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Integrating Instructional Strategies with Thick Narrative Branching SimulationsKira King, PhDDecision Simulation

Rosalyn P. Scott, MD, MSHADayton Veterans Affairs Medical CenterWright State University

Mary Davidson, MSN APRN CHPNVeterans Affairs Healthcare System of Ohio

Edward Bope, MDChief of Primary Care/Palliative Care PhysicianColumbus Veterans Affairs Ambulatory Care Center5/13/14 09:19 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries.The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.

1Palliative Care VP SimulationsType: thick narrative situational VPLearners: primary care providers Content: communication strategiesAccess: scheduled as a patientStrategy: video-based choose your own adventure formatReflection: mentor simulates apprenticeship

(Baile et al., 2001; Bizzocchi & Schell, 2009)

22Creating Effective On-Line LearningU.S. Department of Education reviewed 176 experimental research studies between 1996 2008.Learners: Most common learner: undergraduate and graduate (90%+)Most common content: healthcare or medical education (20 30%)

3Real change happens when people see things they have not seen before.

(David Rock, 2009, p. 218)Effective StrategiesIneffective StrategiesAdaptive contentMedia without learner controlSelf reflectionMultiple choice questions

http://www2.ed.gov/rschstat/eval/tech/evidence-based-practices/finalreport.pdf

3Facilitating Insight4EngagementDecisionsConsequencesReflectionInsightsContext(Allen & Sites, 2012; Means,Toyama, Murphy, Badia & Jones, 2010; Rock, 2009) 4Matched Examples and Non-ExamplesDescription: Best used to teach a concept or kinds of Define concept and show exampleHighlight the discriminating properties of the conceptProvide a pair of similar examplesProvide a pair with an example and a non-exampleBegin with easy to identify contrastsProgress to more similar pairs

5(David Merrill, 2009) Matched Pairs for the Concept: TriangleExample Non-ExampleExample Similar ExampleMatched Example and Non-Example6Open-Ended Closed-EndedWhat challenges Are you able to take are you facing? care of yourself?

Dr. Parker: During our last conversation, we went over your test results and how more chemotherapy or radiation would not helpGiven these circumstances, I want to focus on whats most important for you as we move forward.What will you say next? ReflectionReflectionMatched Example and Non-Example7Open-Ended What challenges are you facing?

Marcus: Eating is tough. Its hard to swallow. Ive been taking little bits of juice and soft stuff like chicken soup.

Closed-EndedAre you able to take care of yourself?

Marcus: Yes, Im fine. Dr. Parker: Are you eating well?Marcus: Yeah, I guess

Discussing Goals of Care8Goals of CareDiscussionReflectionReflectionReflectionNo Goals of CareCardiac ArrestNursing HomeNon-Example

Patient Centered

Non-Example

How will you Discuss Goals of Care?Non-ExampleLets talk with the social worker about nursing homes

Marcus: I want to live at home! I dont want someone telling me what to do!

Patient CenteredCan you share with me whats on your mind?

Marcus: I want to live at home with my dog, Buddy. And my friend Roger is just upstairs.

Non-ExampleYoure tired. Lets discuss this on your next appointment.

One month later..Social Worker: Marcus had a cardiac arrest and is in a nursing home. I dont think hell be able to return home.

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Branching: Delayed Consequences10IntubationResourcesNew GoalsMarcus is in the hospital with all of these tubes. This sure isnt what he wanted. I was hoping he could have stayed at home, but it was tough without help.

I wanted to give you an update on Marcus. Hospice is helping him live as comfortably at home. Hes asked us to help with an Advance Directive.

Home Resources Hospice Not Utilized10Branching TechniquesExamples & Non-ExamplesDelayed ConsequencesConsequencesReflectionReflectionDecisionDecisionConsequencesReflectionReflectionLearners explore examples of what is and what is not the concept. Promotes insightful learning by demonstrating consequences of decisions as the simulation progresses.11Questions?