Dubrowski bricks

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.


Studies = Bricks Researchers = Brick

makers


Too many random bricks


Need theory


Studies = Bricks Programs = Buildings


Students = Bricks makers Researchers = Architects


The scientific filed is changing

Question

Simulation Based Education

Opportunity

Barriers and Gaps

ScientistsActivitiesFunding

Chapter 2

Introduction to Simulation


Learn fasterRemember longer

Be safer

The replication of a task or an event for the purpose of

education and/or assessment.


Why? Logistics


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



WorkingModel

Technical Performance

Communication

Environment

Clinical Knowledge

Attentional capacity threshold

Additional Learning



Technical Performance

Communication

Environment

Clinical Knowledge

Additional Learning

Attentional capacity threshold


Evidence

Dubrowski, A., Brydges, R., Satterthwaite, L., Xeroulis, G., Classe, R. American Journal of Surgery. in press.

Multitasking


Dubrowski, A., Brydges, R., Satterthwaite, L., Xeroulis, G., Classe, R. American Journal of Surgery. in press.

SkillsTest

WrittenTest

Juniors

Fellows


Skills Test: Expert Opinion

05

10152025

Written Test: Score

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1015

2025

Juniors Fellows Juniors Fellows


Kurahashi AM, Harvey A, Macrae H, Moulton CA, Dubrowski A. Technical skill training improves the ability to learn. Surgery. 2010


Can simulation based training help in pre-training?

Practice SkillsTest

WrittenTest

1 week rest


Skills Test: Expert Opinion

05

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Written Test: Score

05

10152025

TrainedNovice Novice

TrainedNovice Novice


simulation performanceimproves


learningenables


simulation

Chapter 3

Future of the Field

Barriers and Gaps


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

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


Process goals lead to better directed, self-guided skills acquisition

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DO

PS

S

core

OutcomeProcess


Pre Post Retention

A house: Progressive Fidelity

Which simulators to use?

Practice: Progressive


Practice: High


Practice: Low


Transfer test


Exp

ert

op

inio

n

0

Progressive High Low


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A house

Chapter 4

Summary

Relevance


Studies = Bricks Researchers = Brick

makers


Studies = Bricks Programs = Buildings

Opportunity

Barriers and Gaps


Scientist

Research training and time

Activities

Programmatic approach

Funding

Long road ahead

Dubrowski bricks

Documents

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