Blended Learning in Basic and Advanced Cardiac Life Support Training Geoffrey T Miller Associate Director Research and Curriculum Development Division of Prehospital and Emergency Healthcare ID: 559861
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Improving Efficiencies in Simulation Education, Blended Learning in Basic and Advanced Cardiac Life Support Training
Geoffrey T. Miller
Associate Director, Research and Curriculum Development
Division of
Prehospital
and Emergency Healthcare
Gordon Center for Research in Medical Education
University of Miami Miller School of MedicineSlide2
Session aimsIn the context of BLS and ACLS training:
Review the fundamental benefits of simulation
Discuss various examples of simulation
Discuss key questions surrounding blended learning
Explore practical applications of simulation
Participate in simulation activities for BLS and ACLS training (Part 2)Slide3
What’s new in medical simulation…Slide4
What is medical simulation?
“In general, medical simulations aim to imitate real patients, anatomic regions, or clinical tasks, or to mirror real-life situations in which medical services are rendered.”
“
simulation
refers broadly to any device or set of conditions… that attempts to present patient problems authentically, whereas a
simulator
,
more narrowly defined, is a simulation device.”
Issenberg
, SB,
Scalese
, RJ. Simulation in Healthcare Education.
Perspectives in Biology and Medicine. Vol. 51, No. 1: 31-46.Slide5
Why use simulation?
Benefits of medical simulation
Safe
environment,
mistake
forgiving
Trainee
focused vs. patient focusedControlled, structured, proactive clinical exposureReproducible, standardized, objectiveDebriefing as a norm in everyday practice public
trust
in profession
Deliberate and repetitive
practiceSlide6
Why use simulation?
Assessment of professional competence
Patient care
Medical knowledge
Practice-based learning & improvement
Communication skills
Professionalism
Systems-based practiceSlide7
Why use simulation?What does the science say…
Overwhelmingly positive and favors use of simulation
Examples:
2. A longitudinal study of internal medicine residents’ retention of advanced cardiac life support skills – Wayne DB, et. al. Academic Medicine, 2006.
“
ACLS skill improved significantly… cohort followed for 14 months and the skills did not decay
”
3. Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case-control study – Wayne DB, et. al. Chest, 2008.
“
Simulation-based educational program significantly improved the quality of care during actual events”
Written evaluation is not a predictor for skills performance in Advanced Cardiovascular Life Support course – Rodgers DL, et. al. Resuscitation 2010
“The
ACLS written evaluation was not a predictor of participant skills in managing a simulated cardiac arrest event”Slide8
Food for thought… and discussion
"Excellence is an art won by training and habituation. We are what we repeatedly do. Excellence, then, is not an act but a habit."
Aristotle Slide9
Another interesting thought… How could learning style affect awareness,
pattern recognition and “habits”?Slide10
A quick case studySlide11
Inattentional blindness
Inattentional
blindness is the phenomenon of not being able to perceive things that are in plain sight
Can result from:
no internal frame of reference, or
mental focus or attention which cause mental distractionsSlide12
‘Right conditions’ for learning in simulation
Feedback
should be provided during the learning experience
Learners should engage in
repetitive practice
Simulation should be
integrated
into the overall curriculumLearners should practice with
increasing levels
of difficulty
Multiple
learning
strategies
should be employed
Simulations should represent
clinical variation
The simulation environment should be
controlled
Simulations should foster
individualized learning
Outcomes
must be clearly
defined
and measured
The
simulator
should be
valid as a representation of a human or situation
Issenberg
SB,McGaghie
WC,
Petrusa
ER, Gordon D,
Scalese
RJ (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review.
Medical Teacher
27(1): 10–28.Slide13
Fidelity
The degree of realism
Types:
Environmental
Physical
Technical
Psychological
Key Question: Is the simulation activity “realistic” enough to accomplish the desired outcomes.Slide14
Fidelity and technology
Low fidelity
High technology
Low fidelity
Low technology
High fidelity
High technology
High fidelity
Low technology
Fidelity
TechnologySlide15
“Realism versus relevance”
Key Question:
Which concept is more important in choosing and developing the
learning
activity?
Realism
RelevanceSlide16
Fidelity (realism)
Adapted from:
Alessi
S. Design of Instructional Simulations.
J Computer-based Instruction
. 1988. 40-7.
Realism and relevance
Prior Learning
Relevance
Novice
Experienced
Expert
Most cost-effective
Best learning
Low
High
None
HighSlide17
Learning ladder
BEME:
multiple learning
strategies
a
nd
clinical
variationSlide18
The ultimate goal?Slide19
Where does simulation fit?Slide20
The ‘big picture”
Attitude
Knowledge
SkillSlide21
Miller’s Pyramid of Competence
Knows
Knows how
Shows
Does
George E. Miller MD. The Assessment of Clinical Skills/Competence/Performance
.
Academic
Medicine. 1990. Vol. 65 No. 9: S63-67.Slide22
Knows
Knows how
Shows
Does
“Knows”
Assessment opportunities:
Multiple-choice question
Essay / Short answer
Oral interview
Learning
Opportunities:
Reading / Independent study
Lecture
Computer-based
Colleagues / PeersSlide23
Knows
Knows how
Shows
Does
Clinical Context
Based Tests
Multiple-choice question
Essay / Short answer
Oral interview
“Knows how”
Learning
Opportunity
Problem-based Ex.
