building competency with blended learning: integrating simulation into continuing education

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Building Competency with Blended Learning: Integrating Simulation into Continuing Education Julianne Perretta MSEd, RRT-NPS The Johns Hopkins Medicine Simulation Center Baltimore, MD

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Building Competency with Blended Learning: Integrating Simulation into Continuing Education. Julianne Perretta MSEd, RRT-NPS The Johns Hopkins Medicine Simulation Center Baltimore, MD. Define Continuing Education Motivations for Learning Competency Assessment vs. Education - PowerPoint PPT Presentation

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Page 1: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Building Competency with Blended Learning:

Integrating Simulation into Continuing Education

Julianne Perretta MSEd, RRT-NPSThe Johns Hopkins Medicine Simulation Center

Baltimore, MD

Page 2: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Define Continuing Education Motivations for Learning Competency Assessment vs. Education Learning Styles (VARK) Questionnaire Adult Learner Characteristics (Knowles) Best Practices in Simulation Education

Page 3: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Objectives

At the end of this session learners will be able to: Determine the goals of continuing education in health

care Differentiate between competency assessment and

education and how that affects simulation design Review key elements of adult learners Identify different learning styles and how different

forms of simulation can address each Initiate simulation design based on some best

practices in Simulation Education

Page 4: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Continuing Education

Health Professions Education: A Bridge to Quality (Institute of Medicine, 2003)1. Provide patient centered care2. Work in interdisciplinary teams3. Employ evidence-based practice4. Apply quality improvement5. Utilize informatics

Page 5: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Continuing Education

“Features, such as opportunities to reflect on learning and apply it to practice, and interpersonal interaction, have been identified as characteristics of CME that are most likely to result in practice enhancement”

-Allen, p. 234

Page 6: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Motivations for Learning

Why are you here today?

Page 7: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Motivations for Learning

1. Social Relationships2. External Expectations3. Social Welfare4. Professional Advancement5. Escape/Stimulation6. Cognitive Interest

Morstain and Smart (1974), noted in Learning in adulthood.

Page 8: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Competency Assessment vs. Education

Sometimes what we call “education” is really assessment, and what we call assessment is not that, either.

What happens when we assess the quality of someone’s work, and they don’t pass?????

Page 9: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Competency Assessment vs. Education “Fail”

What do you do when you find a knowledge deficit? A skills deficit? How do you remediate?

Reteach Reassess Performance Plan

What do you do with them in the meantime?

Page 10: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Competency Assessment vs. Education

eLearning Pre Assessment (study/practice)

New to simulation Nervous performers

Post Assessment (remediation) Specific goals based on performance Score-based Knowledge deficit Decision-making deficit

Unlimited time access

Page 11: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Competency Assessment vs. Education

Skills deficit Partial Task Trainers

I.O. Leg IV arm Central Line Trainer Intubation head

Virtual Reality

Page 12: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Adult Learners: Are more independent and self-directed Want to feel accepted, respected and supported

when learning Want to feel a partnership with their instructor Have a wealth of experience they draw from

when learning Want to feel they can immediately use what they

are learning (problem-centered) Have many different motivations for learning

Malcolm Knowles, Andragogy, 1968, 1980.

Page 13: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Simulation & the Adult Learner Work independently or with a group; use debrief

to direct learning Create a environment of respect, support, and

safety during simulations Dialogue between trainer and learner Build on previous experience and create new

experiences Scenarios that are directly applicable to job Goal oriented learning

Page 14: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Learning Styles

How a person approaches learning tasks “Manner in which…learners most

efficiently and effectively perceive, process, store and recall what they are attempting to learn” (James and Blank, 1993, pp. 47-48).

Helps you identify your strengths and weaknesses as learners

Page 15: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Learning Styles How do you learn best?

VARK Multiple Intelligences(Multiple Intelligences

Questionnaire: http://www.thirteen.org/edonline/concept2class/mi/index.html)

Learning Styles Inventory (Learning Styles Inventory Questionnaire: http://www.rrcc-online.com/%7Epsych/LSInventory.html)

Page 17: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education
Page 18: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Learning Styles

How do you learn best? Visual

Charts graphs flow charts (arrows, circles, hierarchies) algorithms

Page 19: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Learning Styles

How do you learn best? Aural

Lectures Tutorials Tapes Group discussion Email Speaking Webchat “Talking Things Through”

Page 20: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Learning Styles

How do you learn best? Read/write

Text-based input and output List-makers

Page 21: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Learning Styles

How do you learn best? Kinesthetic

Practice Hands-on Examples Simulations

Page 22: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Learning Styles V-

schematics, algorithms in debriefs A-

Debrief discussions Interactive online (with feedback) May be better at telling you the answers than doing them

R- handout and ppt debriefings Readings on evidence-based new info.

