowledge, incorporate assessment skills, and create and implement a plan • Students are given an opportunity to witness the outcome and evaluate their plan and make appropriate changes if necessary • With the use of simulation, students can implement the entire nursing process and are required to think critically

6. Uses of simulation: Appropriate settings • Aviation • Transportation • Nuclear Power Industry • Social and Behavioral Sciences Risk-free practice Teach, practice, and/or evaluate critical-thinking skills Teachconcepts

7. Uses of simulation: Appropriate settings in nursing • Undergraduate • Graduate • Hospitals: Nursing Orientation

8. Advantages of Simulation • Enjoyable, motivating activity • Element of reality is compatible with principles of constructivism • Enhances appreciation of the more subtle aspects of concept/principle • Promotes critical thinking • Allows student to practice reality in a safe setting

9. Limitations of Simulation • Preparation time • Cost can be an issue • Assessment is more complex than some traditional teaching methods

10. Ways to Adapt Simulation • Time • The arc of the activity can be adjusted. • Content • Some simulations offer content more appropriate to specific ages, trainings, and professions. • Expectations • Not all students appreciate the subtleties of a concept as well as others. • Rubrics can be developed to help the educator determine the level of success.

11. Evaluation of the Effectiveness of Simulation • Educators must monitor the process to ensure that students both understand the process and are benefiting from it. • Helpful to develop rubric as a guide • Follow up activities may be helpful to establish a measure of comprehension. • Some prepackaged simulations include assessment suggestions.

12. Evaluation of the Effectiveness of Simulation (cont.) The following are some questions that educators may ask themselves to assess the simulation and its apparent success: Are the desired instructional outcomes well defined? Does this simulation offer an appropriate measure of realism for my group of students? Does the student demonstrate an understanding of his/her role? Are problem solving techniques in evidence? Is the level of ambiguity manageable for this group? Does the student provide meaningful answers to probing questions? Is cooperation between participants in evidence? Has the student been able to resolve the issue satisfactorily? Will follow-up activities be necessary?

13. Conclusion • Simulation is a vehicle for translating classroom knowledge into a safe learning environment (Leigh, 2008). • Simulation allows learners to function in an environment that is as close as possible to an actual clinical situation and provides them an opportunity to “think on their feet, not in their seat” (Rauen, 2004). • Simulation promotes the use of critical and evaluative thinking.

14. Conclusion (cont.) • The main benefits of simulation can be summarized as: • experimentation in limited time, • reduced analytical requirements, • easily demonstrated models. • The main limitations are: • simulation cannot give accurate results when the input data are inaccurate, • simulation cannot provide easy answers to complex questions, • simulation cannot solve problems by itself . • Success is usually determined by the facility and commitment of the participants. • Follow up activities may be helpful to establish a measure of comprehension.

15. References • Bastable, S. B. (2008). Nurse as educator (3 ed.). Sudbury, Massachusetts: Jones and Bartlett. • Cameron, B. (2010). The Effectiveness of simulation in a hybrid and online networking course. Tech Trends, 47 (5), Retrieved from http://www/spingerlink.com/index/982L41375601557X.pdf • Leigh, G. T. (2008). High-fidelity patient simulation and nursing students’ self-efficacy: A review of the literature. International Journal of Nursing Education Scholarship, 5(1). • Moretti, M. A., Cesar, L. M., Nusbacher, A., Kern, K. B., Timerman, S., & Ramires, J. A. (2007). Advanced cardiac life support training improves long-term survival from in-hospital cardiac arrest. Resuscitation, 72, 458-465. • Rauen, C. (2004). Simulation as a teaching strategy for nursing education and orientation in cardiac surgery. Critical Care Nurse, 24 (3), 46 – 51. • Saskatoon Public Schools. (2010, March 17). Instructional strategies online. Retrieved from http://olc.spsd.sk.ca/DE/pd/instr/strats/simul/index.html • Wayne, D. B., Butter, J., Siddall, V. J., Fudala, M. J., Lindquist, L. A., & Feinglass, J. (2005). Simulation-based training of internal medicine residents in advanced cardiac life support protocols: A randomized trial. Teaching and Learning in Medicine, 17(3), 210-216.