Yue Ming Huang, EdD, MHS Assistant Adjunct Professor Department of Anesthesiology David Geffen School of Medicine at UCLA Director of Operations, UCLA.

Yue Ming Huang, EdD, MHSAssistant Adjunct ProfessorDepartment of Anesthesiology

David Geffen School of Medicine at UCLADirector of Operations, UCLA Simulation

Center

Mini Simulation User Network ConferenceWest Coast University, North Hollywood,

CAAugust 20, 2012 1

DisclosuresI have no conflict of interest to disclose.

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Agenda/ObjectivesReview educational principles for adult learners

Review steps for curriculum development

Describe considerations for scholarly dissemination

Provide examples of published curricula and other resources

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Getting to Know YouWho is new to simulation (0-2 years), has 3-5 years, 6-10 years, >10 years of experience?

Who is at a community college, nursing school, medical school, hospital-based simulation center, others?

Who has had formal postgraduate training in education, e.g. Master/Doctorate in Education, Medical Education Fellowship, etc.?

Who has experience publishing curriculum, educational tools, or simulation-based research?

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Simulation as an ExperienceHow many have been in the “hot seat” as a simulation participant/learner?

If you have not, please do so

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History of Experiential Learning“Experience is, for me, the highest authority. The touchstone of validity is my own experience. No other person's ideas, and none of my own ideas, are as authoritative as my experience... Neither the Bible nor the prophets -- neither Freud nor research --neither the revelations of God nor man -- can take precedence over my own direct experience.”

from On Becoming a Person Carl Rogers, 1969

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Educational Principles“We cannot teach another person directly; we can only facilitate his learning.” (Carl Rogers, 1969)

An effective educational environment promotes significant learning if:1) it is non-threatening or low-risk2) facilitator can help learner differentiate his own perceptions through experiences

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Adult Learning Theory (Adult Learning Theory (Malcolm Knowles 1978Malcolm Knowles 1978)) Student centered and self-directed: Adult learners expect to have a say on what is taught, how they are taught, and how they are evaluated; Their feedback needs to be incorporated into program

Experiential: Adults come with prior knowledge and learn best experientially

Relevant: Adults need to know why they need to learn something and how they can apply new knowledge to their job/life.

Problem-solving approach to learning

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Simulation ScenarioConcrete Experience (Doing, feeling,

experiencing)

Simulation ScenarioConcrete Experience (Doing, feeling,

experiencing)Deliberate

PracticeActive

Experimentation

(Applying, trying out what you learned)

Deliberate PracticeActive

Experimentation

(Applying, trying out what you learned)

Guided DebriefingReflective Observation(Reviewing, watching, reflecting)

Guided DebriefingReflective Observation(Reviewing, watching, reflecting)Discussions &

Further StudyAbstract

Conceptualization

(Thinking, processing, learning)

Discussions & Further Study

Abstract Conceptualiza

tion(Thinking, processing, learning)

Simulation as part ofthe ExperientialLearning Cycle

Circumplex of EmotionsCircumplex of EmotionsOptimal

ActivatedState =

Relaxed Alertness(low threat,

high challenge)

6 Steps of Curriculum Design (Kern,

1998)1. Problem Identification and General Needs

Assessment2. Needs Analysis of Targeted Learners3. Goals and Specific Measurable Objectives4. Educational Strategies5. Implementation6. Evaluation and Feedback

Plan ahead with publication/dissemination in mind!

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Step 1. Problem Identification and General Needs AssessmentIdentify the problem or educational gap

What is the current approach (who is doing what, when, how, resource limitations)

What is the ideal approachIdeal – current approach = general assessment

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Step 2. Needs Analysis of Targeted LearnersWho are the learners, level of training, previous experience, current performance, learning styles/preferences

What are barriers or enabling/reinforcing factors

What are the available resources to this group (simulation, faculty, clinical experiences)

Use multiple ways to obtain info/needs assessment

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Needs Assessment Methods1. Informal discussions2. Questionnaires/Surveys3. Interviews4. Focus groups5. Observations6. Tests7. Literature review8. Available documents – ACGME, Joint

Commission, national board research9. Include different sites10. Other ideas?

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Scholarly Work for Steps 1 & 2Systematic review of literatureNeeds assessment reportAssessment tool

Keep in mind:Is there a need? A gap in the literature? Clinical significance?

Has it been done before? Am I contributing something new? Is it generalizable?

Is it innovative and compelling?

