Post on 31-Oct-2014
description
Research in simulation based health professions education:
Building houses or making bricks?
Adam Dubrowski, PhDLearning and Research Institutes
Wilson CentreDepartment of Paediatrics, UofT
www.wordle.net
Chapter 1
Chaos in the Brickyard
Chaos in the BrickyardForscher, BK. Chaos in the Brickyard. Science. 1963 Oct 18; 142(3590): 339.
Chaos in the BrickyardForscher, BK. Chaos in the Brickyard. Science. 1963 Oct 18; 142(3590): 339.
Studies = Bricks Researchers = Brick
makers
Chaos in the BrickyardForscher, BK. Chaos in the Brickyard. Science. 1963 Oct 18; 142(3590): 339.
Too many random bricks
Chaos in the BrickyardForscher, BK. Chaos in the Brickyard. Science. 1963 Oct 18; 142(3590): 339.
Need theory
Chaos in the BrickyardForscher, BK. Chaos in the Brickyard. Science. 1963 Oct 18; 142(3590): 339.
Studies = Bricks Programs = Buildings
Chaos in the BrickyardForscher, BK. Chaos in the Brickyard. Science. 1963 Oct 18; 142(3590): 339.
Students = Bricks makers Researchers = Architects
Chaos in the BrickyardForscher, BK. Chaos in the Brickyard. Science. 1963 Oct 18; 142(3590): 339.
The scientific filed is changing
Question
Simulation Based Education
Opportunity
Barriers and Gaps
ScientistsActivitiesFunding
Chapter 2
Introduction to Simulation
Simulation Based Education
Learn fasterRemember longer
Be safer
The replication of a task or an event for the purpose of
education and/or assessment.
Simulation Based Education
Why? Logistics
Simulation Based Education
Time
EthicsPatient complexityShrinking working hoursDiminishing learning opportunities
Novice in clinical setting is faced with conditions of multitasking.
Simulation can help pre-train on a set of skills so that more cognitive resources are available to learn and perform other skills.
Fitts and Posner, 1954
Why? Mechanisms
Simulation Based Education
Simulation Based Education
WorkingModel
Technical Performance
Communication
Environment
Clinical Knowledge
Attentional capacity threshold
Additional Learning
Simulation Based Education
Simulation Based Education
Technical Performance
Communication
Environment
Clinical Knowledge
Additional Learning
Attentional capacity threshold
Simulation Based Education
Technical Performance
Communication
Environment
Clinical Knowledge
Additional Learning
Attentional capacity threshold
Simulation Based Education
Technical Performance
Communication
Environment
Clinical Knowledge
Additional Learning
Attentional capacity threshold
Simulation Based Education
Technical Performance
Communication
Environment
Clinical Knowledge
Additional Learning
Attentional capacity threshold
Simulation Based Education
Evidence
Dubrowski, A., Brydges, R., Satterthwaite, L., Xeroulis, G., Classe, R. American Journal of Surgery. in press.
Multitasking
Simulation Based Education
Dubrowski, A., Brydges, R., Satterthwaite, L., Xeroulis, G., Classe, R. American Journal of Surgery. in press.
SkillsTest
WrittenTest
Juniors
Fellows
Simulation Based Education
Skills Test: Expert Opinion
05
10152025
Written Test: Score
05
1015
2025
Juniors Fellows Juniors Fellows
Simulation Based Education
Kurahashi AM, Harvey A, Macrae H, Moulton CA, Dubrowski A. Technical skill training improves the ability to learn. Surgery. 2010
Simulation Based Education
Can simulation based training help in pre-training?
Practice SkillsTest
WrittenTest
1 week rest
Simulation Based Education
Skills Test: Expert Opinion
05
10152025
Written Test: Score
05
10152025
TrainedNovice Novice
TrainedNovice Novice
Simulation Based Education
simulation performanceimproves
Simulation Based Education
learningenables
Simulation Based Education
simulation
Chapter 3
Future of the Field
Barriers and Gaps
ScientistsActivitiesFunding
Self-Guided Learning
A brick: Research led by a masters prepared researcher, “one-of” project, funded by RCPSC.
A house: Research led by a PhD prepared researcher, with a programmatic approach, funded by a 5-year NSERC Discovery grant.
A brick
A brick
Purpose: To investigate the usefulness of computer navigation system in training orthopedic surgery skills.
A brick
A brick
A brick
Results: The navigation technology provided no advantage for the learner in retaining and possibly transferring the skills.
Pre Post Retention
A brick
This is a brick study as it is not contributing to building any theoretical models of skills acquisition.
A brick
Instead it provides a very clear answer to the question whether we should use navigation during learning.
A brick
Too many random bricks
A house
NSERC Discovery and PDF funding
A house: Kinesiology
A house: Motor Learning Theory
Framework
A house: Overall Research Goal
Can theoretical principles from kinesiology be applied in the study of
directed self-guided learning in simulation-based education?
A house
Brydges R, Carnahan H, Rose D, Dubrowski A. Comparing self-guided learning and educator-guided learning formats for simulation-based clinical training. J AdvNurs. 2010 Aug;66(8):1832-44. Brydges R, Carnahan H, Rose D, Rose L, Dubrowski A. Coordinating progressive levels of simulation fidelity to maximize educational benefit. Acad Med. 2010May;85(5):806-12. Brydges R, Carnahan H, Safir O, Dubrowski A. How effective is self-guided learning of clinical technical skills? It's all about process. Med Educ. 2009Jun;43(6):507-15. Brydges R, Carnahan H, Dubrowski A. Assessing suturing skills in a self-guided learning setting: absolute symmetry error. Adv Health Sci Educ Theory Pract. 2009Dec;14(5):685-95.
A house: Process vs Outcome Goals
Access to an instructional video
Goal-setting?
Process goals relate to HOW to perform
Outcome goals relate to WHAT the final product should look like
A house: Process vs Outcome Goals
Process goals lead to better directed, self-guided skills acquisition
30
35
40
45
50
DO
PS
S
core
OutcomeProcess
A house: Process vs Outcome Goals
Pre Post Retention
A house: Progressive Fidelity
Which simulators to use?
Practice: Progressive
A house: Progressive Fidelity
Practice: Progressive
A house: Progressive Fidelity
Practice: Progressive
A house: Progressive Fidelity
Practice: High
A house: Progressive Fidelity
Practice: Low
A house: Progressive Fidelity
Transfer test
A house: Progressive Fidelity
Exp
ert
op
inio
n
0
Progressive High Low
A house: Progressive Fidelity
10
20
30
40
50
A house
Chapter 4
Summary
Relevance
Chaos in the BrickyardForscher, BK. Chaos in the Brickyard. Science. 1963 Oct 18; 142(3590): 339.
Studies = Bricks Researchers = Brick
makers
Chaos in the BrickyardForscher, BK. Chaos in the Brickyard. Science. 1963 Oct 18; 142(3590): 339.
Studies = Bricks Programs = Buildings
Opportunity
Barriers and Gaps
ScientistsActivitiesFunding
Scientist
Research training and time
Activities
Programmatic approach
Funding
Long road ahead