Simulation: From theory to implementation
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constructivis m explains how knowledge is constructed when information comes into contact with existing knowledge that has been developed by experiences
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simulation based education, simulation augmented education, medical training, medical education, international education, iterative design
Transcript of Simulation: From theory to implementation
constructivismexplains how knowledge is constructed when information comes into contact with existing knowledge that has been developed by experiences
Simulation in Health Professions Education: F r o m T h e o r y t o I m p l e m e n t a t i o n
Adam Dubrowski, PhD
“Country doctors feel uncomfortable with adhering to standards of care felt mandatory by consultants in the city. An occasional rapid sequence intubation is not enough to maintain proficiency in the procedure. Yet rural physicians working in under-staffed settings cannot easily maintain skills because they can’t leave their communities.”
The country doctor’s lamentTia Renouf, MD Can J Rural Med 2005; 10 (3)
Low frequencyHigh stakes
Just in-timeJust in-place
Pre-hospital Care
Primary Care
Community Hospital
University/Tertiary Hospital
Low Frequency simulation for training
Pre-hospital Care
Primary Care
Community Hospital
University/Tertiary Hospital
Development
Implementation
Silo
Hub and spoke
Methods and tools to merge the gap between the development and the implementation of simulation, leading to a hub-and-spoke model
adam dubrowski
Iterative
DesignWujec (2011)
Pre-hospital Care
Primary Care
Community Hospital
Tertiary Hospital
MRC
D e v e l o p m e n t O f C o m p l e xI n t e r v e n t i o n s
Campbell, et al (2000) BMJ.16;321(7262):694-6.
MRC
D e v e l o p m e n t O f C o m p l e xI n t e r v e n t i o n s
CIPPP r o c e s s b a s e d
d e v e l o p m e n t
Stufflebeam & Shinkfield (2007)Campbell, et al (2000) BMJ.16;321(7262):694-6.
Grand Mid-range Micro
Why use theories in qualitative research? Scott Reeves et al. BMJ 2008; 337 (3) 631
Cognitive Load
Theory (CLT)
Sweller, 1988; van Merrienboer and Sweller, 2010
Kurahashi et. al. 2011
Practice: Trained SkillsTest
WrittenTest
1 week rest
No practice: Novice
Kurahashi et. al. 2011
Skills Test: Expert Opinion
05
10152025
Written Test: Score
05
1015
2025
TrainedNovice Novice
TrainedNovice Novice
Kurahashi et. al. 2011
Reducing the complexity of the
learning environment
reduces cognitive load and improves
handling and learning novel
information.Sweller, van Merrienboer and Paas, 1998
A number of studies suggest skills learned in simulation
improve
McGaghie 2011, Gurusamy 2008, Nestle 2011
A number of studies suggest skills learned in simulation
can transfer to the clinical
setting
Sturm 2008, Grancharov 2009, Seymour 2002, Barusk 2009a, Park 2007, Wahidi
2010
simulation worksHow and why
Need research focuses on instructional design
[…] is the practice of creating "instructional experiences which make the acquisition of knowledge and skill more efficient, effective, and appealing."
Merrill et al., 1996
Instruct iona l Des ign
Clinical technical skills are a subset of
psychomotorskills
Psychomotor
Psychomotor
P h y s i c a l p r a c t i c e
R e p e t i t i v e V a r i a b i l i t yM a s s e d v s D i s t r i b u t e dF e e d b a c k
Wolpert,et al.(2001), Rizzolatti et al. (2001), Calvo-Merino et al. (2005)
Observational practice
Ins t ruct ionsModel ingSoc ia l Network ing
Campbell, et al (2000) BMJ.16;321(7262):694-6.