K- Simulation, hands-on debriefing Can include eSimulation as well

Page 23: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Best Practices in Simulation Education

Experiential Learning (Kolb) Contextual Learning (Kneebone) Situated Learning/Peripheral Participation (Lave &

Wenger) Self-Efficacy and Competency (Maibach et al,

Miller) Deliberate Practice (Ericcson) Feedback (Van de Ridder) Mastery Learning (Bloom)

Hunt et al, 2008

Page 24: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Best Practices in Simulation Education

Experiential Learning (Kolb)1. Direct encounter with

the phenomenon being studied rather than merely thinking about the encounter, or only considering the possibility of doing something about it

2. Education that occurs as a direct participation in the events of life

Page 25: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Best Practices in Simulation Education

Contextual Learning (Kneebone) For learning to be most effective, it must

occur within a context parallel to how individuals will apply the knowledge in their own professional practice

Page 26: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Best Practices in Simulation Education

Same equipment as in unit Groups bring specific equipment BLS training for med students includes how

to function with new BLS skills in hospital setting

Page 27: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Best Practices in Simulation Education

Situated Learning/Peripheral Participation (Lave & Wenger)

Learning through real-life participation Learners observe actions while working side-by-

side with a skilled person (content expert) Begin participating in observed tasks, bringing

them from periphery to participation

Page 28: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Best Practices in Simulation Education

Self-Efficacy and Competency (Maibach et al) A person’s belief in their capability to organize and

execute a course of action to produce given attainments

4 levels of Competence:1.Unconsciously incompetent2.Consciously incompetent3.Consciously competent4.Unconsciously competent

Page 29: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Best Practices in Simulation Education

Self-Efficacy and Competency (Maibach et al) Framework for assessing clinical competency

(Miller)1.Knowledge (knows)2.Competence (knows how)3.Performance (shows how)4.Action (does)

Page 30: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Best Practices in Simulation Education

Hybrid simulations to practice very specific skills Neonatal Chest Tube Management Patient death ECMO NP

Aspirate

Page 31: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Best Practices in Simulation Education

Deliberate Practice (Ericcson) Training activities that promote consistent

improvements in expert performance domains Repetitive performance in a focused domain Rigorous skills assessment (specific formative

feedback) Progressively improved performance in a

controlled setting

Page 32: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Best Practices in Simulation Education

Feedback• “Specific information about the comparison

between a trainee’s observed performance and a standard, given with an intent to improve the trainee’s performance” (Van de Ridder)

Page 33: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Best Practices in Simulation Education

Build debrief tools based on agreed upon standards

Debrief should be based on simulation objectives

Page 34: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Best Practices in Simulation Education

Mastery Learning (Bloom) Aptitude is the length of time it takes a person to

learn not how "bright" a person is, i.e., everyone can learn given the right circumstances

Goal: all learners to achieve the target outcome with little/no variability; amount of time to achieve will vary based on the learners

Page 35: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Best Practices in Simulation Education

Page 36: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Putting it all Together

Continuing education in healthcare should include: Opportunities to reflect on learning Opportunities to apply learning to practice Interpersonal interaction

Page 37: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Putting it all Together

Competency assessment looks for level of knowledge/skills and identifies deficits. Focus is not on new learning.

Should include avenues for remediation and opportunities for student study/practice prior

Page 38: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Putting it all Together

Adult learners: Are problem-centered Have a wealth of experience to draw from Have many different motivations for learning

Page 39: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Putting it all Together

Different learning styles mean people are most comfortable in a particular way.

Build simulations and debriefings to meet these styles

Page 40: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

Putting it all Together

Key learning theories to consider when building a simulation are: Experiential Learning Contextual Learning Situated Learning/ Peripheral Participation Deliberate Practice Feedback Mastery Learning

Page 41: Building Competency with Blended Learning: Integrating Simulation into  Continuing Education

ResourcesAllen, M., Curran, V. Ferrier, D. Ho, K., Kirby, F., Allen, J. et al (2004). Interactive

on-line continuing medical education: Physician’s perceptions and experiences. The Journal of Continuing Education in the Health Professions 24 (4): 227-236.

Hunt, E.A., Fiedor-Hamilton, M., Eppich, W. (2008). Resuscitation education: Narrowing the gap between evidence-based resuscitation guidelines and performance using best educational practices. Pediatric Clinics of North America. 55: 1035-1050.

Institute of Medicine. 2003. Health professions education: A bridge to quality. Washington, DC: The National Academy Press.

Merriam, S.B., Caffarella, R.S. (1999). Learning in Adulthood. San Fransisco: Jossey Bass.

Notes from a Benjamin Bloom Lecture. (1987, April). Retrieved May 15, 2009, from http://www.humboldt.edu/~tha1/mastery.html

Smith, M.K. David A. Kolb on experiential learning. Retrieved May 1, 2009 from http://www.infed.org/biblio/b-explrn.htm

VARK Categories. (2001-2009). Retrieved August 10, 2007, from VARK-A Guide to Learning Styles: http://www.vark-learn.com/english/page.asp?p=categories

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Questions? Please contact me:Julianne S. Perretta MSEd, RRT-NPS

[email protected] Simulation Educator

The Johns Hopkins Medicine Simulation CenterBaltimore, MD