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Step 3. Goals and ObjectivesReview types (learner, process, outcome) and levels of objectives

Learning domains: cognitive, psychomotor, affective

Review Bloom’s Taxonomy of educational objectives

Write SMART (specific, measurable, achievable, relevant, timely) objectives

Ask this question: Who will do what and how much/how well by what time (when)?

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Bloom’s Taxonomy of Educational Objectives

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Learning, Mastery & ExpertiseLearning, Mastery & Expertise

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Expert

Proficient

Competent

Advanced Beginner

Novice

Miller’s Model of Assessment1990

Dreyfus & Dreyfus Model of Skills Acquisition1988

Essential Components of a Learning ObjectiveBehavior/Skill: need to be specific and observable

Condition: under what circumstances is this behavior achieved; are tools/assistance allowed?

Standard: what is an acceptable level of performance; by what criteria is the behavior measured against?

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Step 4. Educational StrategiesUse multiple educational methods and match methods to objectives

Review/discuss pros/cons of different methods

Choose methods that are feasible in terms of resources

Consider different simulation optionsOther interactive methodologies (games, ARS, engaging exercises etc.)

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Simulation MethodsScreen-based virtual patientsRole playsStandardized patientsArtificial models, procedural task trainers

Virtual reality simulatorsFull body computerized simulatorsHybrid simulationGroup learning projectsGames and other engaging activities

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Scholarly Work for Steps 3 & 4Creation/description of a new educational tool or method

Simulation scenariosTheoretical/comparative paper on the merits of educational processes or tools

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Step 5. ImplementationConsider resources: personnel, time, facilities, funding/costs

Administration and operationsPiloting, phasing-in, full implementatoin

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Step 6. Evaluation and FeedbackIdentify users and use (formative, summative), resources for evaluation, questions to ask, evaluation design

Choose/construct measurement method – address reliability, validity, bias

Ethical concernsData collection and analysisResult reporting

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Kirkpatrick’s Levels of EvaluationLevel 1: Reaction – How did learners perceive the course, the process? Satisfaction surveys

Level 2: Learning – What knowledge and skills were gained? Written tests, demonstrations, checklists

Level 3: Behavior - What are the observable practice changes, transfer of learning from lab to job? Field evaluations, observations

Level 4: Results - What are the tangible outcomes (return in investment, cost reduction, improved quality, increased production/efficiency,decreased complications, etc.)

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Indicators of Deep UnderstandingPerformance in Multiple ContextsAbility to Question

Able to ask the right questionsKnow how to find the answersKnow what to do with the answers

Appropriate Performance in Unexpected Situations

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Scholarly Work for Steps 5 & 6Research studyDescriptive study of curriculum implementation

Cost effective analysis reportAssessment tool

Keep in mind:Get IRB and funding earlyDocument each step in detail, keep notesConsult with education and research expertsCollaborate

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Curriculum Maintenance and EnhancementContinuous quality assurance methods for improvement

Faculty developmentResource allocationManagement of changeScholarly activity by learner and faculty

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12 Tips for Effective Short Course Design1. Assess the clinical problem. 2. Determine learning outcomes. 3. Use evidence-based medicine to develop content. 4. Identify resources. 5. Select teaching strategies for active learning. 6. Select teaching strategies that foster reflection.7. Use passive strategies sparingly to ensure a common

knowledge base.8. Create an individualized needs or pre-course

assessment.9. Prepare teachers.10.Commitment to change and evaluation.11.Provide a 2–3 month post-course reflective exercise.12.Use data in an iterative way.

31Lockyer et al, Medical Teacher 2005

6 Steps of Curriculum Design1. Problem Identification and General

Needs Assessment2. Needs Analysis of Targeted Learners3. Goals and Specific Measurable

Objectives4. Educational Strategies5. Implementation6. Evaluation and Feedback

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Where to Publish?Simulation in Healthcare journalMedical education journals (see list at http://www.med.uottawa.ca/aime/eng/journals.html): Academic Medicine, Medical Education, Medical Teacher, Teaching and Learning, Advances in Health Sciences, Journal of Nursing Education, Nurse Education Today, Nurse Educator, etc.