Moulton et al., Ann Surg. 2007
Optimal schedules
Moulton et al., Ann Surg. 2007
1 2 3 4 1 month
1 2 3 41 weekrest
1 month
distributed practice
massed practice
1 31 31 31 31 2 4
T
T
Transfer
distributedmassed
Exp
ert
O
pin
ion
30
20
10
0 Pre-test
Microsurgical drill
Post-test
Rat
Transfer
Moulton et al., Ann Surg. 2007
simulationInstructional designoptimizes
Representat ions o f Ac t ions
Carroll & Bandura (1990), Bandura et al. (1974), Beek & Lewbel (1995)
“Psychomotor learning is …. outside the domain of
online learning.”
Newton, G., Introduction to Developing Online Electrical Course Ware. 1999
P r e p a r a t i o n
Instruction
Instruction & Networking
Traditional Collaborate
PDFs + Video Networked Spot-the-difference
Observe
Spot-the-difference
P r e T e s t
W o r k s h o p
P o s t T e s t
Research: Current
Future: Preparation
Contro
l
Obser
vatio
nal P
ract
ice
OP an
d EN
05
10152025
Traditional Observe Collaborate
Post-
Test
Glo
bal R
ati
ng
s
Research
Social (Ed) netwroking improves learning during the workshop
Conclusion
Campbell, et al (2000) BMJ.16;321(7262):694-6.
MalawiI s s i m u l a t i o n n e e d e d ?
CIPPP r o c e s s b a s e d
d e v e l o p m e n tStufflebeam & Shinkfield (2007)
A mother’s journeyNiranjan Kissoon, MD Pediatr Crit Care Med 2010 Vol. 11, No. 4 Co n t e x t
DistrictHospital
District Health Centre
Community Hospital
Tertiary Hospital
W h a t i s d o n e w e l l
A healthcare worker journeyCo n t e x t
DistrictHospital
District Health Centre
Community Hospital
Tertiary Hospital
W h a t i s d o n e w e l l
W h a t n e e d s t o b e d o n e
A healthcare worker journeyCo n t e x t
DistrictHospital
District Health Centre
Community Hospital
Tertiary Hospital
W h a t i s d o n e w e l l
W h a t n e e d s t o b e d o n e
A healthcare worker journeyCo n t e x t
S i m u l a t i o n
DistrictHospital
District Health Centre
Community Hospital
Tertiary Hospital
E T A T
Univ
ers
ity level
Emergency TriageAssessment & TreatmentIn p u t s
DistrictHospital
District Health Centre
Community Hospital
Tertiary Hospital
Univ
ers
ity levelETAT: Instructional
DesignP r o c e s s
E T A T + +
E T A T
Instructional Design
Univ
ers
ity levelETAT: Instructional
DesignP r o c e s s
DistrictHospital
District Health Centre
Community Hospital
Tertiary Hospital
HIV
HBB
ETAT
ETATHBBHIV
HIV
HBB
ETAT
Different programsSimilar system “journey”Similar strengths (Inputs) Similar weaknesses (Processes)All connected to the University
University as the hub (Train the Trainer)
University as the hub (Train the Trainer)
DistrictHospital
District Health Centre
Community Hospital
Tertiary Hospital
Is this unique to Malawi?
“Country doctors feel uncomfortable with adhering to standards of care felt mandatory by consultants in the city. An occasional rapid sequence intubation is not enough to maintain proficiency in the procedure. Yet rural physicians working in under-staffed settings cannot easily maintain skills because they can’t leave their communities.”
The country doctor’s lamentTia Renouf, MD Can J Rural Med 2005; 10 (3)
MRC
D e v e l o p m e n t O f C o m p l e xI n t e r v e n t i o n s
CIPPP r o c e s s b a s e d
d e v e l o p m e n t
Stufflebeam & Shinkfield (2007)Campbell, et al (2000) BMJ.16;321(7262):694-6.
Adam Dubrowski, [email protected]
Home District Centre
District Hospital
Regional Hospital
Tertiary Hospital
Home Pre-hospital care
Primary Care
Community Hospital
Tertiary Hospital
UniversityTrain the Trainer
Context Input Process Product