Tabletop exercises
Direct observation
MentorsSlide24
Knows
Knows how
Shows
Does
“Shows”
Performance
Assessment
Objective Structured Clinical Examination (OSCE)
Standardized Patient-based
Learning
Opportunity
Skill-based Exercises
Repetitive practice
Small group
Role playingSlide25
Knows
Knows how
Shows
Does
“Does”
Performance
Assessment
Undercover / Stealth standardized patient-based
Video
Learning
Opportunity
ExperienceSlide26
Key questions regardingblended learning modelsSlide27
Who are our Learners?Key Questions:
Who are our learners?
Why do they Learn?
What are their Motivations?Slide28
Blended learningKey Questions:
What is “blended learning?
Where does it happen?
What does this mean to me as a healthcare educator?Slide29
Simulation methodsSlide30
Simulation technologies
Low-tech simulation modalities:
Patient management problems
3D Models
Basic plastic manikin and simple skills
trainers
Simulated or standardized
patientsHigh-tech simulation modalities:Screen-based simulationsIntelligent gaming Realistic high-tech interactive patient simulatorsSlide31
3D models basic plastic manikins
Heart and lung modelsSlide32
Basic plastic manikins
BLS manikins (
Rescusi
Anne)
Simple simulators for teaching
basic interventions and/or physical
examination
skillsSlide33
Standardized Patients
Represent ultimate alternative to live patients
Standardized role play of psychological and physiological aspects of patients
Student examines patient
Facilitator & peers evaluate student performance
Facilitator & SP provide feedback & training Slide34
Screen-based simulations
Software driven systems that include multimedia and VR components.
Ranges from simple non-interactive to fully interactive teaching programs.
Enhance cognitive knowledge, clinical reasoning and decision making. Slide35
Intelligent/Serious gamingSlide36
Realistic high-tech interactive patient simulators
Realistic full-sized manikin, computer, and interface devices that operate manikin physiology and drive monitors
Can be used in a variety of settings (low to high fidelity)Slide37
“Testing force feedback virtual reality products for dogs”Slide38
Learning and assessment opportunitiesSlide39
Large group instructor led
Reach many learners at once
Additional equipment: cameras/projectors/AV
Instructor needs practice
Audience response systemSlide40
Small group instructor led
Focused teaching
Ability to assess individuals’ skills
Hands-on, interactive
Interest up to 2 hrsSlide41
Individual self-directed learning
Important for skills acquisition (deliberate practice)
Ability to work at own pace
Responsible for own learningSlide42
Independent small group learning
Less “hands-on” time
Opportunity to exchange ideas & problem solve
Practice team work
Peer to peerSlide43
AssessmentsShould include assessment of:
Knowledge
– not only factual recall, but comprehension, application, analysis, synthesis and evaluation of cognitive knowledge
Skills
– communication, physical exam, basic life support skills, airway management, IV therapy, defibrillation, time management, problem-solving
Attitudes
– behavior, teamwork, delivering “bad news”Slide44
Assessment
Assessment should be educational and formative
Learning through testing
Feedback to build knowledge and skill
Reflection - error correction – refinement
“Assessment drives learning”Slide45
A case study in developing a blended learning curriculumSlide46
Blended learning – model program
Emergency Response to Terrorism Training
Multiple healthcare professionals
Many learner levels
Methods of delivery
Lecture – case based
Psychomotor skill exercises
Small groupIndividual / independent learnerLarge group exercisesIntegration exercises – SPE-OSCEsSlide47
Templates and blueprints
Key features:
Maps out:
session/course objectives
learning opportunities and objects
assessment opportunities and objects
Provides instructor support materials and objects
Allows assessment of omissions & redundanciesProvides a common understandingSlide48
UM Course Design
Day 1
Didactic
Response Concepts
Operations
PPE
Decontamination
ICS / IMSPsychomotorPPEMedical ManagementAmbulatory DECONIncapacitated DECONDay 2DidacticChemical AgentsBiological AgentsRadiological and Explosive Agents
Large Group Exercises
Triage – computer-based
Tabletop
Integration Exercises
OSCEsSlide49
Case –Based Lecture
Open-air
concert
18,000 people
Temp: 84
°
F
Wind: ENE 12 knots
Chemical weapon from a
boat on shorelineSlide50
Plume throughout concert area
Initially mistaken as smoke machine (part of show)
Hundreds with symptoms within minutes
Concert
Area
Wind
Plume
Case –Based LectureSlide51
Individual Self-learningSlide52
Small group instructor teachingSlide53
Large group exercise (student directed)Slide54
Web/eLearning integrationSlide55
Web/eLearning integrationSlide56
Assessment and feedbackSlide57
The final resultCourse reduced to 8 hours, focused on hands on simulation based activities
Enduring materials allow for on-time, on-demand access by learners for maintenance of knowledge and skill (to a lesser degree)
Faculty time reduced and opportunity for training increased
Student assessment scores increasedSlide58
SummarySimulation offers a wide array of learning and assessment opportunities for BLS and ACLS training
Variation of learning methods and clinical difficulty is key to a successful learning ladder
The greatest effect on sustained learning is developed through the application of a blended learning environment Slide59
Questions and discussionSlide60
For additional information:Geoffrey T. Miller
gmiller@med.miami.edu