Clinical specialty journals: watch for calls for Education issues

MedEdPortal – curriculum, case scenarios, tutorials, facilitator guides

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MedEdPortal Examples Ragsdale L, Gutman D, Kobayashi L. Geriatric Emergency Medicine

Curriculum Using High Fidelity Medical Simulation. MedEdPORTAL; 2010. Available from: www.mededportal.org/publication/3168

Acton R, Schmitz C, Chipman J, Reihsen T, Gilkeson J, Groth S, et al. University of Minnesota Surgical Clerkship Simulation Skills Curriculum and Instructor Guide. MedEdPORTAL; 2010. Available from: www.mededportal.org/publication/7948

Chakraborti C. A Simulation-Based Curriculum For 4th Year Medical Students During An Internal Medicine Acting Internship. MedEdPORTAL; 2009. Available from: www.mededportal.org/publication/1687

Motz L, Lloyd B, Donato A, Chaudhary A, Kaliyadan A, Stavarski D, et al. Interdisciplinary Curriculum and Simulation Cases for Teaching Leadership and Communication to Medical Rapid Response Teams. MedEdPORTAL; 2012. Available from: www.mededportal.org/publication/9145

Brown C, Gephardt G, Lloyd C, Swearingen C, Boateng B. Teaching Palliative Care Skills Using Simulated Family Encounters. MedEdPORTAL; 2011. Available from: www.mededportal.org/publication/8507

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Example Curricular PapersFernandez GL et al. Boot Camp: Educational Outcomes After 4 Successive Years of Preparatory Simulation-Based Training at Onset of Internship. J Surg Educ 2012 Mar-Apr;69(2):242-8.

Binstadt ES et al. A comprehensive medical simulation education curriculum for emergency medicine residents. Ann Emerg Med. 2007 Apr;49(4):495-504, 504.e1-11.

Norman J. Systematic review of the literature on simulation in nursing education. ABNF J. 2012 Spring;23(2):24-8.

Hudson D, Dunbar-Reid K, Sinclair PM. The incorporation of high fidelity simulation training into hemodialysis nursing education: part 2--a pictorial guide to modifying a high fidelity simulator for use in simulating hemodialysis. Nephrol Nurs J. 2012 Mar-Apr;39(2):119-23.

Rhodes HA. Simulation in Kansas practical nursing programs. J Pract Nurs. 2011 Fall;61(3):10-3.

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References• Kern DE et al. Curriculum Development for Medical Education: A Six-Step Approach. Johns Hopkins University Press, 1998.

Lockyer J, Ward R, Toews J. Twelve tips for effective short course design. Med Teach. 2005 Aug;27(5):392-5.

Seropian MA et al. An Approach to Simulation Program Development. Journal of Nursing Education. 2004 Apr;43(4):170-4.

Jeffries PR. A framework for designing, implementing, and evaluating simulations used as teaching strategies in nursing. Nurs Educ Perspect. 2005 Mar-Apr;26(2):96-103.

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Web ResourcesUW collaborative website: http://collaborate.uw.edu/educators-toolkit/scenario-building-library.html-0

Society for Academic Emergency Medicine scenario library: http://www.emedu.org/simlibrary/default.aspx?AspxAutoDetectCookieSupport=1

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Nursing Simulation ResourcesSimulation Innovation Research Center (NLN): http://sirc.nln.org/

California Institute for Nursing and Healthcare (CINH) Simulation Alliance: http://www.cinhc.org/programs/simulation/

Scenario Libraries:Kansas State Board of Nursing:http://www.ksbn.org/cne/SimulationScenarioLibrary.htm

Montgomery College: http://cms.montgomerycollege.edu/nursingsims/

Massachusetts Dept of Higher Ed:http://www.mass.edu/currentinit/Nursing/Sim/Scenarios.asp

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Hot TopicsInterprofessional team training simulation curriculum

Train-the-trainer (faculty/instructor development)

Assessment with simulation

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More to ConsiderHow do I get buy-in for simulation training?What are my available resources/funding opportunities?

What is already in the literature and available online?

How do I incorporate technical and non-technical behavioral skills (e.g. leadership and communication skills training)?

How many simulation sessions/scenarios do I need to achieve objectives?

Realistically/logistically, how often/how many can learners come to the simulation center?

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More to ConsiderHow can I incorporate more independent simulations since I do not have enough faculty to teach?

What do I need to consider for limited space and scheduling?

How do I get all my faculty trained to teach in this curriculum?

How do I add a competency/evaluation component to a course that has been primarily instructional?

What approach should I take when I have to follow a national standardized curriculum?

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Questions?Yue Ming Huang, EdD, MHSEmail: [email protected]

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