Category Archives: Curriculum

Don’t Let the Theory Wonks Slow Down the Progress of Healthcare Simulation


Those of us in the simulation community know well that when used appropriately and effectively simulation allows for amazing learning and contributes to students and providers of healthcare improving the craft. We also know there is very little published literature that conclusively demonstrates the “right way to do it”.

Yet in the scholarly literature there is still a struggle to define best practices and ways to move forward. I believe it is becoming a rate limiting step in helping people get started, grow and flourish in the development of simulation efforts.

I believe that part of the struggle is a diversity of the mission of various simulation programs ranging from entry level students to practicing professionals, varying foci on individualized learning incompetence, versus and/or team working communications training etc. Part of the challenges in these types of scholarly endeavors people try to describe a “one-size-fits-all“ approach to the solution of best practices. To me, this seems ridiculous when you consider the depths and breadth of possibilities for simulation in healthcare.

I believe another barrier (and FINALLY, the real point of this blog post 🙂  is trying to overly theorize everything that goes on with simulation and shooting down scholarly efforts to publish and disseminate successes in simulation based on some missing link to some often-esoteric deep theory in learning. While I believe that attachments to learning theory are important, I think it is ridiculous to think that every decision, best practice and policy in simulation, or experimental design, needs to reach back and betide to some learning theory to be effective.

As I have the good fortune to review a significant number simulation papers it is concerning to me to see many of my fellow reviewers shredding people’s efforts based on ties to learning theories, as well as their own interpretations on how simulation should be conducted. They have decided by reading the literature that is out there (of which there is very little, if any, conclusive arguments on best practices) has become a standard.

My most recent example is that of a paper I reviewed of a manuscript describing an experimental design looking at conducting simulation one way with a certain technology and comparing it to conducting the simulation another way without the technology. The authors then went on to report the resulting differences. As long as the testing circumstances are clearly articulated, along with the intentions and limitations, this is the type of literature the needs to appear for the simulation community to evaluate and digest, and build upon.

Time after time after time more recently I am seeing arguments steeped in theory attachments that seem to indicate this type of experimental testing is irrelevant, or worse yet inappropriate. There is a time and place for theoretical underpinnings and separately there is a time and place for attempting to move things forward with good solid implementation studies.

The theory wonks are holding up the valuable dissemination of information that could assist simulation efforts moving forward. Such information is crucial to assist us collectively to advance the community of practice of healthcare simulation forward to help improve healthcare globally.  There is a time to theorize and a time to get work done.

While I invite the theorist to postulate new and better ways to do things based on their philosophies, let those in the operational world, tell their stories of successes and opportunities as they are discovered.

Or perhaps it is time that we develop a forum or publication of high quality, that provides a better vehicle for dissemination of such information.

So…… in the mean time….. beware of the theory wonks. Try not to let them deter from your efforts to not only move your own simulation investigations forward, but to be able to disseminate and share them with the rest of the world!

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Filed under Curriculum, design, patient safety, return on investment

FIVE TIPS on effectively engaging adult learners in healthcare simulation

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Filed under Curriculum, design

Beware of the Educational Evangelist!

beware educational evangelistThey are everywhere now days like characters in pokemon go. They seem to hang out in high concentration around new simulation centers.

You know the type. Usually they start off by saying how terrible it is for someone to give a lecture. Then they go on to espouse the virtues and values of student – centered education claiming active participation and small group learning is the pathway to the glory land. They often toss in terms like “flipped classroom”. And just to ensure you don’t question their educational expertise they use a word ending with “-gogy” in the same paragraph as the phrase “evidence-based”.

If you ask them where they have been in the last six months you find out that they probably went to a weekend healthcare education reform retreat or something equivalent…….

My principal concern with the today’s educational evangelist is that they are in search of a new way of doing everything. Often times they recommend complete and total overhauls to existing curriculum without regard to a true understanding of how to efficiently and effectively improve, and/or analyze the existing resources required to carry out such changes.

Further, the evangelist usually has a favorite methodology such as “small group learning”, “problem-based learning” or “simulation-based learning” that they are trying to convert everyone to through prophecy.

An easy target of all educational evangelist is the lecture, and often that is where the prophecy begins. They usually want to indicate that if lecture is happening, learning is not. As I discussed in a previous blog article lecture is not dead, and when done well, can be quite engaging and create significant opportunities for learning and is maximally efficient in terms of resources.

If you think about a critically it is just as easy to do lousy small group facilitation as it is to do a lousy lecture. Thus, the potential gains in learning will not achieve maximal potential. The difference is small group facilitation like simulation, generally take significantly more faculty resources.

The truth is the educational evangelist is a great person to have in and amongst the team. Their desire for change, generally instilled with significant passion are often a source of great energy. When harnessed they can help advance and revise curricula to maximize, and modernize various educational programs.

However, to be maximally efficient all significant changes should undergo pre-analysis, hopefully derived from a needs assessment, whether it is formal or informal. Secondly, it is worth having more than one opinion to decide the prioritization of what needs to be changed in a given curriculum. While the evangelist will be suggestive that the entire curriculum is broken, often times with a more balanced review you find out that there are areas of the curriculum that would benefit from such overhaul, and some aspects that are performing just fine.

When you begin to change aspects of the curriculum, start small and measure the change if possible. Moving forward on a step-by-step basis will usually provide a far better revised curriculum then an approach that “Throws out the baby and the bathwater”. Mix the opinions of the stalwarts of the existing curriculum methods with the evangelists. Challenge existing axioms, myths and entrenched beliefs like “Nothing can replace the real patient for learning….” If this process is led well, it will allow the decision making group to reach a considerably more informed position that will lead to sound decisions, change strategies, and guide investments appropriately.

So if you’re the leader or a member of a team responsible for a given curriculum of healthcare instruction and confronted with the educational evangelist, welcome their participation. Include them in the discussions moving forward with a balanced team of people have them strive to create an objective prioritization of the needs for change. This will allow you to make excellent decisions with regard to new technologies and/or methods that you should likely embrace for your program. More importantly you will avoid tossing out the things that are working and are cost efficient.

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