Monthly Archives: October 2013

Fun Stuff, Details and Blooms Taxonomy – Considering the Outcomes for Improved Learning Encounter Design

While I am the first to snooze (with drool) when people at adult education classes mention Blooms Taxonomy, the details of what is trying to be accomplished during a learning activity involving simulation should be thoroughly sorted out to allow for proper design decisions. Today I will use central insertion as the case in point example.

One of the challenges when creating educational encounters for people is to truly break down into small pieces what we are setting out to accomplish. This is an important early task in trying to create an effective educational encounter that may involve a hybrid of technology or learning modalities. Classifying the learning into knowledge, skills etc. at a fairly detailed level will help us to make good choices with regard to design.

Practicing clinical providers who are also working as educators need to pause and think of things in a very stepwise fashion. For example, as a competent Emergency Physician I have the ability to walk into a room evaluate a patient and the surrounding data and decide that the patient needs a central line placed. I also have the skills to perform the procedure (which also has important cognitive as well as psychomotor components).

In the design of a simulation of the same patient described in the last paragraph we must remain cognizant of the fact, that as an experienced emergency physician the recognition of the need for the central line and the requisite ability to safely put is seemingly a simple connected situation. This is a situation that occurs routinely when I am working in the clinical department of my hospital. However when creating a learning encounter involving simulation I must stop and realize that the skills to evaluate a patient and recognize that a central line is needed as part of the treatment plan, is DISTINCTLY different then the skills and knowledge needed to place the line.

Again, we must be careful that our simulations do not seek to recreate reality per se, unless we are sure that we want the reality re-created. This thoughtful consideration approach our learning encounters can be designed in a way that maximizes the time and resources in a most efficient, but also effective way.

The implications are huge. If your true learning objectives are to evaluate the ability of a person to place a central line safely and you create a “big” scenario of a decompensated patient in Diabetic Ketoacidosis to do it, you are wasting considerable time and effort, as well as taking the focus away from the line placement objectives. Further, you run the risk of the participant not making the proper diagnostic evaluation, and/or missing the fact that the patient required a line. Should that occur, you miss the opportunity to evaluate them placing the line. This is what I call dependent learning objectives. (not a bad thing, just needs to be recognized)

If your objectives also include identifying the fact that the patient needs a line, then by all means create the accompanying scenario, but at least you have made a thoughtful decision on how to create the opportunity to allow you to evaluate the objectives that you are setting for the learning encounter.

Lastly I will conclude with a reminder that all procedural skills have associated cognitive learning objectives and they should be accounted for in the designs of your scenarios. Too many times participants engage in task training of the psychomotor skills of the procedure at many simulation centers around the world and then are expected to learn the cognitive part by osmosis. Or perhaps they were shown a series of slides at the beginning of the workshop quickly before they were “getting on to the fun stuff”. This leads to significant problems downstream with implications on patient safety, the ability to teach others, as well as the capability to properly process and make decisions when things don’t go as planned.

So go forth and plan your educational masterpieces, but consider the principles of a detailed recognition of what your trying to accomplish!

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Beware of Rule Club – Your Simulations Must Fit Within Your Operational World

NoRuleClubHow many rules have been vetted in the literature with regard to how simulation should be designed and conducted? The answer?  (drum roll, please……..)  Not many.  This is an important point to consider when making the decisions that are part and parcel to you creating successful simulations. Healthcare simulation can take on many forms including designs for pure teaching activities through assessment activities, covering a broad range of objectives or simply a few. The bottom line is there are many ways to do simulation correctly. 

One of the first things to be aware of is that you must start with the end in mind. Ask yourself what you really want to accomplish. And by the way, I’m not talking about the simulation. The simulation is actually the means to get to what you want to accomplish. Hopefully! What you a want to accomplish is ensuring that the healthcare providers who complete your learning and/or assessment activity are likely to provide better healthcare in the future by way of increasing their confidence and competence in what they do.

Common rule club fallacies include imposing some magical formula on the length of the debriefing as related to the length of simulation, demanding that you must use video review, demanding that you must design your simulation to mimic real healthcare, demanding that you must use the highest technology available, demanding that you must conduct your simulation in an environment that is as real as possible, demanding that you must debrief in a different room than where the simulation took place, demanding that you must not let the simulator die and on and on and on…… Bunk….. it’s all bunk.

Trying to follow all of the rules of rule club will just slow you down, impede your ability to reach your goals and make you sit around and wonder why you didn’t accomplish what you set out to do even though you were working so hard. Worse yet, it might even make your boss think that you can’t get enough done.

Are their best practices emerging, is there some science to guide us? Absolutely!  Just not much! We know we must provide a safe learning environment, provide feedback that usually will include a debriefing (but maybe not always). But there is no secret recipe hidden on the planet that you will be able to receive at a meeting and go home to bake a magical, successful simulation cake.

Your job however is to try and sort through the best practices, read the science that is available, learn from others, learn from people like me who teach all of the time at workshops, symposiums and conferences. But THEN you must go home and figure out how to design your efforts that fit in the operational constraints that fit your situation. Such constraints may be related to budget, personnel availability, equipment, space or other factors to name a few. Some may be the amount of time that you can actually have access to the participants (this is particularly true if you are working with practicing professionals as your normal learner group.)

So in summary, envision and brainstorm with the end it mind. Then take all of your accumulated knowledge of the science and best practices as well as the information you get from others and make the program fit your realities! Do this non-apologetically, collect data along the way, and you will find yourself becoming much more productive then if you are trying to follow a specific recipe of rule club who tend to stand atop the mountain and issue commandments to make you feel guilty if you don’t follow them!

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