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!